PNHP

Sen. Bernie Sanders introduces single payer bill

Sen. Bernie Sanders introduces single payer bill

Single-payer health reform bill introduced in Senate

PNHP
Press release
March 26, 2009
Challenging head-on the powerful private insurance and pharmaceutical industries, Vermont’s Sen. Bernie Sanders introduced a single-payer health reform bill, the American Health Security Act of 2009, in the U.S. Senate Wednesday.
The single-payer approach embodied in Sanders’ new bill stands in sharp contrast to the reform models being offered by the White House and by key lawmakers like Senators Max Baucus (D-Mont.) and Edward Kennedy (D-Mass.). Their plans would preserve a central role for the private insurance industry, sacrificing both universal coverage and cost containment during the worst economic crisis since the Depression.
In contrast, Sanders’ new legislation would cover all of the 46 million Americans who currently lack coverage and improve benefits for all Americans by eliminating co-pays and deductibles and restoring free choice of physician. The most fiscally conservative option for reform, single payer slashes private insurance overhead and bureaucracy in medical settings, saving over $400 billion annually that can be redirected into clinical care.
Highlights of the bill include the following:

  • Patients go to any doctor or hospital of their choice.
  • The program is paid for by combining current sources of government health spending into a single fund with modest new taxes amounting to less than what people now pay for insurance premiums and out-of-pocket expenses.
  • Comprehensive benefits, including coverage for dental, mental health, and prescription drugs.
  • While federally funded, the program is to be administered by the states.
  • By eliminating the high overhead and profits of the private, investor-owned insurance industry, along with the burdensome paperwork imposed on physicians, hospitals and other providers, the plan saves at least $400 billion annually – enough money to provide comprehensive, quality care to all.
  • Community health centers are fully funded, giving the 60 million Americans now living in rural and underserved areas access to care.
  • To address the critical shortage of primary care physicians and dentists, the bill provides resources for the National Health Service Corps to train an additional 24,000 health professionals.

Sanders, who serves on the Senate Committee on Health, Education, Labor, and Pensions, is a longtime advocate of fundamental health care reform. His new bill draws heavily upon the single-payer legislation introduced by the late Sen. Paul Wellstone (D-Minn.) in 1993, S. 491, and closely parallels similar legislation pending before the House, H.R. 1200, introduced by Rep. Jim McDermott (D-Wash.).
https://pnhp.org/news/2009/march/singlepayer_health_.php
S.703 – American Health Security Act of 2009 – full text:
https://pnhp.org/PDF_files/American-Health-Security-Act-single-payer.pdf
Thomas (S.703 is listed but the text has not yet been received from GPO):
http://thomas.loc.gov/

At a rare time in our history when comprehensive reform may become a reality, it is important that the single payer model be represented in the legislative process. The House already has Rep. John Conyers’ H.R.676 and Rep. Jim McDermott’s H.R.1200, and now the Senate has Sen. Bernie Sanders’ S.703.
S.703 is very similar to H.R.1200, with two important additions regarding budgeting. Specified funds are budgeted for community health centers, and other specified funds are budgeted for the support of the National Health Service Corps, health professions education, and nursing education, including education of clinical nurse practitioners, certified registered nurse anesthetists, certified nurse midwives, and physician assistants.
These additions in budgeting are not simple tweaks to the bill. They provide a remedy for both the deterioration in our primary care infrastructure and the impaired access to care in underserved regions. There is an urgent need to provide the professionals and the facilities that can help fill the most serious voids in our health care delivery system today.
S.703 has been referred to the Senate Finance Committee, chaired by Sen. Max Baucus, who is determined to join with Senators Ted Kennedy, Charles Grassley and Mike Enzi to enact reform this year. Sen. Sanders will have some input as a member of the Budget Committee and a member of Sen. Kennedy’s HELP Committee.
What happens now? Will Senators Baucus and Kennedy take a fresh look at single payer as a model that addresses many of the policy problems that they currently face with their model based on private plans? Or will they accept Sen. Sanders’ contribution emphasizing the importance of health centers and primary care professionals? Or will they look at his budgeted numbers and decide that they can’t add those to the deficits they already face with their unnecessarily over-priced model of reform? Will they simply say that they’ll have to deal with that later, after they fix the insurance problem (the later that never comes)?
It’s great that there is a single payer bill in the Senate, but now is not the time to sit back and watch the process unfold. We certainly support the emphasis on improving primary care access, but we need to support that within a financing framework that will make it happen – a single payer national health program.

Sen. Bernie Sanders introduces single payer bill

Single-payer health reform bill introduced in Senate

PNHP
Press release
March 26, 2009

Challenging head-on the powerful private insurance and pharmaceutical industries, Vermont’s Sen. Bernie Sanders introduced a single-payer health reform bill, the American Health Security Act of 2009, in the U.S. Senate Wednesday.

The single-payer approach embodied in Sanders’ new bill stands in sharp contrast to the reform models being offered by the White House and by key lawmakers like Senators Max Baucus (D-Mont.) and Edward Kennedy (D-Mass.). Their plans would preserve a central role for the private insurance industry, sacrificing both universal coverage and cost containment during the worst economic crisis since the Depression.

In contrast, Sanders’ new legislation would cover all of the 46 million Americans who currently lack coverage and improve benefits for all Americans by eliminating co-pays and deductibles and restoring free choice of physician. The most fiscally conservative option for reform, single payer slashes private insurance overhead and bureaucracy in medical settings, saving over $400 billion annually that can be redirected into clinical care.

Highlights of the bill include the following:

* Patients go to any doctor or hospital of their choice.

* The program is paid for by combining current sources of government health spending into a single fund with modest new taxes amounting to less than what people now pay for insurance premiums and out-of-pocket expenses.

* Comprehensive benefits, including coverage for dental, mental health, and prescription drugs.

* While federally funded, the program is to be administered by the states.

* By eliminating the high overhead and profits of the private, investor-owned insurance industry, along with the burdensome paperwork imposed on physicians, hospitals and other providers, the plan saves at least $400 billion annually – enough money to provide comprehensive, quality care to all.

* Community health centers are fully funded, giving the 60 million Americans now living in rural and underserved areas access to care.

* To address the critical shortage of primary care physicians and dentists, the bill provides resources for the National Health Service Corps to train an additional 24,000 health professionals.

Sanders, who serves on the Senate Committee on Health, Education, Labor, and Pensions, is a longtime advocate of fundamental health care reform. His new bill draws heavily upon the single-payer legislation introduced by the late Sen. Paul Wellstone (D-Minn.) in 1993, S. 491, and closely parallels similar legislation pending before the House, H.R. 1200, introduced by Rep. Jim McDermott (D-Wash.).

https://pnhp.org/news/2009/march/singlepayer_health_.php

S.703 – American Health Security Act of 2009 – full text:
https://pnhp.org/PDF_files/American-Health-Security-Act-single-payer.pdf

Thomas (S.703 is listed but the text has not yet been received from GPO):
http://thomas.loc.gov/

Comment:

By Don McCanne, MD

At a rare time in our history when comprehensive reform may become a reality, it is important that the single payer model be represented in the legislative process. The House already has Rep. John Conyers’ H.R.676 and Rep. Jim McDermott’s H.R.1200, and now the Senate has Sen. Bernie Sanders’ S.703.

S.703 is very similar to H.R.1200, with two important additions regarding budgeting. Specified funds are budgeted for community health centers, and other specified funds are budgeted for the support of the National Health Service Corps, health professions education, and nursing education, including education of clinical nurse practitioners, certified registered nurse anesthetists, certified nurse midwives, and physician assistants.

These additions in budgeting are not simple tweaks to the bill. They provide a remedy for both the deterioration in our primary care infrastructure and the impaired access to care in underserved regions. There is an urgent need to provide the professionals and the facilities that can help fill the most serious voids in our health care delivery system today.

S.703 has been referred to the Senate Finance Committee, chaired by Sen. Max Baucus, who is determined to join with Senators Ted Kennedy, Charles Grassley and Mike Enzi to enact reform this year. Sen. Sanders will have some input as a member of the Budget Committee and a member of Sen. Kennedy’s HELP Committee.

What happens now? Will Senators Baucus and Kennedy take a fresh look at single payer as a model that addresses many of the policy problems that they currently face with their model based on private plans? Or will they accept Sen. Sanders’ contribution emphasizing the importance of health centers and primary care professionals? Or will they look at his budgeted numbers and decide that they can’t add those to the deficits they already face with their unnecessarily over-priced model of reform? Will they simply say that they’ll have to deal with that later, after they fix the insurance problem (the later that never comes)?

It’s great that there is a single payer bill in the Senate, but now is not the time to sit back and watch the process unfold. We certainly support the emphasis on improving primary care access, but we need to support that within a financing framework that will make it happen – a single payer national health program.

Congressmen will talk about health reform

By Cathleen F. Crowley
Albany Times Union
March 26, 2009

As the nation grapples with improving the health care system and making it more affordable, a contingent of people believe the answer is a single-payer system.

But advocates worry that their idea is being sidelined.

Representatives of the single-payer movement were initially locked-out of health care summit called by President Barack Obama earlier this month — until supporters raised a ruckus.

“I think mainstream wisdom in Washington is reform that is not built on the private health insurance industry will not pass,” said Dr. Andrew Coates, an Albany doctor who is secretary of the Capital District Chapter of Physicians for a National Health Plan. “They do not want a knock-down, drag-out fight.”

Under a single-payer system, private doctors and hospitals deliver health care but the bill is paid by the government. It’s also known as “Medicare for all.”

Single-payer advocates will host a forum on Sunday at the Westminster Presbyterian Church to explain the system to people who are not familiar with it. U.S. Rep. John Conyers Jr. of Michigan, who has proposed a single-payer bill in Congress, will speak along with U.S. Rep. Paul Tonko, of Amsterdam, who signed on as a co-sponsor to his fellow Democrat’s bill.

Conyers, who eventually attended Obama’s health summit, said he presumes the late invitation was due to the administration’s reluctance to give his bill prominence.

A single-payer system would eliminate the need for private health insurance and potentially wipe out the industry.

“The insurance lobby is the one that has kept us from a single-payer system for the last three or four generations,” Conyers said in a telephone interview.

The Presbyterian Church USA has decided that a single-payer system is the best option for health reform, and is hosting 10 forums around the country to educate people about it.

Single-payer “streamlines what is the biggest waste in the system, which is the incredible (duplication) of effort and time doctors and practitioners spend just following the paper trail,” said the Rev. Cass Shaw.

Shaw is leader of the Albany Presbytery, which represents 73 congregations and 8,000 Presbyterians in the Capital Region.

In addition to the congressmen, the forum will have a panel of faith leaders from churches, mosques and synagogues in the area.

“For us, it’s a religious issue as well as a civic issue,” Shaw said.

Sunday’s free forum will be from 2 to 4:30 p.m. at Westminster Presbyterian Church, 262 State St., Albany. Call 434-7371 for more information.

Change we can believe in: Americans need single payer now

by Claudia Chaufan
www.opednews.com
March 27, 2009

As president Obama recently acknowledged, the need to reform health care is no longer an issue. Indeed, on March 5th the White House convened a Health Care Summit, that so far have been followed by Regional Forums in Michigan on March 12, in Vermont on March 17, in Iowa on March 23rd, and upcoming ones in North Carolina on March 31st and in our state, in Los Angeles on April 6th.

But the question remains: what sort of health care reform will serve our needs so that we do not find ourselves having this conversation again ten or twenty years down the road? After all, back in 1973 we also “hoped” that the HMO Act introduced that year by President Nixon would resolve the problem of rising costs and of an increasing number of individuals unable to protect themselves from the financial burden of disease.

Yet we are no better today than we were back then. And we will not be better tomorrow unless we get things right. Which is why I want to argue that, special interest groups aside, from a strictly policy perspective neither the State of California nor the nation as a whole can afford not to choose single payer. It is no longer just the moral problem of millions of uninsured, underinsured, or the thousands dead for lack of health insurance — and we will keep counting the bodies unless we get things right — but also the severe economic problem that is eroding the fiscal health of our state and of our nation.

Let me illustrate my claim with the example of our state. As both Democrats and Republicans in Sacramento are well aware, the State of California spends a great deal on health care, to fund public programs and insure state employees and their families, including retirees. Just recently, it was reported that retiree health care costs for our state will exceed 50 billion dollars this year. From the point of view of the current budget this is unaffordable. And even if it were affordable this year, unfortunately for the California General Fund the revenue that purchases that care keeps growing at a rate roughly equal to that of the economy, yet costs of health care are growing four times faster. This means that unless costs are controlled, the state will be forced to continue cutting benefits, reimbursement rates, or enrollment — most likely all of these.

And here is where single payer becomes critical: it is the only well tested financing mechanism, internationally, and nationally, that can bring costs of health care down, because it is the only one which embodies two demonstrable policy principles critical to cost control.

The first, risk pooling, simply means putting all those who will be insured into large pools, preferably a single one, which is precisely what single payer does. Risk pooling is critical to cost control for several reasons: the most obvious one is that it allows the system to purchase on behalf of a large number of people, an extremely powerful, and well documented, cost-cutting strategy in health care. For instance, while people in Spain, that has a single payer system, pay 9 dollars for Lanzoprasol, a widely used drug to reduce acidity, people in Maryland, U.S., with its public-private financing system, pay $329 for the same dose of the same product.

Risk pooling also cuts costs by reducing administrative waste, because it eliminates useless paper pushing, which results from marketing multiple plans or underwriting policies for different categories of people and eats up no less than 30 cents of each health care dollar. While this administrative overhead is not “waste” for private for profit insurers — indeed, their very survival depends on being able to separate “good” from “bad” customers to meet their first and foremost responsibilities with shareholders — from the perspective of a high-performing health care system this overhead stands in the way of meeting the very goal of the system: eliminating financial barriers to medically necessary care. Attempting to regulate these solidly engrained business practices among experience-rating private insurers, as some have suggested, would not only be largely futile — it has been tried repeatedly, and has failed — but also extraordinarily expensive.

Last yet not least, risk pooling allows for cross-subsidizing, which means that at any given moment the least costly majority, roughly 80%, subsidizes the most costly minority, roughly 20%. We do not know who will be in that minority at any given moment, but we know that the division between those who need more or expensive care and those who need less or less costly care gravitates towards those proportions, which is why cross-subsidizing is critical to the system being not only financially sustainable as a system but also affordable to individuals and families participating in the system when they most need it, that is, when they need medical care.

Cross-subsidizing is also critical to minimizing the need for programs of subsidies for “special categories” — the too sick, too old or too poor or “not poor but not rich enough to shop alone in the private market” — which are ultimately paid by taxpayers, whether or not they qualify for those subsidies or programs.

The second principle, compulsory cooperative financing, simply means that playing is not optional — everybody must. And because playing is not optional, single payer meets the criterion of shared responsibility, very popular among health policy experts these days. Yet because of the cooperative dimension, people are not expected to pay more than what they can afford, so contributions are a proportion of income and unrelated to health status. This way, individuals and families can always predict and afford their part.

And by combining public financing with private delivery, cooperative compulsory financing, the single payer version of shared responsibility, has the added advantage of being the sort of public-private partnership that gives people meaningful choices, not of undecipherable policies with obscure restrictions, including restricted lists of “preferred providers”, but choices of services they need and providers they prefer, who are given the healthy incentive to compete for patients by providing good services.

Now, some argue that Americans need to embrace the principle of “shared responsibility” — incidentally, hardly a meaningful policy concept. At any rate, what could be more “shared responsibility” than single payer, while still being economically sound? With single payer, playing is not optional, yet the rules of the game are fair and sustainable, because contributions are a predictable proportion of income that individuals and families can surely afford. And the advantage of the single-payer version of shared responsibility is that by combining public financing with private delivery, single payer is the public-private partnership that gives people meaningful choices, not of undecipherable policies that let us down when we get sick, or that constrain health care consumers to lists of “preferred providers”, but choices of services we need and providers we prefer.

Meaningful choices also encourage the competition that matters: among providers of services who try to excel to attract patients, not among insurers for “good customers”, those who happen to be more profitable and need health care the least.

More recently, many have praised the individual-mandate, Massachusetts style. Yet I would invite those who support this model to ponder over the critical distinction between coverage and care: it is well-established in the health policy community that much of the coverage available to Massachusetts residents, even if affordable, hardly qualifies as insurance, because it does little to eliminate financial barriers to care. In fact, the courts have ruled that several thousand residents were to be allowed to remain uninsured, i.e., exempted from buying policies that were
affordable, but useless. And the program overall is also proving fiscally unsustainable.

And to those who argue for a “public option” — one that, interestingly, private insurers, self-proclaimed lovers of “free market competition” are fighting to the death on the grounds that competing with a public plan would be “unfair” — let me remind them that this option has tended to fall under the burden of “adverse risk selection” — yet another well studied problem of mixed-financing systems. What this means is that the public plan, sooner or later, ends up with all the “bad customers” — the too old, too sick or too poor — that the private insurers have succeeding in avoiding for the last several decades, and will continue to avoid. We really have no good reason to believe that the outcomes will be different this time, which is why the rest of the international community –Canada, all European nations, Australia, Japan, and more recently, Taiwan — has long opted for social insurance, of which the single payer model is the strongest type in terms of cost control.

For all these reasons, if the goal of health care reform in California and in our nation is to control costs, while guaranteeing a medically necessary amount of health care universally, single payer, SB810 in California and HR 676 at the federal level, is not only the best but really the only way to go, and the time to go for it is now, both for our children’s sake, and for the viability of our economy.

Himmelstein and Woolhandler on a public plan option

Public Plan Option in a Market of Private Plans

By David Himmelstein, M.D. and Steffie Woolhandler, M.D., M.P.H.:
The “public plan option” won’t work to fix the health care system for two reasons.
1. It forgoes at least 84 percent of the administrative savings available through single payer. The public plan option would do nothing to streamline the administrative tasks (and costs) of hospitals, physicians offices, and nursing homes, which would still contend with multiple payers, and hence still need the complex cost tracking and billing apparatus that drives administrative costs. These unnecessary provider administrative costs account for the vast majority of bureaucratic waste. Hence, even if 95 percent of Americans who are currently privately insured were to join the public plan (and it had overhead costs at current Medicare levels), the savings on insurance overhead would amount to only 16 percent of the roughly $400 billion annually achievable through single payer — not enough to make reform affordable.
2. A quarter century of experience with public/private competition in the Medicare program demonstrates that the private plans will not allow a level playing field. Despite strict regulation, private insurers have successfully cherry picked healthier seniors, and have exploited regional health spending differences to their advantage. They have progressively undermined the public plan — which started as the single payer for seniors and has now become a funding mechanism for HMOs — and a place to dump the unprofitably ill. A public plan option does not lead toward single payer, but toward the segregation of patients, with profitable ones in private plans and unprofitable ones in the public plan.
www.pnhp.org

The option to purchase a public plan within a market of private health insurance plans would merely provide one more player in our inefficient, dysfunctional, fragmented, multi-payer system of financing health care, that is if the public option even survives the political process. It would leave in place the deficiencies that have resulted in very high costs with the poorest health care value of all nations (i.e., overpriced mediocrity in health care).
Those who believe that the people of this nation would have the wisdom to drop their private plans and join the government program are ignoring history. When Congress authorized private plans to compete with our existing public program, Medicare, many enrollees did just the opposite. One-fifth have left the traditional Medicare program and joined the private plans.
So why should we care? Why shouldn’t they have the right to choose private plans if they want them? We know that those private plans are wasting money, both in their own costs and the administrative burden they place on the delivery system, but what all too many don’t realize is that we are all paying for that waste because of the inherent structural deficiencies in our financing system. Plus we are being deprived of the reforms needed in our health care delivery system that our own single payer monopsony would bring us.
Single payer activists, don’t give up. As President Obama said in his press conference this week, “persistence!”

Himmelstein and Woolhandler on a public plan option

Public Plan Option in a Market of Private Plans

By David Himmelstein, M.D. and Steffie Woolhandler, M.D., M.P.H.:

The “public plan option” won’t work to fix the health care system for two reasons.

1. It forgoes at least 84 percent of the administrative savings available through single payer. The public plan option would do nothing to streamline the administrative tasks (and costs) of hospitals, physicians offices, and nursing homes, which would still contend with multiple payers, and hence still need the complex cost tracking and billing apparatus that drives administrative costs. These unnecessary provider administrative costs account for the vast majority of bureaucratic waste. Hence, even if 95 percent of Americans who are currently privately insured were to join the public plan (and it had overhead costs at current Medicare levels), the savings on insurance overhead would amount to only 16 percent of the roughly $400 billion annually achievable through single payer — not enough to make reform affordable.

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

www.pnhp.org

Comment:

By Don McCanne, MD

The option to purchase a public plan within a market of private health insurance plans would merely provide one more player in our inefficient, dysfunctional, fragmented, multi-payer system of financing health care, that is if the public option even survives the political process. It would leave in place the deficiencies that have resulted in very high costs with the poorest health care value of all nations (i.e., overpriced mediocrity in health care).

Those who believe that the people of this nation would have the wisdom to drop their private plans and join the government program are ignoring history. When Congress authorized private plans to compete with our existing public program, Medicare, many enrollees did just the opposite. One-fifth have left the traditional Medicare program and joined the private plans.

So why should we care? Why shouldn’t they have the right to choose private plans if they want them? We know that those private plans are wasting money, both in their own costs and the administrative burden they place on the delivery system, but what all too many don’t realize is that we are all paying for that waste because of the inherent structural deficiencies in our financing system. Plus we are being deprived of the reforms needed in our health care delivery system that our own single payer monopsony would bring us.

Single payer activists, don’t give up. As President Obama said in his press conference this week, “persistence!”

Media Advisory: Single-payer supporters to rally at March 31 health forum in Greensboro

Physicians, nurses and health reform advocates to urge enactment of an improved 'Medicare for All,' decry outsized influence of corporate medicine at regional meeting

FOR IMMEDIATE RELEASE
March 26, 2009

Contacts:
Jonathan Kotch, M.D.
Mark Almberg, PNHP, (312) 782-6006, cell: (312) 622-0996, mark@pnhp.org

What

Press conference and rally to express support for single-payer national health insurance and to protest the “marginalization of majority opinion” at Tuesday’s White House Forum on Health Care Reform at the North Carolina A&T Alumni Foundation Event Center in Greensboro, at 9 a.m. EDT.

The health forum will be hosted by North Carolina Gov. Bev Perdue. Senior White House policy officials will participate and help moderate a discussion involving diverse stakeholders in health care reform, according to Perdue’s office.

Advocates of single-payer national health insurance, sometimes called an improved “Medicare for All,” will be inside and outside, urging that single payer be “on the table” as a full-fledged option for reform. They will also decry the outsized role of the private health insurance industry, Big Pharma, and other representatives of corporate medicine at the forum.

Physicians wearing their white coats and other health reform advocates will assert that national health insurance is being accorded a minor, marginalized role at the forum, even though surveys show two-thirds of Americans and 59 percent of U.S. physicians support it.

They will demand that the single-payer model be given pride of place in the health care debate in view of that model’s effectiveness in providing truly universal, comprehensive care; its ability to contain costs; and the fact that the annual savings in administrative costs — $400 billion — would mean that a U.S. single-payer system would require no increase in overall health spending.

The pro-single-payer rally is co-sponsored by Health Care for All NC, the state chapter of Physicians for a National Health Program (PNHP); Progressive Democrats of America and its local coalition partner, Progressive Democrats of North Carolina; and Healthcare-Now, a national grassroots coalition for single-payer health reform.

Dr. Jonathan Kotch said today: “The single-payer alternative to industry-driven proposals has been systematically ignored until PNHP and others took their message to the streets. It is only through direct action that the political and financial power of insurance, pharmaceutical and for-profit medical interests can be challenged. The majority of the people want single payer, and our message to the White House is, pay attention.”

Who

Jonathan Kotch, M.D., professor of maternal and child health, University of North Carolina at Chapel Hill
Miriam Thompson, M.S.W., Health Care for All – North Carolina
Carol Shores, M.D., an ear, nose and throat specialist in Chapel Hill

When

9 a.m. EDT, Tuesday, March 31

Where

North Carolina A&T Alumni Foundation Event Center, 200 N. Benbow Rd., Greensboro, N.C.

###

Physicians for a National Health Program (www.pnhp.org), a membership organization of over 16,000 physicians, supports a single-payer national health insurance program. PNHP is headquartered in Chicago and has chapters across the United States. To contact a physician-spokesperson in your area, contact info@pnhp.org or call (312) 782-6006.

Press Release: Single-payer health reform bill introduced in Senate

Would save $400 billion on bureaucracy, enough to cover all 46 million uninsured Americans

FOR IMMEDIATE RELEASE
March 26, 2009

Contacts:
Quentin Young, M.D., (312) 782-6006
Mark Almberg, (312) 782-6006, cell: (312) 622-0996, mark@pnhp.org

Challenging head-on the powerful private insurance and pharmaceutical industries, Vermont’s Sen. Bernie Sanders introduced a single-payer health reform bill, the American Health Security Act of 2009, S. 703, in the U.S. Senate Wednesday. The bill is the first to directly take on the powerful lobbies blocking universal health reform in the Senate since Sen. Paul Wellstone’s tragic death.

The single-payer approach embodied in Sanders’ new bill stands in sharp contrast to the reform models being offered by the White House and by key lawmakers like Senators Max Baucus (D-Mont.) and Edward Kennedy (D-Mass.). Their plans would preserve a central role for the private insurance industry, sacrificing both universal coverage and cost containment during the worst economic crisis since the Depression.

In contrast, Sanders’ new legislation would cover all of the 46 million Americans who currently lack coverage and improve benefits for all Americans by eliminating co-pays and deductibles and restoring free choice of physician. The most fiscally conservative option for reform, single payer slashes private insurance overhead and bureaucracy in medical settings, saving over $400 billion annually that can be redirected into clinical care.

“This is excellent news for the nation’s health,” said Dr. Quentin Young, national coordinator of Physicians for a National Health Program and a past president of the American Public Health Association. “There is now an affordable cure for our dysfunctional health care system. In the face of our present economic calamity, this is an urgent necessity.”

Highlights of the bill include the following:

* Patients go to any doctor or hospital of their choice.

* The program is paid for by combining current sources of government health spending into a single fund with modest new taxes amounting to less than what people now pay for insurance premiums and out-of-pocket expenses.

* Comprehensive benefits, including coverage for dental, mental health, and prescription drugs.

* While federally funded, the program is to be administered by the states.

* By eliminating the high overhead and profits of the private, investor-owned insurance industry, along with the burdensome paperwork imposed on physicians, hospitals and other providers, the plan saves at least $400 billion annually – enough money to provide comprehensive, quality care to all.

* Community health centers are fully funded, giving the 60 million Americans now living in rural and underserved areas access to care.

* To address the critical shortage of primary care physicians and dentists, the bill provides resources for the National Health Service Corps to train an additional 24,000 health professionals.

“We are confident that Sen. Sanders’ bill will accelerate the national drive for the only reform that we know will work,” Young said. “A majority of physicians endorse such an approach. Fifty-nine percent of U.S. physicians support national health insurance. Two-thirds of the public also supports such a remedy. We remember well that President Obama once acknowledged that single-payer national health insurance was the best way to go. It still is.”

Sanders, who serves on the Senate Committee on Health, Education, Labor, and Pensions, is a longtime advocate of fundamental health care reform. His new bill draws heavily upon the single-payer legislation introduced by the late Sen. Paul Wellstone (D-Minn.) in 1993, S. 491, and closely parallels similar legislation pending before the House, H.R. 1200, introduced by Rep. Jim McDermott (D-Wash.).

A single-payer bill introduced by Rep. John Conyers Jr. (D-Mich.), H.R. 676, obtained 93 co-sponsors in the House during the last session. It has been reintroduced in the new Congress as the U.S. National Health Care Act with the same bill number.

A copy of the bill is available here. (PDF)

Physicians for a National Health Program, a membership organization of over 16,000 physicians, supports a single-payer national health insurance program. To contact a physician-spokesperson in your area, call (312) 782-6006 or visit www.pnhp.org/stateactions.

Culling dependent coverage a great return on investment

Employers getting more strict on health-care eligibility

By Steve Twedt
Pittsburgh Post-Gazette
March 25, 2009
Facing a difficult economy and running short of ways to reduce health-care costs, employers are becoming more aggressive about checking the eligibility of their workers’ dependents.
A Watson Wyatt survey of 489 employers this month for the National Business Group on Health found that audit reviews are the fastest growing change that companies are making to their health-care programs, well ahead of health risk appraisals or improving case management.
During an eligibility audit, employees are asked to document that family members on their health plans are eligible for coverage. They may be required to produce marriage certificates, proof of college enrollment or tax forms. Ex-spouses are not eligible. Nor are sickly uncles who live with the family. Stepchildren may not be eligible either, depending on the plan.
The appeal of eligibility audits is that they almost guarantee hard-dollar savings — with estimates of ineligible dependents typically in the 5 to 12 percent range — and they often can pay for themselves within a year.
“We have completed dependent eligibility audits for over 50 employers and we have yet to have a case where the employer did not receive a return on investment of over 300 percent within one year. Many times it is well over 1,000 percent,” said Michael Browning of Chapman Kelly, Inc., consultants in Jeffersonville, Ind.
Pittsburgh-based Daniel Priga, a principal with Mercer consulting, said the firm “conservatively” estimates a $1,900 savings per year for every ineligible dependent taken off the books. Such a return “is hard to find in today’s environment.”
http://www.post-gazette.com/pg/09084/957986-28.stm

Doing eligibility audits of dependents covered by employer-sponsored plans is yet one more example wherein our current dysfunctional system of financing health care actually promotes administrative waste. A rational system uses administrative services efficiently to pay for the health care that patients need. In the United States, much of the administrative cost of health care financing is due to efforts to avoid paying for health care.
Only in the United States do we consider that taking health insurance away from individuals to be a “return on investment.”

Culling dependent coverage a great return on investment

Employers getting more strict on health-care eligibility

By Steve Twedt
Pittsburgh Post-Gazette
March 25, 2009

Facing a difficult economy and running short of ways to reduce health-care costs, employers are becoming more aggressive about checking the eligibility of their workers’ dependents.

A Watson Wyatt survey of 489 employers this month for the National Business Group on Health found that audit reviews are the fastest growing change that companies are making to their health-care programs, well ahead of health risk appraisals or improving case management.

During an eligibility audit, employees are asked to document that family members on their health plans are eligible for coverage. They may be required to produce marriage certificates, proof of college enrollment or tax forms. Ex-spouses are not eligible. Nor are sickly uncles who live with the family. Stepchildren may not be eligible either, depending on the plan.

The appeal of eligibility audits is that they almost guarantee hard-dollar savings — with estimates of ineligible dependents typically in the 5 to 12 percent range — and they often can pay for themselves within a year.

“We have completed dependent eligibility audits for over 50 employers and we have yet to have a case where the employer did not receive a return on investment of over 300 percent within one year. Many times it is well over 1,000 percent,” said Michael Browning of Chapman Kelly, Inc., consultants in Jeffersonville, Ind.

Pittsburgh-based Daniel Priga, a principal with Mercer consulting, said the firm “conservatively” estimates a $1,900 savings per year for every ineligible dependent taken off the books. Such a return “is hard to find in today’s environment.”

http://www.post-gazette.com/pg/09084/957986-28.stm

Comment:

By Don McCanne, MD

Doing eligibility audits of dependents covered by employer-sponsored plans is yet one more example wherein our current dysfunctional system of financing health care actually promotes administrative waste. A rational system uses administrative services efficiently to pay for the health care that patients need. In the United States, much of the administrative cost of health care financing is due to efforts to avoid paying for health care.

Only in the United States do we consider that taking health insurance away from individuals to be a “return on investment.”

Health care for all, but how?

Forum panelists promote single-payer system

By John McVey
The Journal (WV)
March 25, 2009

SHEPHERDSTOWN — The panelists at the “Health Care for All – How?” forum Tuesday evening started with the premise that the way Americans pay for health care needs to be changed.

Their question was, “How do we get there from here?”

Dr. Margaret Flowers of Maryland Physicians for a National Health Program and Richard McVay of Penn Action were the panelists for the forum, which was sponsored by Eastern Panhandle Single-Payer Action Network and the Shepherd University Health Center.

Hannah Geffert, an adjunct professor at Shepherd, was the moderator.

Almost 100 people attended the symposium in the Robert C. Byrd Center for Legislative Studies on the Shepherd campus.

Flowers, who left her pediatrics practice to work full time on a single-payer health care system, gave a bit of the history of how health care is paid for in America.

She said that during World War II, companies were prohibited from giving raises to employees, so in order to attract and keep the best workers, businesses began offering benefits, such as paid health care insurance, to their employees.

“No other country ties health insurance to employers like we do,” she said.

The health care provider dynamic changed in the 1980s, Flowers said. Private, for-profit health care providers became dominant.

“Patients became customers, and health care became a commodity,” she said.

This system is very good at making money but not very good at providing health care, Flowers said.

To her, the solution is a single-payer, publicly funded, privately delivered, health care system, namely, the expansion of Medicare to cover everyone in the country from cradle to grave.

The shift would take place all at once, without a transition period in which private and public insurance companies would compete for customers.

However, she said there is a large, well-heeled special interest group that opposes such a plan – insurance companies.

“They love mandatory insurance, subsidies and a public-private partnership,” Flowers said. “They don’t like a single-payer program.”

She and McVay agree that the time is ripe to push for reforming the way Americans pay for health care.

“We have to get it done this year,” McVay said. “The alignment is right. The mood of the people is right. The next big issue is health care, and we can’t straighten out the economy without health care reform.”

He also agreed that there is a big battle ahead because of monied interests opposing any kind of reform that would take the private insurance companies out of the picture.

However, McVay would like to see a hybrid form of payer system, at least to start. There would be both private insurance companies and a public system competing for customers, although he said the single-payer system eventually would win out.

Responding to a question from the audience, McVay said his group wants to start at the state level.

“Politically, it makes sense to start with the states, build a system, a model, and then take it to the federal level,” he said.

Minimum wage and Social Security started with the states, then were adopted by the federal government, McVay said.

The key to changing the system is getting business on board, he said.

McVay and Flowers also agreed without hesitation that health care is a human right.

“The way (health care) is delivered in this country is immoral,” McVay said.

For more information about EPSPAN, call (304) 671-0433, (304) 876-3158, or e-mail epspan@gmail.com

N.H. house backs single-payer health plan

New Hampshire Business Review
Wednesday, March 25, 2009

The New Hampshire House went on record in favor of a single-payer national health-care system Tuesday, in a last minute, 192-150 roll call vote.

Rep. Jill Shaffer Hammond, D-Peterborough, spoke for the resolution, HCR2, which supports the federal National Health Insurance Act and calls for similar coverage offered in other industrialized nations. The federal act, currently languishing in Congress, goes far beyond what President Obama, and most Democratic candidates running to the left of him, proposed in the last campaign. The act would increase the Medicaid payroll tax to 4.5 percent from 1.2 percent, allowing the federal government to insure everyone not currently insured, said Shaffer Hammond Ć¢ā‚¬ā€œ an amount, she contended, that is far lower than the amount most people currently pay for health insurance.

Already, she said, the government pays for veterans, elderly and the poor, and all high-risk groups with expensive coverage.

Add on government workers, and “we are more than 60 percent there already,” she said.

“No more would the small-business owner faced with a 23 percent increase in insurance premiums have to negotiate a 16 percent increase and then talk to their employees about doubling their deductible,” she said. “No more would a family have to face medical bankruptcy. Let’s liberate our small business to compete locally, nationally and globally.”

Rep. John Hunt, R-Rindge who asked for the roll call vote, urged representatives to vote against the bill, adding “say no to payroll taxes.”