PNHP

Battle over public option to private insurance plans

Battle over public option to private insurance plans

Health-Care Battle Set to Focus on Public Plan

By Laura Meckler
The Wall Street Journal
March 24, 2009
Congress is poised for a battle over whether an ambitious health-care overhaul should include a new government-run health plan to compete with private companies in the effort to cover the uninsured.
The matter is likely to come to a head first in the Senate Finance Committee, where Chairman Max Baucus (D., Mont.) has pledged to write a bipartisan bill. His partner, Sen. Charles Grassley of Iowa, the top Republican on the panel, is adamantly opposed to the provision for a public health-care plan. As such, aides in both parties say it’s unlikely a public plan will be included in the legislation now being negotiated.
The House of Representatives, on the other hand, is likely to include the provision in its version of the bill, expected in late spring or early summer, aides say. That suggests the issue would have to be worked out in negotiations between the chambers later this year.
But opponents say a public plan would be an unfair competitor because it could become big enough to drive down reimbursements to doctors and hospitals, much like Medicare does, putting more cost pressure on the private sector. Consumers would then flock to the public plan because its premiums would be cheaper, opponents fear, and ultimately no viable private plans would remain.
Insurance companies, many of which support other aspects of the health-system overhaul, strongly oppose a public plan, said Karen Ignagni, president of America’s Health Insurance Plans, the industry lobby group. “It’s a very short step to a Medicare-like program for all Americans in a single-payer system,” she said.
http://online.wsj.com/article/SB123785156695519283.html

And…

Hearing: Addressing Insurance Market Reform in National Health Reform

U.S Senate Committee on Health, Education, Labor, and Pensions
March 24, 2009
Senator Tom Harkin: I want to ask about a public plan… Can a public plan coexist with private insurance plans? That seems to be a question I’m getting all of the time. Can we have a health reform that has all these private plans, and then have a public plan?
Ronald A. Williams, MS, Chairman and Chief Executive Officer, Aetna Inc.: My opinion is no, it cannot…
Janet Trautwein, Executive Vice President and CEO, National Association of Health Underwriters: I would just add to that, and also I don’t think it is possible for a public and private sector to compete on a level playing field. I don’t see any way that that’s possible…
Karen Pollitz, M.P.P., Research Professor, Health Policy Institute at Georgetown University: Private health insurance and public plans coexist today… …I think it’s absolutely essential.
Karen Ignagni, M.B.A., President and CEO, America’s Health Insurance Plans: …what we have done is propose an aggressive system of government regulation that would supervise private sector competition…
Len Nichols, Ph.D, Director, Health Policy Program at the New America Foundation: …if we just decide to put everybody into Medicare, except for the private plans that would survive for maybe three years… we’re going to end up with a system that is basically going to be run from Washington and Baltimore… think about a public plan model more like what state employees do… …let it compete with the private insurance industry… …a PPO type arrangement… We would suggest even stronger firewalls between the people who run the new marketplace and the people who run the plan…
Katherine Baicker, PhD, Professor of Health Economics, Department of Health Policy and Management at the Harvard School of Public Health: …I worry that in practice one ends up doing more harm than good…
Sandy Praeger, Health Insurance Commissioner, State of Kansas: The public plan… and I’ve read Dr. Nichols’ report… and I think he makes some very good points. …if it’s competing on a level playing field with the private marketplace… If you have equal rules and are treating the public plan the same as the private plan, it can help drive market changes…
http://help.senate.gov/Hearings/2009_03_24/2009_03_24.html

Perhaps the surest sign of trouble for the proposal to offer a public Medicare-like plan to compete with private insurance plans is the commitment of Finance Chairman Max Baucus that reform will be bipartisan along with the adamant opposition of a public option by Ranking Member Charles Grassley. Having discarded other public insurance proposals such as single payer, even before the negotiations began, the competing Medicare-like option is standing alone as the obvious trade-away for achieving political consensus.
The insurance industry contends that a public plan would provide “unfair” competition to the private plans, just as the private Medicare Advantage plans had to be granted large overpayments to counter the “unfair” advantage of the traditional public Medicare program. It is surprising how many others perpetuate this framing that the private insurers should be granted extra tax dollars in order to level the playing field with a more efficient government health financing system. The real unfairness is gifting taxpayer funds to the private insurers.
So what is being proposed as a compromise public insurance option? Let’s have the government set up a private insurance-style PPO, and require it to copy the private sector business model of taking away choice through restricted provider lists, expanding administrative functions including the necessity of marketing its product, competing on benefits and cost-sharing provisions, and engaging in all of the other non-beneficial excesses of the marketplace. Just to be absolutely certain that the public option has all of the flaws of the private health plans, Len Nichols would put up even stronger firewalls between the government administrators and the government’s own public option disguised as a private plan. And this ridiculous effort to “level” the playing field is all for the benefit of… not the patients… but the insurers!
What is sad is that the enemies of reform have already won. They have managed to eliminate comprehensive reform from the national dialogue and have reduced the debate to whether or not we’ll add one more plan, a public plan, to our dysfunctional, fragmented, multi-payer system that costs so much and serves us so poorly. Anyone who believes that the mere additional option of purchasing a public insurance plan is going to transform our health care system is living in La La Land.

Battle over public option to private insurance plans

Health-Care Battle Set to Focus on Public Plan

By Laura Meckler
The Wall Street Journal
March 24, 2009

Congress is poised for a battle over whether an ambitious health-care overhaul should include a new government-run health plan to compete with private companies in the effort to cover the uninsured.

The matter is likely to come to a head first in the Senate Finance Committee, where Chairman Max Baucus (D., Mont.) has pledged to write a bipartisan bill. His partner, Sen. Charles Grassley of Iowa, the top Republican on the panel, is adamantly opposed to the provision for a public health-care plan. As such, aides in both parties say it’s unlikely a public plan will be included in the legislation now being negotiated.

The House of Representatives, on the other hand, is likely to include the provision in its version of the bill, expected in late spring or early summer, aides say. That suggests the issue would have to be worked out in negotiations between the chambers later this year.

But opponents say a public plan would be an unfair competitor because it could become big enough to drive down reimbursements to doctors and hospitals, much like Medicare does, putting more cost pressure on the private sector. Consumers would then flock to the public plan because its premiums would be cheaper, opponents fear, and ultimately no viable private plans would remain.

Insurance companies, many of which support other aspects of the health-system overhaul, strongly oppose a public plan, said Karen Ignagni, president of America’s Health Insurance Plans, the industry lobby group. “It’s a very short step to a Medicare-like program for all Americans in a single-payer system,” she said.

http://online.wsj.com/article/SB123785156695519283.html

And…

Hearing: Addressing Insurance Market Reform in National Health Reform

U.S Senate Committee on Health, Education, Labor, and Pensions
March 24, 2009

Senator Tom Harkin: I want to ask about a public plan… Can a public plan coexist with private insurance plans? That seems to be a question I’m getting all of the time. Can we have a health reform that has all these private plans, and then have a public plan?

Ronald A. Williams, MS, Chairman and Chief Executive Officer, Aetna Inc.: My opinion is no, it cannot…

Janet Trautwein, Executive Vice President and CEO, National Association of Health Underwriters: I would just add to that, and also I don’t think it is possible for a public and private sector to compete on a level playing field. I don’t see any way that that’s possible…

Karen Pollitz, M.P.P., Research Professor, Health Policy Institute at Georgetown University: Private health insurance and public plans coexist today… …I think it’s absolutely essential.

Karen Ignagni, M.B.A., President and CEO, America’s Health Insurance Plans: …what we have done is propose an aggressive system of government regulation that would supervise private sector competition…

Len Nichols, Ph.D, Director, Health Policy Program at the New America Foundation: …if we just decide to put everybody into Medicare, except for the private plans that would survive for maybe three years… we’re going to end up with a system that is basically going to be run from Washington and Baltimore… think about a public plan model more like what state employees do… …let it compete with the private insurance industry… …a PPO type arrangement… We would suggest even stronger firewalls between the people who run the new marketplace and the people who run the plan…

Katherine Baicker, PhD, Professor of Health Economics, Department of Health Policy and Management at the Harvard School of Public Health: …I worry that in practice one ends up doing more harm than good…

Sandy Praeger, Health Insurance Commissioner, State of Kansas: The public plan… and I’ve read Dr. Nichols’ report… and I think he makes some very good points. …if it’s competing on a level playing field with the private marketplace… If you have equal rules and are treating the public plan the same as the private plan, it can help drive market changes…

http://help.senate.gov/Hearings/2009_03_24/2009_03_24.html

Comment:

By Don McCanne, MD

Perhaps the surest sign of trouble for the proposal to offer a public Medicare-like plan to compete with private insurance plans is the commitment of Finance Chairman Max Baucus that reform will be bipartisan along with the adamant opposition of a public option by Ranking Member Charles Grassley. Having discarded other public insurance proposals such as single payer, even before the negotiations began, the competing Medicare-like option is standing alone as the obvious trade-away for achieving political consensus.

The insurance industry contends that a public plan would provide “unfair” competition to the private plans, just as the private Medicare Advantage plans had to be granted large overpayments to counter the “unfair” advantage of the traditional public Medicare program. It is surprising how many others perpetuate this framing that the private insurers should be granted extra tax dollars in order to level the playing field with a more efficient government health financing system. The real unfairness is gifting taxpayer funds to the private insurers.

So what is being proposed as a compromise public insurance option? Let’s have the government set up a private insurance-style PPO, and require it to copy the private sector business model of taking away choice through restricted provider lists, expanding administrative functions including the necessity of marketing its product, competing on benefits and cost-sharing provisions, and engaging in all of the other non-beneficial excesses of the marketplace. Just to be absolutely certain that the public option has all of the flaws of the private health plans, Len Nichols would put up even stronger firewalls between the government administrators and the government’s own public option disguised as a private plan. And this ridiculous effort to “level” the playing field is all for the benefit of… not the patients… but the insurers!

What is sad is that the enemies of reform have already won. They have managed to eliminate comprehensive reform from the national dialogue and have reduced the debate to whether or not we’ll add one more plan, a public plan, to our dysfunctional, fragmented, multi-payer system that costs so much and serves us so poorly. Anyone who believes that the mere additional option of purchasing a public insurance plan is going to transform our health care system is living in La La Land.

Residents learn about health care options

Madison forum discusses alternatives to for-profit system

By Katelyn Farago
Daily Record
March 22, 2009

MADISON — Borough residents Geoff and Laurie Thomas are currently facing a reality many unemployed and self-employed Americans share. They are paying for their own health insurance.

For the Thomases, who are insured under Cobra, the cost is $900 per month.

Unsatisfied with the accessibility and affordability of health care in the current for-profit system, the couple decided to organize a health care forum at the Madison Public Library Saturday and showed the PBS Frontline documentary “Sick Around The World.” The documentary examines the health care systems of five capitalist democracies in order to determine what the United States might be able to learn from them.

“This gives us a view of what’s possible,” Laurie Thomas said.

The couple also organized a forum at the library last year.

A believer in the principles of a participatory democracy, she said she thinks citizens have the responsibility to educate themselves on important issues such as health care.

She said she would personally prefer to have a national health care system in the United States, and supports the new congressional bill, House Resolution 676, which would ensure that every American is provided with comprehensive health insurance coverage by essentially expanding and improving Medicare.

After the documentary, the Thomases held an informal discussion. One resident spoke up to say that he has Parkinson’s disease, and has not been able to get health coverage. He asked the room what he could do.

Another resident described the American resistance to socialized medicine as a “joke,” explaining that the United States has other socialized institutions, namely education and law enforcement.

And yet another resident asked what could be done, and how citizens could help get HR 676 passed.

“It’s going to take a movement of activists,” Laurie Thomas said, and her husband, Geoff, emphasized education. Both are members of Healthcare-now! and Physicians for a National Health Care Program — organizations in favor of a single-payer health care system.

Madison resident Sarah Mercuri, who works as a human relations consultant, has been paying for her own health care for seven years. But after being laid off, she said she doesn’t think she can afford to pay for it any longer.

“Health care in this country just isn’t affordable,” she said. “If you lose your job, you basically lose your health coverage.”

Mercuri said she was motivated to attend the forum because she wanted to show her support for HR 676.

Dr. Carol Dimond, M.D., also a supporter of the bill, said she thinks it’s important to spread the word about the legislation.

“There are too many people suffering unnecessarily,” she said. “I feel there is a need for single-payer (health care),” Dimond said.

Protests at White House healthcare hearing in Iowa

By Kay Henderson
Reuters
March 23, 2009

DES MOINES, Iowa (Reuters) – The latest White House regional forum on healthcare drew protests and complaints on Monday along with a promise that government-run insurance was at least on the table for discussion.

“Why are we having this shameful event?” said Mona Shaw, a political activist, at the start of the session. “People are dying,” she said, because of what she termed a callous insurance industry.

Iowa Governor Chet Culver who chaired the event cued up a video message from President Barack Obama as security personnel escorted Shaw from the room.

It was the third of five regional meetings which Obama hopes would help Congress figure out how to overhaul the U.S. healthcare system, which is the most expensive in the world even though some 46 million Americans have no health insurance.

Obama plans to make sweeping changes to the system this year to try to cut the number of uninsured while improving the quality of care and controlling costs that are forecast to reach $2.5 trillion dollars this year.

About 20 protesters at the meeting waved signs and chanted “Everybody in, nobody out” — a demand for universal coverage.

Dr. Jess Fiedorowicz, a psychiatrist at the University of Iowa Hospitals who was with the protest group, told the meeting a majority of Americans support a “single payer” or government-run national health insurance program.

“Can we put it on the table for discussion?” Fiedorowicz asked Nancy-Ann De Parle, director of the White House Office on Health Reform.

“Can we study costing? Can we study feasibility of this truly universal, socially just and fiscally responsible alternate to our currently unjust and woefully inefficient system?” Fiedorowicz asked. Many in the crowd applauded.

Vashti Winterburg, 61, co-chair of Kansas Health Care for All, said she opposes any plan that keeps health insurance companies in business.

She said the Kansas nonprofit board she serves on is finding it more and more difficult to pay the premiums of workers who provide in-home care to the elderly.

Chris Peterson, 53, who farms near Clear Lake, Iowa, said he cannot buy private health insurance for his wife or himself two years after his insurance carrier dropped them. They now have $14,000 in medical debt.

(Editing by Michael Conlon and Chris Wilson)

http://www.reuters.com/article/healthNews/idUSTRE52M70020090323

Merkley backs single-payer system

By Rachel Beck
Corvallis Gazette-Times
March 22, 2009

“Health care” were the two words on everyone’s lips Saturday in a public meeting with U.S. Sen. Jeff Merkley.

About 150 people packed a conference room at the Corvallis-Benton County Public Library for a town hall meeting, Merkley’s first in Corvallis since his November election victory over incumbent Gordon Smith.

Merkley described his four committee assignments and the challenges he hopes to help solve.

“We are facing one of the most difficult moments we’ve seen in the economy in our lifetimes,” he said.

Fielding questions, he said, “I will support a single-payer plan if we can get it to the floor.”

But he said there must be a bill on the table by summer or Congress will get bogged down by other issues.

“We may not get this opportunity for another 20, 30 years,” he said.

Merkley said he has signed on to a bill that would quadruple money to health clinics, which are cost-effective. He also supports wellness programs, particularly for youth, which act as preventative care.

Merkley said lack of oversight over companies such as Halliburton was a huge problem, and a questioner asked if he would refuse campaign contributions from such companies. Merkley said the question was too broad.

Dr. Paul Hochfeld of Corvallis drew a parallel between the senator’s answer and the power of insurance companies in the healthcare debate. He wanted to know how the political process could be fixed to keep industry from unfairly influencing legislation.

Merkley didn’t offer specifics but said the current campaign funding models aren’t working to make sure voices are heard equally.

The economy was another topic. Merkley compared stimulus funding to a short-term pain with long-term benefits, much preferable to not doing anything and facing worse problems down the road.

Merkley said after the meeting that he was struck by how many people turned out and the energy of the crowd. Topics raised were mostly the same he’s heard elsewhere in the state.

“I think by and large it’s the same cross-section of addressing fundamental concerns of healthcare and jobs,” he said.

He said he and fellow Democrat Sen. Ron Wyden hope to work to highlight Oregon as a state on the cutting edge of renewable energy technology.

http://www.gazettetimes.com/articles/2009/03/22/news/community/1loc02_merkley.txt

Bayh howls with the Blue Dogs

Moderate Senate Dems Launch New Group to Shape Public Policy

U.S. Senator Evan Bayh
Press release
March 18, 2009
A diverse group of 16 Senate Democrats today announced the formation of a new moderate coalition that will meet regularly to shape public policy. The groupā€™s goal is to work with the Senate leadership and the new administration to craft common-sense solutions to urgent national problems.
Leading the new group are Democratic Senators Evan Bayh of Indiana, Tom Carper of Delaware and Blanche Lincoln of Arkansas. All three leaders are honorary co-chairs of Third Way, a progressive Democratic policy group, and Senators Bayh and Carper have led the centrist Democratic Leadership Council.
In addition to Senators Bayh, Carper and Lincoln, others joining the group are Senators Mark Udall and Michael Bennet of Colorado, Mark Begich of Alaska, Kay Hagan of North Carolina, Herb Kohl of Wisconsin, Mary Landrieu of Louisiana, Joe Lieberman of Connecticut, Claire McCaskill of Missouri, Ben Nelson of Nebraska, Bill Nelson of Florida, Mark Pryor of Arkansas, Jeanne Shaheen of New Hampshire, and Mark Warner of Virginia.
… the Moderate Dems are joined by a shared commitment to pursue pragmatic, fiscally sustainable policies across a range of issues, such as deficit containment, health care reform, the housing crisis, educational reform, energy policy and climate change.
http://bayh.senate.gov/news/press/release/?id=b30d7f79-9eb1-4819-980f-9489825825ba

And…

For Blue Dogs, Health Budget Raises Questions of ‘When,’ Not Just ‘How’

By David Clarke
CQ
March 16, 2009
As the congressional budget panels prepare to write their fiscal 2010 blueprint, members of the Blue Dog Coalition of fiscally conservative Democrats want to make sure that any expansion of health care coverage is fully paid for–and that its tax or spending offsets are guaranteed to yield savings down the road.
Leaders of the 51-member coalition wrote to the House and Senate Budget committees as well as congressional leaders stating their support for President Obama’s goal of offsetting the cost of a planned health care overhaul. But the Blue Dog leaders said they do not want the savings to be achieved too far in the future if new spending in the short term is going to exacerbate already high federal deficits.
“While we agree that reforming our health care system will eventually lead to savings, it would be irresponsible to take on additional large-scale deficit spending in the short term without the ability to definitively quantify future savings,” Blue Dog leaders wrote March 13 in a two-paragraph letter.
The Blue Dogs are major boosters of the congressional “pay as you go” budget rule that requires new mandatory spending or tax cuts to be fully offset with increases in revenue or spending cuts elsewhere.
http://www.commonwealthfund.org/Content/Newsletters/Washington-Health-Policy-in-Review/2009/Mar/Washington-Health-Policy-Week-in-Review-March-23-2009/For-Blue-Dogs-Health-Budget-Raises-Questions-Of-When-Not-Just-How.aspx

The Blue Dog coalition in the House of Representatives has often assisted Republicans in preventing the advancement or even the introduction of progressive legislation that increases government spending. Supposedly their mission is merely to avoid deficit spending by enforcing “paygo” rules (all new spending is offset with other program cuts or with new revenues), but all too often they seem to not only support elimination of deficit spending, but also the policy of “no new taxes.” It appears that they are not only concerned about deficits, but they also seem to want to avoid an increase in the size of the federal budget.
Now Sen. Evan Bayh and fifteen of his colleagues have decided to establish a Blue Dog-type coalition in the Senate. In an obvious effort to wield more power from the middle, they “are joined by a shared commitment to pursue pragmatic, fiscally sustainable policies across a range of issues, such as… health care reform…” Ouch!
Although most observers of the Washington political scene believe that the make or break on comprehensive health care reform will occur in the Senate, there are enough Blue Dogs in the House to not be discounted as major players since they could side with the Republicans if new taxes are used to comply with paygo.
But look at what has happened in the Senate. The moderate Democrats are no longer passive observers (not that they ever really were). Now with their newfound power, the battle for cloture has shifted. Instead of Democrats simply requiring one or two Republican votes to invoke cloture, they must also meet the demands of these sixteen Senate Blue Dog look-alikes. The Republicans now not only have one vote to spare on preventing cloture, they also have a very large buffer in the Democratic Party to prevent comprehensive tax-and-spend health care reform.
There goes any adequate government option to the private plans – “because of adverse selection, we can’t pay for it.” There goes adequate subsidies for private plans for average-income Americans – “without new taxes, we can’t pay for it.” There goes adequate regulatory oversight for the private plans – “unless we have high deductibles and stripped down benefits, the people can’t pay for the plans.”
Single payer would provide the Blue Dogs with the reform they want, or should want. Health care budgets would be balanced without increasing spending over our current level. They just have to understand that funneling health care dollars through our tax system is more efficient than turning them over to private insurers. They need to look at all dollars going into health care, and not just the public dollars.

Bayh howls with the Blue Dogs

Moderate Senate Dems Launch New Group to Shape Public Policy

U.S. Senator Evan Bayh
Press release
March 18, 2009

A diverse group of 16 Senate Democrats today announced the formation of a new moderate coalition that will meet regularly to shape public policy. The groupĆ¢ā‚¬ā„¢s goal is to work with the Senate leadership and the new administration to craft common-sense solutions to urgent national problems.

Leading the new group are Democratic Senators Evan Bayh of Indiana, Tom Carper of Delaware and Blanche Lincoln of Arkansas. All three leaders are honorary co-chairs of Third Way, a progressive Democratic policy group, and Senators Bayh and Carper have led the centrist Democratic Leadership Council.

In addition to Senators Bayh, Carper and Lincoln, others joining the group are Senators Mark Udall and Michael Bennet of Colorado, Mark Begich of Alaska, Kay Hagan of North Carolina, Herb Kohl of Wisconsin, Mary Landrieu of Louisiana, Joe Lieberman of Connecticut, Claire McCaskill of Missouri, Ben Nelson of Nebraska, Bill Nelson of Florida, Mark Pryor of Arkansas, Jeanne Shaheen of New Hampshire, and Mark Warner of Virginia.

… the Moderate Dems are joined by a shared commitment to pursue pragmatic, fiscally sustainable policies across a range of issues, such as deficit containment, health care reform, the housing crisis, educational reform, energy policy and climate change.

http://bayh.senate.gov/news/press/release/?id=b30d7f79-9eb1-4819-980f-9489825825ba

And…

For Blue Dogs, Health Budget Raises Questions of ‘When,’ Not Just ‘How’

By David Clarke
CQ
March 16, 2009

As the congressional budget panels prepare to write their fiscal 2010 blueprint, members of the Blue Dog Coalition of fiscally conservative Democrats want to make sure that any expansion of health care coverage is fully paid for–and that its tax or spending offsets are guaranteed to yield savings down the road.

Leaders of the 51-member coalition wrote to the House and Senate Budget committees as well as congressional leaders stating their support for President Obama’s goal of offsetting the cost of a planned health care overhaul. But the Blue Dog leaders said they do not want the savings to be achieved too far in the future if new spending in the short term is going to exacerbate already high federal deficits.

“While we agree that reforming our health care system will eventually lead to savings, it would be irresponsible to take on additional large-scale deficit spending in the short term without the ability to definitively quantify future savings,” Blue Dog leaders wrote March 13 in a two-paragraph letter.

The Blue Dogs are major boosters of the congressional “pay as you go” budget rule that requires new mandatory spending or tax cuts to be fully offset with increases in revenue or spending cuts elsewhere.

http://www.commonwealthfund.org/Content/Newsletters/Washington-Health-Policy-in-Review/2009/Mar/Washington-Health-Policy-Week-in-Review-March-23-2009/For-Blue-Dogs-Health-Budget-Raises-Questions-Of-When-Not-Just-How.aspx

Comment:

By Don McCanne, MD

The Blue Dog coalition in the House of Representatives has often assisted Republicans in preventing the advancement or even the introduction of progressive legislation that increases government spending. Supposedly their mission is merely to avoid deficit spending by enforcing “paygo” rules (all new spending is offset with other program cuts or with new revenues), but all too often they seem to not only support elimination of deficit spending, but also the policy of “no new taxes.” It appears that they are not only concerned about deficits, but they also seem to want to avoid an increase in the size of the federal budget.

Now Sen. Evan Bayh and fifteen of his colleagues have decided to establish a Blue Dog-type coalition in the Senate. In an obvious effort to wield more power from the middle, they “are joined by a shared commitment to pursue pragmatic, fiscally sustainable policies across a range of issues, such as… health care reform…” Ouch!

Although most observers of the Washington political scene believe that the make or break on comprehensive health care reform will occur in the Senate, there are enough Blue Dogs in the House to not be discounted as major players since they could side with the Republicans if new taxes are used to comply with paygo.

But look at what has happened in the Senate. The moderate Democrats are no longer passive observers (not that they ever really were). Now with their newfound power, the battle for cloture has shifted. Instead of Democrats simply requiring one or two Republican votes to invoke cloture, they must also meet the demands of these sixteen Senate Blue Dog look-alikes. The Republicans now not only have one vote to spare on preventing cloture, they also have a very large buffer in the Democratic Party to prevent comprehensive tax-and-spend health care reform.

There goes any adequate government option to the private plans – “because of adverse selection, we can’t pay for it.” There goes adequate subsidies for private plans for average-income Americans – “without new taxes, we can’t pay for it.” There goes adequate regulatory oversight for the private plans – “unless we have high deductibles and stripped down benefits, the people can’t pay for the plans.”

Single payer would provide the Blue Dogs with the reform they want, or should want. Health care budgets would be balanced without increasing spending over our current level. They just have to understand that funneling health care dollars through our tax system is more efficient than turning them over to private insurers. They need to look at all dollars going into health care, and not just the public dollars.

Real life medical debt bankruptcies

Bankruptcy filings soared in 2008

By Darrell Smith
The Sacramento Bee
March 17, 2009
Bankruptcy filings in Sacramento and the Central Valley continue to soar as weary residents seek relief from the grip of foreclosures and rising unemployment.
More than 31,000 personal and business bankruptcy petitions were filed in the Eastern District of the U.S. Bankruptcy Court in 2008, an increase of 79 percent over 2007’s filings, according to a report released by the federal court.
The caseload is such that callers to the U.S. Bankruptcy Court in Sacramento are greeted with a message that says clerical staff are too busy to speak with them.
“We have never experienced increases with the number of percent we’re seeing,” said Richard Heltzel, clerk at the U.S. Bankruptcy Court for the Eastern District of California, based in Sacramento.
“With unemployment comes the loss of health insurance – so many of our bankruptcies are triggered by uninsured health care costs,” Heltzel said. “I expect to see close to 40,000 cases this year.”
http://www.sacbee.com/1089/story/1707863.html

Landmark studies have confirmed beyond any doubt that medical debt is a significant contributor to personal bankruptcy. Yet the opponents of comprehensive reform continue to challenge the data. In the report of John Goodman and his colleagues discussed in yesterday’s message, they stated, “Well-designed economic studies have found no statistical link between bankruptcies and health problems.”
Richard Heltzel, clerk at the U.S. Bankruptcy Court for the Eastern District of California, is not a health policy wonk. His only qualification is that he sees the health care costs listed in the personal bankruptcy filings.
Medical debt is a very real problem, faced by very real people, and it really does contribute to personal bankruptcy. Fortunately, most in Washington seem to understand that now, even if they disagree on what we are going to do about it. We can tell them how this problem can be eliminated, but they are still rejecting our advice, preferring instead to ensure the solvency of the private insurance industry.

Real life medical debt bankruptcies

Bankruptcy filings soared in 2008

By Darrell Smith
The Sacramento Bee
March 17, 2009

Bankruptcy filings in Sacramento and the Central Valley continue to soar as weary residents seek relief from the grip of foreclosures and rising unemployment.

More than 31,000 personal and business bankruptcy petitions were filed in the Eastern District of the U.S. Bankruptcy Court in 2008, an increase of 79 percent over 2007’s filings, according to a report released by the federal court.

The caseload is such that callers to the U.S. Bankruptcy Court in Sacramento are greeted with a message that says clerical staff are too busy to speak with them.

“We have never experienced increases with the number of percent we’re seeing,” said Richard Heltzel, clerk at the U.S. Bankruptcy Court for the Eastern District of California, based in Sacramento.

“With unemployment comes the loss of health insurance – so many of our bankruptcies are triggered by uninsured health care costs,” Heltzel said. “I expect to see close to 40,000 cases this year.”

http://www.sacbee.com/1089/story/1707863.html

Comment:

By Don McCanne, MD

Landmark studies have confirmed beyond any doubt that medical debt is a significant contributor to personal bankruptcy. Yet the opponents of comprehensive reform continue to challenge the data. In the report of John Goodman and his colleagues discussed in yesterday’s message, they stated, “Well-designed economic studies have found no statistical link between bankruptcies and health problems.”

Richard Heltzel, clerk at the U.S. Bankruptcy Court for the Eastern District of California, is not a health policy wonk. His only qualification is that he sees the health care costs listed in the personal bankruptcy filings.

Medical debt is a very real problem, faced by very real people, and it really does contribute to personal bankruptcy. Fortunately, most in Washington seem to understand that now, even if they disagree on what we are going to do about it. We can tell them how this problem can be eliminated, but they are still rejecting our advice, preferring instead to ensure the solvency of the private insurance industry.

Numbers work for single-payer care

By Paul Heise
Lebanon Daily News
03/19/2009

President Barack Obama apparently accepts the conventional wisdom about the failure of the Clinton health-care program: That the very powerful economic and political interests (remember Harry and Louise) that roused the country’s fear of socialism to block Hillary-care will again be able to block a universal, single-payer system. So Obama isn’t even going to try.

Is he right to concede this point? That depends. First, is the public perception of a single-payer system really that bad, and is the cost of wiping out the private insurance companies really economically and politically intolerable? The answers: no, and no.

We know that the Republican message machine is working very hard to label Obama with the dreaded socialist stigma. But the American public is aware how crazy that Republican claim is. Only a couple of months ago the Bush administration nationalized half the banking system without hesitating for a moment. So that ploy is backfiring.

The polls show that message is being seen for what it is, an admission that the right wing has no constructive ideas and is reduced to negative smear tactics at the Rush Limbaugh level.

The Obama administration knows this and is making decisions based on that fact. In the student-loan program, it is quite willing to cut out the private-sector middleman to make that program more efficient despite the whining complaints. The government already guarantees all the loans and would save about $4 billion per year.

Yet we have to admit that the huge savings that could come from eliminating the insurers from the health-care industry would come at the expense of a specific group of people.

That brings us to the fact that changes in government programs, instituted for the common good, often concentrate their impact on specific industries or localities. Sometimes the government compensates, i.e., pays off, the losers, and sometimes it does not. Eminent domain constitutes the most common such compensation.

In 1960, when trade liberalization was being considered, President John Kennedy said: “(T)here is an obligation to render assistance to those who suffer as a result of national trade policy.”

The Trade Adjustment Assistance Program was then instituted and has for years assisted workers, firms and communities that were adversely affected by increased imports. In the present day, the president’s stimulus package, The American Recovery and Reinvestment Act of 2009, expanded the coverage and enhanced the benefits of this program.

Change the word “trade” to “health-care” in Kennedy’s statement, and it is applicable to implementation of a single-payer health-care system.

The medical-insurance carriers administer benefits of approximately $356 billion with 450,000 people and a payroll of $22 billion. Compare that with the Social Security Administration, which administers benefits of $700 billion with 80,000 people and total administrative costs of $10.5 billion.

No harm would come to the medical care of the American people by ending the role of the insurance companies. Most of that payroll cost, and other administrative costs, are employed largely in shuffling claims and determining how to deny benefits, tasks that would disappear under a single-payer system. Virtually everything that the medical insurance carriers do constitutes a make-work project.

The general question of compensating the economic losers, in effect buying them off, is a legitimate economic and moral issue that is not settled. What do we owe people when their lives are affected adversely by government policy? Conversely, we do not expect specific winners to pay the compensation.

The question reaches from simple eminent domain to compensation for false imprisonment to paying off trade or health-care affected firms and workers.

The question does get sticky. When western cattlemen demanded compensation for the loss of subsidized grazing rights on federal land, they were rebuffed because it meant that welfare recipients likewise deserved compensation for lost benefits.

The moral question of whether or not to buy off the medical-insurance carriers and their employees is an unsolved political issue that we can only fight about. The economic question, on the other hand, can be settled rather simply by doing the arithmetic. The example of the rest of the world shows you can get far more medical care for far less money without insurance companies.

Single payer is still the most efficient way even if you pay off the insurance carriers and their employees. And that would be the bold change that Obama promised us.

A resident of Mt. Gretna, Heise holds a Ph.D. in economics and is professor emeritus of economics at Lebanon Valley College. His column appears every other Thursday. He can be reached at his blog:

paulheise.blogspot.com

http://www.ldnews.com/ci_11949767

Why the media blackout on single payer?

Birmingham News
Letter to the Editor
Wednesday, March 18, 2009

It’s amazing that single-payer insurance (national health insurance) is barely covered in the media right now. With President Barack Obama’s focus on both health care and the economic crisis, you’d think information about the most cost-efficient way to design our health care system would be front and center. Add the fact 60 percent of all Americans and 59 percent of physicians favor national health insurance, and you might have to wonder whether private insurance and drug companies are now running the media. We already know they run Congress.

They’ve showered U.S. Sen. Max Baucus, D-Montana, with $413,000 since 2005 in the name of “campaign contributions.” And now, it’s no surprise Baucus is pushing health care reform that mandates Americans buy private insurance.

The truth is, we can save $350 billion annually by removing private insurance companies and going to a single-payer system. And, we wouldn’t be starting from scratch since our Medicare system is already national health insurance for those 65 and older.

Prestigious medical groups, religious organizations, labor unions, economists and others say national health insurance is the way to go. Obama is now asking for input on his new Web site, www.healthreform.gov, before additional health care legislation is written. Submit your ideas and demand national health insurance – as part of the real change you voted for last November.

Linda A. Haynes
Community outreach coordinator
Huntsville chapter of Health Care for Everyone – Alabama
Huntsville

It was wrong to link forum access to cash

Editorial
Des Moines Register
March 19, 2009

The White House selected Iowa as one of only five states to host a regional forum on reforming health care, a top priority for President Barack Obama. On Monday, hundreds of people will gather at the Polk County Convention Center in Des Moines. Such a gathering offers “an opportunity for Americans from all over the country to voice their concerns and ideas about reforming our health-care system,” according to the White House’s health-reform Web site.

Iowa had a different plan, offering tickets and recognition to those willing to pay thousands of dollars to be a sponsor. Up until yesterday anyway – when the Register started asking questions. The episode offers a peek at the cozy relationship between government and powerbrokers – and how that typically ensures the powerful will get their seat at the table, while ordinary Americans may get sidelined.

Last week, Gov. Chet Culver’s office announced that tickets were to be distributed by a lottery. Tickets were expected to be hard to come by, and some health-care advocates voiced concerns that they wouldn’t get to attend. With the sponsorship plan, that wasn’t going to be a worry for those forking over big bucks.

In an e-mail obtained by the Register, Kate Walton, Culver’s top health-care adviser, offered a “sponsorship opportunity” to recipients including AARP, the Federation of Iowa Insurers and the Iowa Hospital Association to “help defray the cost of the event.”

“We are hoping sponsors could participate at the $5,000 level, but are certainly open to discussion if that amount is in excess of what you are able to do, but you would still like to be included as a sponsor. Event sponsors will be visibly acknowledged at the event, so we would appreciate you sharing your organization’s logo if you choose to participate,” according to the e-mail.

The message: Pay up and you can have a space at the table and special recognition at the event. If you can’t pay $5,000, maybe we can negotiate.

Phil Roeder, Culver’s communications director, told the Register the White House had said the governor’s office could use sponsorships to defray expenses. But when initially contacted Wednesday morning, a White House spokeswoman said she didn’t know about the plan. By noon, she had released a brief statement that there would be “no outside sponsorship of the event.”

It’s no secret wealthy and powerful special interests dominate health-care discussions in this country. But the governor’s office essentially extended an invitation for them to do so – and to send their logo for a little extra publicity. Iowa Health System, the state’s largest hospital system, told the Register it had paid the state $5,000 to be a sponsor.

Now Iowa Health and any other takers will be getting refunds. And any tickets that had been reserved for donors should be distributed through the lottery.

It shouldn’t take the White House – or the newspaper – to point out what a bad idea this was. Essentially selling tickets and recognition for such a forum undermines the very intent of the gathering. Obama has said he wants everyone bringing ideas – not just those who can afford to buy a seat.

Additional Facts

A reminder about ethics

The e-mail from state government asking for donations in exchange for tickets and recognition also included an attachment.

It begins: “The Iowa White House Forum on Health Reform is made possible by generous donations from people like you. It is especially important for individuals and corporations to show their commitment to health-care reform through a monetary gift.”

What?

Donations from “people like you” (aka those who can give thousands of dollars) didn’t make the forum possible. President Barack Obama did, by saying the forums would be conducted. Monday’s gathering was going to happen with or without such donations.

The rest of the attachment reminded recipients that state law requires public disclosure of such donations to an ethics and campaign disclosure board.

Perhaps some staffers in state government need a refresher course in the ethic that money shouldn’t buy special access to public-policy discussions.