PNHP

Forum to highlight Vt. health successes

Forum to highlight Vt. health successes

Single-payer advocates fight preference for incremental changes

By Nancy Remsen
Burlington Free Press
March 15, 2009

For 90 minutes Tuesday afternoon, 400 people will vie for time to share an idea or concern they have about health care during the second of five regional health reform forums sponsored by the Obama White House.

Critics say that’s hardly sufficient time to take the public’s pulse on health reform. Some will rally outside the Davis Center at the University of Vermont, where the forum takes place, to demonstrate support for publicly financed health care. It’s an idea they say is getting short shrift from President Barack Obama as he assembles a health reform plan.

Others say this forum signals the president’s new approach to developing health reform policy and a recognition that Vermont is home to some good reform ideas.
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“He is reaching out to states and regions that have something to offer,” said Republican Gov. Jim Douglas, who will co-host the forum with Gov. Deval Patrick, a Democrat from Massachusetts. The first forum was held last week in Michigan. Others are planned in Iowa, California and North Carolina.

Greg Marchildon, state director of AARP in Vermont, is among the 400 people invited to attend.

“Of all of the five, this one matters most,” he said, “because Vermont, Massachusetts and Maine are where things have been done over the past 10 years.”

Marchildon lists Vermont’s accomplishments in chronic-care management, progress toward development of an electronic network for medical information and creation of Catamount Health, which showed how to subsidize private health insurance and expand coverage to more uninsured people.

“Vermont is an unquestioned national leader,” Marchildon said. “Some very important components of what Vermont has done are getting close attention from the Obama administration and in Congress.”

Dr. Deb Richter of Montpelier, a family practice physician and advocate for a publicly financed health care system, has also been invited. She’ll go in, but first will join the rally outside.

“I’ll bring the message from the people outside,” she said. “Our intent is to show the amount of support for publicly financed health care.”

While single-payer advocates such as Richter have been invited to this and other forums, she said White House officials have indicated a total overhaul of the health care financing system they advocate isn’t under consideration.

“We want this discussed as a serious option,” Richter said. “This problem is too big for small fixes.”

Another forum participant, Dr. Paul Jarris, warns, “If we try to go for the perfect, we will end up with nothing.” Jarris is a former commissioner of health in Vermont who now serves as executive director of the Association of State and Territorial Health Officials in Washington, D.C. “Let’s just do something.”

“Obama is bringing people around the table and saying there are many good ideas. Let’s see what is achievable,” Jarris explained. He contrasted this with the Clinton administration’s decision to roll out a completed plan. “It is a fundamentally different approach and far more likely to succeed,” Jarris said.

Before leaving Vermont in 2006, Jarris helped launch the Blueprint for Health, one of the programs attracting national attention. The Blueprint focuses on promoting public health through means as diverse as advocating for walking paths, teaching patients how to stay well and manage illnesses, and transforming medical practices so doctors focus more on prevention rather than after-the-fact treatment.

Jarris said he met Friday with Nancy-Ann DeParle, director of the White House Office of Health Reform, who will attend Tuesday’s forum in Burlington. “She is very interested in the Blueprint and how to make it a national model.”

The Douglas administration sees the forum as the start of a national health reform conversation. Douglas said he would have a chance to share more details about Vermont’s successes in April when he and other forum hosts meet to report on the proceedings.

Douglas noted he has already had conversations with Obama about the president’s health reform concerns and areas of interest. “I really think what we have in place here is quite consistent with his goals,” Douglas said.

Contact Nancy Remsen at 578-5685 or nremsen@bfp.burlingtonfreepress.com. To get Free Press headlines delivered free to your e-mail, sign up at www.burlingtonfreepress.com/newsletters

How to Pay Less for More Health Care

New York Times
Letters
Published: March 14, 2009

To the Editor:

Re “A Start on Health Care Reform” (editorial, March 8):

Yes, the administration has “ducked some of the most contentious issues.” President Obama has said he wants “ideas that work.” But any plan that retains the private, multipayer insurance system that is the source of our out-of-control costs cannot possibly work. And a plan in which people keep the insurance they have will not help the growing number of Americans who find they are underinsured.

The Congressional Budget Office has shown that a mandate to purchase insurance will not lead to universal coverage. It has shown, as well, that neither information technology nor chronic disease management nor comparative effectiveness analysis — all of which the administrationis counting on — will significantly curb costs. Only a unified public plan, based on our successful experience with Medicare, can truly address the problems of the health care system.

Leonard Rodberg
Flushing, Queens, March 8, 2009

The writer is research director of the New York metro chapter of Physicians for a National Health Program and a professor of urban studies at Queens College, CUNY.

Fair-Weather Reformers

Washington Post
Letter to the Editor
Thursday, March 12, 2009; Page A18

The pharmaceutical and insurance lobbies have offered early support for President Obama’s effort to reform health care [“In Health Plan, Industry Sees Good Business,” front page, March 5]. Judging by the measures discussed, they have little reason to oppose it.

Mr. Obama and many legislators favor incremental changes such as increasing Medicaid drug rebates and expanding the use of health information technology, measures that do nothing to trim the massively wasteful administrative spending associated with private insurance. Subsidizing expensive and inadequate health insurance or requiring that Americans purchase it would be a windfall to the private insurance industry, as Medicare Part D is to the pharmaceutical industry.

However, the moment the bottom line of these special interests is threatened, the reception will not be so rosy. Karen Ignagni, president and chief executive of the lobby group America’s Health Insurance Plans, has fired warning shots over proposed cuts to Medicare Advantage. With this program, private insurers receive a government subsidy of 14 percent over the costs of regular Medicare while selectively enrolling seniors with less costly illnesses and pocketing the difference.

If we truly want to reduce costs and expand health-care access to all Americans, we must eliminate private insurance and move to a single-payer system of financing. But we must be prepared to fight the special interests that won’t see this as “good business.”

James Floyd
Research Fellow
Public Citizen
Washington

Health care now rationed by ability to pay

By Bill Roy
Topeka Capital-Journal
March 13, 2009

Some claim universal medical care would open the floodgates of use and cost of medical care, and the government would soon be in the business of overtly rationing care. That’s pretty frightening unless we look objectively at how we are now rationing medical care, and how badly our results compare with nations with universal coverage.

Today, only America among advanced nations rations medical care by ability to pay. And the results are horrendous except for rich Americans, many of whom are trying to scare you out of universal medical care provided on the basis of need, not price. They like what they have.

No one disputes that this nation spends at least 1 1/2 times per capita more for medical care than any other nation. Some studies indicate we do not get more medical care, we just pay more for what we get.

It’s hard to have missed the numbers: $8,000 per capita this year; $15,000 a year for a family policy that may include deductibles and co-pays; annual increases usually twice the rate of increase of the gross domestic product; and government expenditures similar to nations with universal medical care.

Today, one of $6 goes for medical care and salaries of for-profit health insurance executives.

Our system of rationing medical care by ability to pay costs us money and lives. No other civilized nation requires a ransom to access medical care.

A 2002 study by the Institute of Medicine of the National Academy of Science estimates conservatively that 18,000 people died in 2000 because they did not have health insurance. The IOM further concluded “137,000 people died from 2000 through 2006 because they lacked health insurance, including 22,000 people in 2006.”

Rationing medical care by price is deadly for the poor, but not for the rich. Health and Human Services studies indicate the rich live on average 4½ years longer than the poor in America. This difference is widening as incomes have widened more rapidly since Reagan and the rich won America’s class war.

Our nation, which is the only industrial nation in the world that rations medical care by price, ranks 41st in the world in life expectancy. We lose more young lives too.

America lags in newborn mortality and children who die before age 5. Forty-four nations have lower death rates before age 5 than we do.

One can only conclude our medical care rationing system is both very costly and very deadly, especially for poorer Americans. It would be difficult not to do better with any universal care system that does not ration care by ability to pay.

Nations where individual states plan and administer medical care systems can work well, and could approach utopia if they had as much money as we spend. Federal Medicare worked very well until Republicans and their fellow treasury-raiders legislated Medicare D and Medicare Advantage, programs set up to favor for-profit providers, not patients or taxpayers.

How well and at what price states could deliver medical care will depend on how well-structured their delivery systems are and the availability of proper personnel. With resources now available in America, waiting lines or delayed services would be the exception.

No medical care system can do everything for everyone everywhere.

Services are and will be available in Topeka that are not available in Hays, and services will be available in Hays that are not available in Goodland. But movement through the system, whether physical or administrative, can be planned, facilitated, and markedly superior to our present non-system.

In sum, we can have a rational system and use it to its optimum as needed. Any covert rationing would come about because of limitations of personnel or physical facilities, which at current expenditure rates would be highly unlikely.

Beware of those who feign fear of medical care rationing in any universal system, but seem unaware of the death-dealing results we have in our present system of rationing by ability to pay.

Dr. Bill Roy is a retired physician and former member of Congress. He has a law degree and lives in Topeka. He may be reached at wirroy@aol.com.

President Bill Clinton on single payer

Bill Clinton on Health Care Reform

CNN Larry King Live
March 11, 2009
Dr. Sanjay Gupta, CNN chief medical correspondent: Tonight, Bill Clinton exclusive on the nightmare that keeps 45 million Americans from seeing a doctor — the health care disaster.
****
GUPTA: All right. Let’s drill down specifically on something you said earlier. When it comes to sort of creating these silos of health care reform — you have sort of single payers and more governmental involvement on one send — one end, free market involvement solely on the other end. Single payer never has really caught traction politically. Is it politically unpalatable or is it a bad idea?
Bill CLINTON: Well, I think it’s more politically unpalatable than it is a bad idea, because single payer is not socialized medicine. Canada has a single payer system and a private health care provider system. Our single payer systems are Medicare and Medicaid.
GUPTA: Sure.
CLINTON: And Medicare is quite popular.
The good thing about single payer is the administrative costs are quite low. We probably waste $200 billion a year between the insurance administrative costs, the doctors and other health care providers’ administrative costs and employers’ administrative costs in health care that we would not waste if we had any other country’s system.
On the other hand, if you look at the experience of Germany, France, Japan — that don’t have pure single payer systems, they have more mixed systems — their costs are actually slightly lower overall than Canada’s. So there’s something to be said for having a mixed system if you can get the administrative costs down, because then the systems have enough competition in them to try to restrain costs and it’s not all up to the political bodies.
In Canada, because it’s all financed through the government, it’s more difficult sometimes for the politicians to say no than for just the regular management of the health care system to cut the costs.
So I think you can have a mixed system. If you look at the French system, which scores very high on every international measure…
GUPTA: Yes.
CLINTON: …it’s mostly publicly financed, but there’s enough private in there that there’s some tension that’s creative and positive.
GUPTA: Do you think there is a degradation quality of care with a single payer system? Is that a concern? Should that be a concern?
CLINTON: Well there’s no evidence of that in Canada that I’m aware of, except for excessive delays, which they always try to come to grips with. The British, you know, do have a completely government-run system, but they allow people who can afford it to get outside the system. And they’ve also started running hospitals almost like charter schools in America, that is, they have these trust hospitals that perform very well and therefore they’re given more control over setting their priorities, specializing and cutting delays.
There are all kinds of different ways to do it. But first, you do have to cover everybody. And then you have to stop people from gaming the system. There’s a lot of gaming going on now in the American system so that we spend more than anybody else and get loss for it.
I think that once you get the universal coverage, I think the health insurers then could play a more positive role than they do now, which is often involved in — you know, they make a lot of money through saying no and sort of the inordinate paperwork burdens that are put on doctors and hospitals and other providers.
GUPTA: What is it about the insurance industry that you just brought up? They tried to scuttle the health care reform plan of ’93. Now they’re saying we also believe in universal health care. A politically tactile question, I guess, are you buying it? Do you think they’re being honest?
CLINTON: I think some of them really do want it. Yes. If you look at their new organization, the person who heads it came out of a progressive background and favored, as a philosophical matter, coverage.
Secondly, I think they now understand that, in terms of the health of America and the well-being of our economy, we can’t go on basically giving them more and more dollars every year — the insurance industry — and getting people sicker and sicker and leaving more and more people behind.
I mean look at all the healthcare problems. The child obesity problem, which is my obsession, is the most glaring manifestation of a system that treats sick people and doesn’t keep people well. And that’s one where, I think, by the way, we can get broad bipartisan support on trying to — to do more on wellness. And that will save money.
I think the insurance industry realizes that they — a lot of the smarter ones realize that they could kill the goose that laid the golden egg here, that America can no longer go on spending more money and getting less for it and having all this money go to them and that they can make a lot of money and do well by making us healthier at a more affordable price.
http://transcripts.cnn.com/TRANSCRIPTS/0903/11/lkl.01.html

Former President Bill Clinton makes two very important points here. (1) Single payer dramatically reduces administrative waste, and he implies that it would be popular, as is Medicare now. (2) The private insurers “make a lot of money through saying no,” and “we can’t go on basically giving them more and more dollars every year — the insurance industry — and getting people sicker and sicker and leaving more and more people behind.” Single payer is good; private insurers are bad.
In contrast, his comments suggesting that private insurers could play a beneficial role in a system of universal coverage are not supported by the facts.
He says that private plans in other nations provide competition which helps to lower costs below that of Canada. Wrong. First, our experience with the Medicare Advantage plans demonstrates that competing private plans increase costs instead of decreasing them. Second, there are many factors that influence health care spending besides the structure of the financing system.
According to the OECD, “Whatever the role played in a health system, private health insurance has added to total health expenditure.” According to the WHO, “Evidence shows that private sources of health care funding are often regressive and present financial barriers to access. They contribute little to efforts to contain costs and may actually encourage cost inflation.” Spending in the nations cited by President Clinton would be even lower if they had a pure single payer system. (qotd 8/21/07)
As for his optimism for a beneficial role of private insurers in our future, he had to take that one from his wish list. It’s been on all of our wish lists for decades. Isn’t it time to quit wishing, accept the fact that they’re incorrigible, and move on with our own single payer national health program?

President Bill Clinton on single payer

Bill Clinton on Health Care Reform

CNN Larry King Live
March 11, 2009

Dr. Sanjay Gupta, CNN chief medical correspondent: Tonight, Bill Clinton exclusive on the nightmare that keeps 45 million Americans from seeing a doctor — the health care disaster.

****

GUPTA: All right. Let’s drill down specifically on something you said earlier. When it comes to sort of creating these silos of health care reform — you have sort of single payers and more governmental involvement on one send — one end, free market involvement solely on the other end. Single payer never has really caught traction politically. Is it politically unpalatable or is it a bad idea?

Bill CLINTON: Well, I think it’s more politically unpalatable than it is a bad idea, because single payer is not socialized medicine. Canada has a single payer system and a private health care provider system. Our single payer systems are Medicare and Medicaid.

GUPTA: Sure.

CLINTON: And Medicare is quite popular.

The good thing about single payer is the administrative costs are quite low. We probably waste $200 billion a year between the insurance administrative costs, the doctors and other health care providers’ administrative costs and employers’ administrative costs in health care that we would not waste if we had any other country’s system.

On the other hand, if you look at the experience of Germany, France, Japan — that don’t have pure single payer systems, they have more mixed systems — their costs are actually slightly lower overall than Canada’s. So there’s something to be said for having a mixed system if you can get the administrative costs down, because then the systems have enough competition in them to try to restrain costs and it’s not all up to the political bodies.

In Canada, because it’s all financed through the government, it’s more difficult sometimes for the politicians to say no than for just the regular management of the health care system to cut the costs.

So I think you can have a mixed system. If you look at the French system, which scores very high on every international measure…

GUPTA: Yes.

CLINTON: …it’s mostly publicly financed, but there’s enough private in there that there’s some tension that’s creative and positive.

GUPTA: Do you think there is a degradation quality of care with a single payer system? Is that a concern? Should that be a concern?

CLINTON: Well there’s no evidence of that in Canada that I’m aware of, except for excessive delays, which they always try to come to grips with. The British, you know, do have a completely government-run system, but they allow people who can afford it to get outside the system. And they’ve also started running hospitals almost like charter schools in America, that is, they have these trust hospitals that perform very well and therefore they’re given more control over setting their priorities, specializing and cutting delays.

There are all kinds of different ways to do it. But first, you do have to cover everybody. And then you have to stop people from gaming the system. There’s a lot of gaming going on now in the American system so that we spend more than anybody else and get loss for it.

I think that once you get the universal coverage, I think the health insurers then could play a more positive role than they do now, which is often involved in — you know, they make a lot of money through saying no and sort of the inordinate paperwork burdens that are put on doctors and hospitals and other providers.

GUPTA: What is it about the insurance industry that you just brought up? They tried to scuttle the health care reform plan of ’93. Now they’re saying we also believe in universal health care. A politically tactile question, I guess, are you buying it? Do you think they’re being honest?

CLINTON: I think some of them really do want it. Yes. If you look at their new organization, the person who heads it came out of a progressive background and favored, as a philosophical matter, coverage.

Secondly, I think they now understand that, in terms of the health of America and the well-being of our economy, we can’t go on basically giving them more and more dollars every year — the insurance industry — and getting people sicker and sicker and leaving more and more people behind.

I mean look at all the healthcare problems. The child obesity problem, which is my obsession, is the most glaring manifestation of a system that treats sick people and doesn’t keep people well. And that’s one where, I think, by the way, we can get broad bipartisan support on trying to — to do more on wellness. And that will save money.

I think the insurance industry realizes that they — a lot of the smarter ones realize that they could kill the goose that laid the golden egg here, that America can no longer go on spending more money and getting less for it and having all this money go to them and that they can make a lot of money and do well by making us healthier at a more affordable price.

http://transcripts.cnn.com/TRANSCRIPTS/0903/11/lkl.01.html

Comment:

By Don McCanne, MD

Former President Bill Clinton makes two very important points here. (1) Single payer dramatically reduces administrative waste, and he implies that it would be popular, as is Medicare now. (2) The private insurers “make a lot of money through saying no,” and “we can’t go on basically giving them more and more dollars every year — the insurance industry — and getting people sicker and sicker and leaving more and more people behind.” Single payer is good; private insurers are bad.

In contrast, his comments suggesting that private insurers could play a beneficial role in a system of universal coverage are not supported by the facts.

He says that private plans in other nations provide competition which helps to lower costs below that of Canada. Wrong. First, our experience with the Medicare Advantage plans demonstrates that competing private plans increase costs instead of decreasing them. Second, there are many factors that influence health care spending besides the structure of the financing system.

According to the OECD, “Whatever the role played in a health system, private health insurance has added to total health expenditure.” According to the WHO, “Evidence shows that private sources of health care funding are often regressive and present financial barriers to access. They contribute little to efforts to contain costs and may actually encourage cost inflation.” Spending in the nations cited by President Clinton would be even lower if they had a pure single payer system. (qotd 8/21/07)

As for his optimism for a beneficial role of private insurers in our future, he had to take that one from his wish list. It’s been on all of our wish lists for decades. Isn’t it time to quit wishing, accept the fact that they’re incorrigible, and move on with our own single payer national health program?

Attendees at White House forum voice health care reform ideas

By Jay Greene
Crain’s Detroit Business
Mar. 12, 2009

Reducing costs and improving health care quality through comprehensive reform can make the struggling Detroit 3 auto industry more competitive with foreign companies, said several speakers Thursday at a White House health care reform forum in Dearborn.

Health care costs add $1,200 to $1,600 to the price of every car made in Detroit, making reform a competitive necessity, said Michigan Gov. Jennifer Granholm, who helped moderate the two-hour forum held at the Ford Conference and Event Center.

The forum — the first of five to be held nationally over the next month — was also led by Wisconsin Gov. Jim Doyle and Melody Barnes, director of the White House Domestic Policy Council.

“We spend far more in the U.S. for health care than any other country and we have lower outcomes,” Granholm said. “Health care is an issue that we must address if we want to compete globally.”

More than 25 attendees spoke about their own experiences with the health care system or to express suggestions on how to improve the health care delivery system.

Absent from the discussion, however, was how to pay for expanding access and making health care insurance more affordable.

Barnes said savings can come from adopting electronic medical records, reducing costly chronic diseases through early detection with prevention and wellness programs, and using evidence-based medical treatments.

Congressmen John Dingell Jr., D-Dearborn, and John Conyers, D-Detroit, agreed reforming the health care industry is long overdue.

Conyers, who has introduced single-payer legislation, H.R. 676, said improving access to care is complex, “but not as hard as people may think.”

Dingell, who said his father introduced the nation’s first health care reform plan in 1948, said “health care is a right, not a privilege.”

Dr. Jim Mitchiner, an emergency physician from Clawson who supports a single-payer system, said health care insurance should not be linked to a job that can be lost or taken away.

“I see people every day who have lost their job and have no insurance. It makes no sense. You lose a job and they don’t take away your life or auto insurance policy,” Mitchiner said. “I have lost complete faith in the private insurance industry.”

Under single-payer, private insurance companies would be abolished and health care would be financed through the government. The private delivery system of hospitals, doctors and other providers would be maintained.

Addressing the half dozen people who also spoke out in favor of a single-payer system, Barnes said President Barack Obama wants to reach a pragmatic solution to health care reform, one that can be achieved this year.

“The president believes we need to be building on our current health care system (that maintains the current private health insurance industry),” Barnes said. “It is the most expeditious way to go.”

But Barnes said if Obama could create a health care system from scratch, the president would go with a single-payer system.

“We believe in the employer-based system, but we need a public-private partnership,” said Dan Loepp, CEO of Blue Cross Blue Shield of Michigan.

Unlike 15 years ago when the insurance industry strongly opposed President Clinton’s effort to reform health care, Loepp said the industry now favors reform.

“We support guarantee issue with an individual mandate (to be covered with health insurance),” Loepp said.

But illustrating one of the flaws in the current health insurance system, Adrian Campbell-Montgomery, a mother of two, described how Blue Cross in 2004 denied payment to a Southeast Michigan hospital where she was treated for cancer.

“I was 22-years-old and needed surgery. I got a bill for $8,000 that I couldn’t pay,” Campbell-Montgomery said. “Blue Cross denied payment because there were recommendations you needed to be 26 years or older for that kind of surgery.”

Two weeks ago, Campbell-Montgomery received more bad news. She was diagnosed with ovarian cancer.

“I already owe $10,000 for that. I am trying to get Medicaid. Where does this end? You have to stop denying people,” she said.

Sister Mary Ellen Howard, executive director of the Cabrini Clinic in Detroit, asked who in the audience is going to help Campbell-Montgomery. Cabrini is the nation’s oldest free clinic.

“I am mad. Who is going to help her? Mr. Loepp?” Howard said. “People are dying. We need to do something about it.”

Before Loepp could respond, however, Mike Duggan, CEO of Detroit Medical Center, offered to take care of Campbell-Montgomery.

“We will take care of you at DMC,” said Duggan, noting that up to 25 percent of the Medicaid recipients in Michigan receive some care at DMC.

“The system is crazy. Hospitals close in the city. It is more profitable to go elsewhere,” he said. “A lot of things need to be done to (reduce) costs.”

Ricardo Guzman, CEO of Community Health and Social Services Center in Detroit, said the five federally qualified health centers in Detroit need funds to rebuild their aging facilities. CHASS has three clinic locations.

“Our mission is to provide services to the uninsured and under-insured,” Guzman said. “We keep people out of the emergency department and we save insurers money. We need money for infrastructure. Our buildings are falling apart.”

Nurses should be at the table when the health care reform legislation is drafted, said Teresa Cervantez Thompson, dean of nursing and health at Madonna University in Livonia.

“Nursing should be the foundation of reform,” she said. “We need more coordination and case management of care.”

VT: Single-payer advocates plan to protest health care forum

By DANIEL BARLOW
Rutland Herald
March 13, 2009

MONTPELIER — Vermont doctors and other medical professionals who support a single-payer health care system plan to protest next week’s Burlington health care reform forum organized by President Barack Obama’s administration.

Deb Richter of the organization Vermont Health Care for All said Thursday that some single-payer advocates have been invited to attend the forum, moderated by Vermont Gov. James Douglas and Massachusetts Gov. Deval Patrick, but that the issue will not be seriously considered.

“It’s clear that a single-payer approach is not favored by inside the beltway politicians and the two governors headlining the event,” said Richter, a physician. “We saw the same thing with their health care event in D.C. … supporters of a single-payer system were shut out of the meeting.”

Douglas, a Republican, and Patrick, a Democrat, were handpicked by Obama earlier this month to headline the health care reform forum — one of five that will be held across the country as the new president prepares an overhaul of the system.

Douglas walks a fine line on health care reform. He vetoed a major public expansion of health care pushed by Democratic lawmakers several years ago and later compromised with the same lawmakers on the creation of Catamount Health, a public-private insurance program for the uninsured.

But next week’s forum comes at the same time as Douglas has proposed eliminating 38 Vermont Department of Health employees as part of his 2010 budget plan, including several who work on the Blueprint for Health — one of Vermont’s top health care reform efforts that Douglas is expected to promote next week.

“I find it particularly ironic you would propose to cut people in a program you are going to be bragging about next week,” House Speaker Shap Smith said.

Douglas said he hopes all such layoffs will be avoided by the union agreeing to pay cuts and other concessions.

“This is not an easy process,” said Douglas, who added that departments and agencies make recommendations about where to make cuts. “Yesterday was a very difficult one for my team.”

Christine Finley, deputy commissioner for public health, said that the potential layoffs — a couple of which may involve positions that work on the blueprint — will not weaken the state’s commitment to the program. The department is now working on how to manage those cuts if the layoffs do prove to be necessary, she said.

“The work of the blueprint is clearly a priority for the health department,” Finley said. “We have not changed our priority.”

It is hard to define how many health department workers help on the blueprint because most of those engaged in the department in helping Vermonters manage or avoid chronic diseases — from asthma work to anti-tobacco efforts — work on the blueprint in some capacity.

“It really is our effort to prevent chronic disease in the state and it cuts across what we do,” Finley said.

The single-payer demonstration will begin around noon outside of the Davis Center on the University of Vermont campus, according to Richter, and end around 1 p.m., the start time of the forum inside.

Richter said she was invited to the session earlier this week and will attend. But with a running time of 90 minutes — and an expected televised message from Obama to kick start the session — there is no way a massive overhaul of the health care industry can be debated that day, she said.

“We need a massive overhaul,” Richter said. “These Band-Aids will not work anymore.”

Richter said she expects doctors and health professionals from Massachusetts, Maine, New Hampshire, New York and Connecticut to travel to Burlington next Tuesday to participate in the demonstration.

During his weekly press conference Thursday, Douglas was surprised to hear that single-payer advocates will demonstrate outside of the forum. While he noted that Obama does not prefer the single-payer approach for this round of reforms, he said advocates with that position have been invited to the session.

“There will be single-payer advocates at the meeting,” Douglas said. “We are interested in hearing a broad range of viewpoints.”

Rebecca Deusser, the deputy press secretary for Gov. Patrick, had no comment Thursday on next week’s demonstrations or the governor’s position on single-payer health care. She said Patrick supports Obama’s approach to health care reform.

“Successful health care reform in Massachusetts has become a national model — with more than 98 percent of residents covered by health insurance,” she said in a prepared statement. “The governor looks forward to joining the discussion on how best to make quality health care available to all Americans, while containing skyrocketing costs.”

The Vermont Public Interest Research Group, a Montpelier organization that has advocated for a single-payer health care system, will be participating in next week’s forum — although they share the concerns of others that the issue will not be given a full hearing.

Susan Baker, the health care advocate for VPIRG, said the group’s ultimate goal is a single-payer system, but they recognize that an incremental approach that relies on a partnership between governments and the private insurance companies has stronger public support.

“We think it is great that people will be demonstrating outside and pushing the issue,” Baker said. “But we also believe that it will be productive to be inside and part of the discussion.”

Louis Porter contributed to this report.

daniel.barlow@timesargus.com

Single-payer is the cure

By John Nichols
Capital Times
3/10/2009

Health care reform is a vital and engaging concern for tens of millions of Americans.

But you would not have known it from Thursday’s White House Forum on Health Reform, which was so narrowly focused and uninspiring that it almost made Hillary Clinton’s bumbling efforts of the 1990s look good.

President Barack Obama sounded some of the right notes. “Now I know people are skeptical about whether Washington can bring about this change. Our inability to reform health care in the past is just one example of how special interests have had their way, and the public interest has fallen by the wayside … (But) this time, there is no debate about whether all Americans should have quality, affordable health care — the only question is, how?

Unfortunately, that is a mighty major “only question.”

And Thursday’s forum made little room for those capable of answering it.

The White House was packed with the political insiders, corporate lobbyists and a few administration-designated “everyday Americans,” who helped to illustrate the depth of the crisis that the insiders have allowed to metastasize over the past decade or so.

Only a handful of serious reformers were allowed in.

Thanks to pressure from the Leadership Conference for Guaranteed Healthcare, Physicians for a National Health Program, Unions for Single Payer Health Care and the Progressive Democrats of America, an invitation was extended to House Judiciary Committee Chair John Conyers, D-Mich., the sponsor of H.R. 676, legislation that seeks to create a single-payer insurance program, which would take profiteering out of the health care system.

Also present was Dr. Oliver Fein, President of Physicians for a National Health Program.

But right before him on the White House list of “Community Leaders and Stakeholders Expected to Attend” were the CEOs of Pfizer and Pharmaceutical Research and Manufacturers of America (PhRMA).

While the doctor’s name was missing from the speaker lists, the names of the CEOs were on it, along with representatives of the U.S. Chamber of Commerce, America’s Health Insurance Plans, the Blue Cross Blue Shield Association and the Business Roundtable.

The weight of opinion at what was supposed to be a wide-ranging discussion of health reform was — at best — on the side of tinkering with the existing for-profit system.

“Change we can believe in” was not on the agenda.

Who could have put it there?

Dr. Quentin Young, the Chicago doctor who served as the Rev. Martin Luther King Jr.’s personal physician and whose medical office cared for the Obama family, ought to be at the table. “(Single-payer) no longer is the best solution,” he says. “It’s the only solution.”

Why wasn’t Dr. Young on the speaker list?

Where was his longtime ally, Dr. Linda Farley, the Dane County physician who has been honored with the American Academy of Family Physicians Presidents Award and named the Wisconsin State Medical Society’s Physician Citizen of the Year? “Health care is a service, not a commodity,” says Farley. “Physicians must be committed to providing quality care to all the people based on their need, not on their ability to pay. (Single-payer) would allow physicians and other health care workers to concentrate on the health of patients and populations, without the hassles of excessive paperwork.”

Where, on the long list of congressional participants, was the name of U.S. Rep. Tammy Baldwin? Elected to Congress as an outspoken advocate for single-payer health care, the Wisconsin Democrat is a member of the key committee in the House that deals with health care issues — Energy and Commerce — and she has succeeded in developing bipartisan coalitions that allow for state experimentation with various reform plans. In other words, she’s a principled yet very practical player in the debate.

Baldwin should have been speaking.

The point here is not to give up on the Obama administration as a vehicle for real reform. White House forums of the sort held Thursday are “for the cameras” events that set the tone — not the policy — of an administration.

The president knows that single-payer is the right fix for what ails the American health care system.

As recently as last August, Obama told a health care forum in New Mexico: “If I were designing a system from scratch, I would probably go ahead with a single-payer system.”

The insurance industry and its allies don’t want to start from scratch and make a system that works.

They want to keep patching up a system that doesn’t work — that fails to provide care to roughly 50 million Americans, that leaves another 50 million underinsured and that is defined more by its cost overruns than its quality — so that they can keep profiteering.

Thursday’s White House sessions provided a great forum for advocates of “patching up” and “tinkering with” a broken system.

But that’s not the treatment that is needed. That’s a prescription for failure.

Obama is better positioned that any president in decades — perhaps ever — to design a system from scratch.

The special interests, corporate insiders and congressional compromisers who made the mess and fear the change won’t remind him of that fact — as Thursday’s forum so amply illustrated.

Real reformers should keep banging on the doors and demanding a place at the table.

Single-payer is not “an alternative.”

It is not one of “various treatment options.”

It is the cure.

John Nichols is the associate editor of The Capital Times.

Blog debate – PNHP versus HCAN reform strategy

Blog Debate: “An Obsolete Model”

By Tim Foley
Change.org
Health Care
March 12, 2009
This is the second day of a blog debate about what approach we should take on health care reform in 2009. Debaters are Dr. Don McCanne, a retired family physician now serving as Senior Health Policy Fellow for Physicians for a National Health Program, and Jason Rosenbaum, a writer and activist, and the Deputy Director of Online Campaigns for Health Care for America Now! Dr. McCanne will be presenting the “single-payer” point of view, and Mr. Rosenbaum will be presenting the “public competitor” point of view.
This is Dr. McCanne’s answer to the question: Is there anything valuable that private insurance brings to the table which, with far more muscular federal regulation, would enhance an American universal health care system?
Dr. McCanne: Everyone agrees that we need comprehensive reform of health care financing if we expect to slow the escalation of costs, while improving allocation of our resources. To achieve these goals, do we need to replace our dysfunctional financing system with an efficient public program, or can we simply use increased regulatory oversight to transform our private insurers into a better functioning system?
Systems using private plans that achieve near-universal coverage, such as Switzerland and Holland, are often cited as examples that we can emulate. These systems are more expensive, with greater administrative complexity, less equity, and fall short of true universality, though they satisfy those who ideologically prefer private to public administration. Some nations also use public programs for low-income individuals, comparable, in principle, to Medicaid in the United States. So how would it work if we were to regulate the private plans and then mandate the purchase of those plans?
There is a very fundamental difference between our private plans and theirs. Other nations that use private plans do so within a program of social insurance. Their plans are designed for the public good, assisting individuals in receiving the care they need without having to be concerned about the source of payment. They fulfill the insurance function by effectively pooling risks, whether through a single risk pool or though various methods of risk adjustment.
Our private plans are based on a business model designed to ensure success in the health care marketplace. Success is defined by the medical loss ratio, spending the least they can on health care. Much of their profound administrative waste is due to their elaborate efforts to avoid paying for care.
The plethora of private plans merely demonstrates the insurers’ innovations in restricting benefits — preventing payment for non-covered services; increasing deductibles and other forms of cost sharing — erecting financial barriers to care; contracting with limited lists of providers — penalizing patients who need care outside of the restricted lists; selective marketing to healthy populations — especially the healthy workforce and their young, healthy families; using underwriting and rescissions to avoid paying for essential care; and on and on. These are great business tools, ensuring success of the insurers, but they are anathema to the more egalitarian goals of social insurance systems. They defeat the insurance function of pooling risk by segregating out the low-cost healthy into their own market, and dumping the high-cost sick onto taxpayer funded programs.
Suppose we heavily regulate our private insurers and require guaranteed issue of plans that actually include all necessary services, and remove barriers to care such as restrictive lists of providers and unaffordable deductibles. This would require a massive, revolutionary transformation of the missions, goals, and administrative functions of our business-model private plans designed to prevent paying for care, into social insurance private plans designed to remove the financial system as a barrier to care.
Anyone who believes that this would be a simple transformation needs to have a conversation with insurance executives with their nine-figure compensation packages or with the large institutional investors who have fared extremely well under our market-based health care financing system.
As if that weren’t enough, there is one more unique problem in the United States. Our health care costs are much higher than in any other nation. If we were effective in covering everyone with a choice of private plans, whether with or without a public option, and if those plans covered the necessary care that people actually need, imagine the premium that would have to be charged.
The Milliman Medical Index has demonstrated that an average family of four with employer-sponsored coverage — a healthy sector — already pays $15,600 for their health care. That is only average; many pay more. With a typical household income of $60,000, that is no longer affordable. Now add into the pool the less healthy members of our population and just imagine what the premium would have to be. Financing our health care system through a specific premium assigned to an individual or family, based on an adequate package of benefits, has become an obsolete model of paying for health care.
We need a single, universal risk pool that is equitably funded. That would most easily be accomplished through progressive taxes. Once we do that, why would we continue to support the intrusion of the wasteful private insurers that do no more than take away our choice of hospitals, physicians and other professionals? Public administration is much more efficient, plus enrollment is a one-time event — absolutely everyone is covered for life.
http://healthcare.change.org/blog/view/blog_debate_an_obsolete_model
For the full debate (in progress):
http://healthcare.change.org/

Members of Physicians for a National Health Program (PNHP) and supporters of the Health Care for America Now! coalition (HCAN) are all passionately dedicated to the goal of achieving reform that will provide affordable, high quality care for everyone. We are bothers and sisters in the cause. The ultimate goals of both organizations are the same, but the strategies are quite different.
The PNHP single payer concept has been around for a couple of decades, but Congress has failed to move on it. The HCAN leadership decided that reform will never occur unless the private insurance industry plays a major role in the future of health care financing, but that the insurers must be challenged with a competing, public Medicare-like option. In theory, the public option would be a better value, and the private plans would fade away as individuals opt to change to the new Medicare program.
There is massive, intense opposition to the public option by the same elements that have been successful in defeating reform in the past. AHIP, PhRMA, the U.S. Chamber of Commerce, the Republican members of Congress, and many others are all opposed to the Medicare-like option.
If the final legislation includes a well-designed public option (adequate benefit package, truly affordable premiums, no excessive cost sharing, the use of private insurer funds for risk adjustment, etc.) then there will be no comprehensive reform. The opponents are powerful enough to defeat it.
If the final legislation includes an emasculated public option, or leaves it out altogether, then reform will be based on a market of private plans.
Following the HCAN strategy, it is absolutely inevitable that private plans will continue to play a major role in financing health care, whether or not comprehensive reform is enacted. The reason that I selected my response on private insurance from our PNHP/HCAN blog debate is that everyone has to understand very clearly why private health plans are an obsolete method of financing an expensive health care system like we have in the United States. Once everyone understands that, we can reject the HCAN strategy and move forward with the program America needs: a single payer national health program.
You are encouraged to follow the debate this week (only four questions) and provide your comments (http://healthcare.change.org/). Tim, Jason and I are very interested in your thoughts, and hopefully the policymakers will be as well.