PNHP

Blog debate – PNHP versus HCAN reform strategy

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/

Comment:

By Don McCanne, MD

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.

Bill Clinton on Health Care Reform

Dr. Sanjay Gupta and former Pres. Bill Clinton
CNN, Larry King Live
March 11, 2009

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

——-

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?

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 ate 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.

State must act to control costs of top-heavy health-care system

By Dr. Bruce Bender
Worcester Telegram & Gazette
Wednesday, March 11, 2009

Nearly three years after Massachusetts enacted landmark health care reform, the state can point to success in expanding coverage. But it has yet to address another significant issue: cost. By not addressing cost, the state puts the goal of universal coverage and the system in general at risk.

As it is, the cost of the subsidized insurance program, a key component of the reform bill, turned out to be much higher than expected. It will only get more expensive. Experts predict this program will double in size and expense over the next two years — and that was before Massachusetts’ recent economic decline that resulted in 50,000 lost jobs and an unemployment rate of 6.9 percent, the highest in 15 years. The number of residents who may join the ranks of the subsidized program will add to the programs’ costs.

What’s worse, the current program is not able to contain rising health care costs at a time when the state lacks financial flexibility, and is dependent on federal funding, which ends in two years, to help pay for the subsidized program. Even if the program’s costs held steady at today’s level, there’s no guarantee the state will continue to receive federal funding when the agreement ends.

That’s an important reason for Massachusetts to find ways to control costs. Otherwise, Gov. Deval L. Patrick, who has already proposed cuts in his 2010 budget, will have to raise taxes or cut services — or, more likely, do both.

Massachusetts should find ways to reduce the administrative costs of providing health care. Rather than pay an average of 34 to 38 cents of each health-care dollar, we should work to match the same percentage as Canada, 17 cents. This could save $9 billion annually, which could either help prevent the need to cut health-care programs or could be shifted to help our towns, schools, universities, parks, roads, and bridges.

One way to reduce administrative costs is to move to a single-payer system. Employer-sponsored health insurance is an extremely inefficient and expensive way to provide coverage, particularly given the number of small businesses in the state. Administratively, it is hugely expensive to determine which employees are eligible, notify them, explain the options, get them signed up or to sign a waiver sheet, etc. And small businesses are not eligible for the same benefits or prices as large businesses.

This uneven playing field places a substantial burden on business, one that impacts everyone in the state. Increased employer health costs mean increased prices on goods and services.

Employees should oppose employer-sponsored insurance because it is restrictive. An employee who has a special need that is better covered by a different program does not have that option. This is not because of the employer. It is because of the restrictions placed on so-called group insurance plans for small businesses. We cannot even offer all the plans within a single provider.

We provide in-home services to help seniors stay in their homes. This has been recognized by seniors, their families, and Massachusetts as a cost-effective solution. But many of our clients require part-time help — and part-timers run into problems because of restrictions placed on us by insurance companies. That’s why, despite paying 150 people each pay period, only about 30 meet the requirements placed on us by the insurers, which excludes 120 employed people from the system. Further, employees should not have to stay at a job that they hate, or work more than they can, or take a job because of the benefits.

The only sensible approach is the one adopted by every other civilized nation: a single-payer system. It would provide far more choice and better care, including preventive care, and be able to provide universal coverage, regardless of age, pre-existing conditions or work status.

Massachusetts has a responsibility to address cost and access issues before it looks for more money for an already failing system. Single-payer health care for Massachusetts can be the answer.

Bruce Bender, M.D., owns the Home Instead Senior Care franchise located in Northboro.

Health care: crisis or opportunity?

Forum examines issue

Joy Slagowski
Daily News-Sun
March 11, 2009

A health-care expert said Tuesday night there is one way to receive comprehensive medical treatment: Go to jail.

“Prisoners are the only people in this country who receive quality care as the result of their constitutional rights,” said Dr. Jonathan Weisbuch,-founder of Arizona Coalition for a State and National Health Plan and former director of the Maricopa County Department of Public Health. “(Maricopa County Sheriff Joe) Arpaio and Maricopa County spend over $20 million a year to serve health needs of people in jail. It’s an extraordinary situation.”

Weisbuch and Rep. Phil Lopes, D-District 27,-author of the Arizona Health Security Act, discussed “The Broken Healthcare System: Crisis or Opportunity” during a forum hosted by the League of Women Voters of Northwest Maricopa County. The event took place at the Unitarian Universalist Church in Surprise. About 50 people attended the session co-sponsored by the Daily News-Sun.

With the economy in crisis and people losing their jobs, the health-care crisis worsens as more people become uninsured, Weisbuch said.

“And 30 percent of Americans are considered uninsurable if they were to buy insurance individually, because of pre-existing conditions,” Weisbuch said.

Health-care costs have increased at a rate of three times the national inflation rate since 1970, he said.

So health-care reform goals need to focus on access to quality care for everyone and adequate reimbursement for medically necessary care, he said.

Weisbuch advocates for HR 676, also known as Conyers Bill, sponsored by Rep. John Conyers of Michigan.

The bill is considered Medicare for all, where patients choose their own doctor and a trust fund pays for care.

Critics call single-payer plans such as the Conyers Bill socialized medicine, but Weisbuch said there are already four socialized medical systems in place in this country: the Department of Defense health system, the veterans health system, Indian health services and the Bureau of Prisons health services.

Lopes said the number of uninsured residents in Arizona is 20 percent of the population.

He has proposed a state plan, based on a plan that New Mexico has been working on for years, to create a 15-member commission to operate the health care for the state and redistribute the money in the system.

“All of the money we are paying out of pocket in co-pays, premiums, what employers are paying for employees, all add up to $30 billion in Arizona,” Lopes said. “We could provide health care for everyone in the state for $30 billion.”

After the meeting, Shirley McAllister of Sun City said she has been a supporter of single-payer health plans since her late husband fought cancer for 20 years and was covered by three different plans.

“We had Medicare, insurance from his university, insurance from my university, and it took so much time and effort to handle the paperwork,”” McAllister said.

“And I thought, if I am having a tough time, how would those with a high school education or less ever keep things straight? That’s when I became a believer,” McAllister said.

Joy Slagowski may be reached at 623-876-2514 or jslagowski@yourwestvalley.com.

The health care summit

By RICHARD DAVIS
Brattleboro Reformer
Wednesday, March 11

Last Thursday, President Obama hosted a health care summit at the White House. He invited 125 of the most influential people involved in health care reform in the U.S.

The list included all of the usual suspects.

There was the infamous Billy Tauzin, former congressman who now heads the pharmaceutical industry’s biggest lobbying company.

Massachusetts Senator Ted Kennedy was elevated to almost Pope-like status in the health care reform world merely by his presence.

The insurance companies and the drug companies and the providers were well represented. There was also a cross section of members of Congress, including Vermont Sen. Bernard Sanders.

Obama was making a public show of trying to get it right this time by inviting people with differing views. He was making it clear that he was moving beyond the mistakes of the past.

We should not be naive enough to think this summit was anything more than a PR event. Of course, that may not be such a bad thing. Symbolism is important. The summit marks the official start of the Obama plan to enact meaningful health care reform before the end of the year. Political pundits think that means that legislation has to make it to the President’s desk by Labor Day.

This event also made it clear that the White House will now be the people’s house. I was able to sit at my computer and watch all of the proceedings of the summit from

Obama’s opening and closing remarks to glimpses of all five breakout sessions. I kept moving from one session to another, trying to figure out who was in the room and whether or not it would be worth hearing what they had to say.

The speechifying was predictable. There were the status quo holders of the drug and insurance industry and there were the coy politicians who really didn’t say what they meant or reveal what that thought, other than to talk around the issue. Yet it was truly an event where just showing up was the most important thing.

From my point of view, as someone who believes we need to enact a national single payer system yesterday, things were disappointing. The prospects for meaningful reform seem slim, but I am cautiously optimistic that a least a few shreds of good will come from the Obama initiative.

The Obama team wants to offer a public insurance plan to compete with private insurance. They are also talking about eliminating exclusions for pre-existing conditions and waiting periods for all insurance.

Opponents are preparing the next round of Harry and Louise ads. They will raise the specter of socialized medicine and the evils of government run health care. Their argument will fail this time not only because it isn’t true, but also because people are hurting so much that they understand what changes need to be made.

Vermonters can feel good about their representation at the summit as well as having strong voices for sensible health care reform in Washington. If it were not for Sanders’ remarks during a breakout session, I think I would have been less hopeful when I finally clicked the last tab to exit the live feed.

The camera was at Sanders’ back and every time someone spoke who had a viewpoint that was antithetical to his, you could see him squirming in his seat. I kept thinking that was me and half the state of Vermont feeling uncomfortable, hearing statements that would kill any hope of serious reform.

When Sanders’ turn came to speak he said, “It is insane that 56 million Americans today do not have access to a doctor.” Then he went on to say that this country needs a single payer system. He even had the courage to confront the power brokers by saying that the insurance companies are the problem with our health care system and that their profiteering is harming people.

I’m sure most of those at Sanders’ session quickly dismissed his remarks as coming from “that socialist from Vermont.” But that guy from Vermont represents the viewpoint of millions of Americans and he will never let his opponents forget that.

Sanders sees hope for reform in increasing support for Federally Qualified Health Centers (FQHC), something he has championed for years.

In remarks before the summit he said, “The United States has to join the rest of the major nations of the world and have a national health care program that addresses the enormous waste and bureaucracy in our current system. I am pleased that we have made significant success in the stimulus bill on primary health care by doubling resources devoted to Federally Qualified Health Centers and tripling the amount for training health care professionals.”

He summed up the day’s event saying, “I think it was a very good meeting. Our health care system is disintegrating and I very much appreciate the president stepping up to the plate and wanting to move rapidly on it. The president understands that we need universal health care for every man, woman and child. So I think we are off to a good start and I applaud the president.”

And I applaud Bernie.

Richard Davis is a registered nurse and executive director of Vermont Citizens Campaign for Health. He writes from Guilford and welcomes comments at rbdav@comcast.net.

Protest set for New England Obama health care forum on March 17

FOR IMMEDIATE RELEASE
March 12, 2009

Contact:
Deborah Richter, M.D., at drdebvt@sover.net or call (802) 371-7754 (cell), (802) 224-9037 (home), (802) 741-7004 (pager)

One of five regional forums on health care reform arranged by the Obama administration will be held at the University of Vermont’s Davis Center on Tuesday, March 17, from noon to 1:30 p.m. Vermont Gov. Jim Douglas and Massachusetts Gov. Deval Patrick are hosting the event.

A publicly financed universal health care system, or as it is sometimes called, a single-payer system, is not on the agenda for discussion. Douglas and Patrick oppose a universal health care system. As for Obama, he stated unequivocal support for single payer in 2003. As a presidential candidate and as president he so far has not repeated his support.

New England is home to a strong universal health care movement. Advocates are marshaling their resources and are staging a large protest outside the university’s Davis Center in Burlington, starting before noon. Their spokespersons describe it as “peaceful and respectful.”

The purpose of the demonstration is to show the enormous support for the single-payer plan and to insist that it be considered as a serious option for reform. Expectations are that hundreds of doctors, nurses and concerned citizens will begin arriving at the Davis Center around 11 a.m. from Maine, New Hampshire, Massachusetts, New York and of course Vermont. Organizers have received responses from hundreds of doctors and nurses in the region indicating they intend to join the protest.

Dr. Deborah Richter, one of the organizers representing Vermont Health Care for All, said, “There will be more discussion of substance outside the Davis Center meeting room than inside.

“All polls,” she continued, “show that we hold the majority opinion. To fix the problems, the focus must include more than the uninsured. All of us are having problems with paying insurance. All the evidence shows that a publicly financed system — something like Medicare — could save money and cover everyone.

“By excluding us from any substantive discussion of health care reform confines us to what we call the marginalized majority. It is time for our leaders to take single payer seriously.”

Groups Protest Health Insurance Heavyweights

This piece was produced in conjunction with the Huffington Post.

Arthur Delaney, Huffington Post:

Congressman Eric Massa (D-N.Y.) led a protest Monday outside the Ritz-Carlton hotel in Washington, site of the 2009 national conference of America’s Health Insurance Plans (AHIP), a trade group for the health insurance industry.

“We are not radicals! We are not a fringe element!” shouted Massa, who opted not to use the bullhorn provided by protest organizers. “We are the 48 million Americans who cannot access health care today!”
To read the full article: http://www.huffingtonpost.com/2009/03/10/eric-massa-protests-outsi_n_173520.html

Bloomberg columnist on single payer

No Reason to Demonize U.S. Single-Payer Health

Commentary by John F. Wasik
Bloomberg.com
March 11, 2009
It’s time to stop kicking sand in the face of single-payer health care. It may be the strongest solution around to insure every American at a lower cost.
After decades of industry campaigns against this model — dubbed by its critics as “socialized” medicine — it’s important to stop whining and evaluate the many economic benefits. Health care is a fundamental human right.
If President Barack Obama wants real change in American health care, he will have to get over the fear of even mentioning single-payer concepts. At his health-care summit last week, only the threat of a demonstration garnered late invitations for Oliver Fein and Congressman John Conyers, two leading proponents of the single-payer plan.
Health-care costs have become a crippling personal-finance burden for 45 million uninsured and 25 million underinsured Americans. Those outside of the fractured employer-based system are only one illness away from financial ruin.
Lose your job and most likely your health coverage will disappear unless you want to pay exorbitant rates. And it’s getting worse. Because of the growing jobless rate, some 14,000 Americans are losing their coverage daily, according to the Center for American Progress Action Fund.
A single-payer plan would cover everybody regardless of employment situation and save money by cutting out middlemen.
(John F. Wasik, co-author of “iMoney,” is a Bloomberg News columnist. The opinions expressed are his own.)
http://www.bloomberg.com/apps/news?pid=20601039&refer=columnist_wasik&sid=ao58otXrmrPM

Single payer should not only be back in the national dialogue on reform, it should be front and center as the golden standard by which all other options are compared.

Bloomberg columnist on single payer

No Reason to Demonize U.S. Single-Payer Health

Commentary by John F. Wasik
Bloomberg.com
March 11, 2009

It’s time to stop kicking sand in the face of single-payer health care. It may be the strongest solution around to insure every American at a lower cost.

After decades of industry campaigns against this model — dubbed by its critics as “socialized” medicine — it’s important to stop whining and evaluate the many economic benefits. Health care is a fundamental human right.

If President Barack Obama wants real change in American health care, he will have to get over the fear of even mentioning single-payer concepts. At his health-care summit last week, only the threat of a demonstration garnered late invitations for Oliver Fein and Congressman John Conyers, two leading proponents of the single-payer plan.

Health-care costs have become a crippling personal-finance burden for 45 million uninsured and 25 million underinsured Americans. Those outside of the fractured employer-based system are only one illness away from financial ruin.

Lose your job and most likely your health coverage will disappear unless you want to pay exorbitant rates. And it’s getting worse. Because of the growing jobless rate, some 14,000 Americans are losing their coverage daily, according to the Center for American Progress Action Fund.

A single-payer plan would cover everybody regardless of employment situation and save money by cutting out middlemen.

(John F. Wasik, co-author of “iMoney,” is a Bloomberg News columnist. The opinions expressed are his own.)

http://www.bloomberg.com/apps/news?pid=20601039&refer=columnist_wasik&sid=ao58otXrmrPM

Comment:

Don McCanne, MD

Single payer should not only be back in the national dialogue on reform, it should be front and center as the golden standard by which all other options are compared.

Put Single-Payer on the Table

By Amy Goodman
TruthDig
Posted on Mar 10, 2009

http://www.democracynow.org/2009/3/11/dr_quentin_young_obama_confidante_and

President Barack Obama promises health-care reform, but he has taken single-payer health care off the table. Single-payer is the system that removes private insurance companies from the picture; the government pays all the bills, but health-care delivery remains private. People still get their choice of what doctor to go to and what hospital to use. Single-payer reduces the administrative costs and removes the profit that insurance companies add to health-care delivery. Single-payer solutions, however, get almost no space in the debate.

A study just released by Fairness and Accuracy in Reporting, a media watchdog group, found that in the week before Obama’s health-care summit, of the hundreds of stories that appeared in major newspapers and on the networks, “only five included the views of advocates of single-payer–none of which appeared on television.” Most opinion columns that mentioned single-payer were written by opponents.

Congress is considering H.R. 676, “Expanded and Improved Medicare for All,” sponsored by John Conyers, D-Mich., with 64 co-sponsors. Yet even when Rep. Conyers directly asked Obama at a Congressional Black Caucus meeting if he could attend the White House health-care summit, he was not immediately invited. Nor was any other advocate for single-payer health care.

Conyers had asked to bring Dr. Marcia Angell, the first woman editor in chief of The New England Journal of Medicine, the most prestigious medical journal in the country, and Dr. Quentin Young. Young is perhaps the most well-known single-payer advocate in America. He was Martin Luther King Jr.’s doctor when King lived in Chicago. “My 15-minute house calls would stretch into three hours,” he told me.

But he came to know Barack Obama even better. Though his medical partner was Obama’s doctor, Young was his neighbor, friend and ally for decades. “Obama supported single-payer, gave speeches for it,” he said.

This past weekend, hundreds turned out to honor the 85-year-old Young, including the Illinois governor and three members of Congress, but the White House’s response to Conyers’ request that Young be included in the summit? A resounding no. Perhaps because Obama personally knows how persuasive and committed Young is.

After much outcry, Conyers was invited. Activist groups like Physicians for a National Health Program (pnhp.org) expressed outrage that no other single-payer advocate was to be among the 120 people at the summit. Finally, the White House relented and invited Dr. Oliver Fein, president of PNHP. Two people out of 120.

Locked out of the debate, silenced by the media, single-payer advocates are taking action. Russell Mokhiber, who writes and edits the Corporate Crime Reporter, has decided that the time has come to directly confront the problem of our broken health-care system. He’s going to the national meeting of the American Health Insurance Plans and is joining others in burning their health-insurance bills outside in protest. Mokhiber told me, “The insurance companies have no place in the health care of American people. How are we going to beat these people? We have to start the direct confrontation.” Launching a new organization, Single Payer Action (singlepayeraction.org), Mokhiber and others promise to take the issue to the insurance industry executives, the lobbyists and the members of Congress directly, in Washington, D.C., and their home district offices.

Critical mass is building behind a single-payer system. From Nobel Laureate in Economics Joseph Stiglitz, who told me, “I’ve reluctantly come to the view that it’s the only alternative,” to health-care providers themselves, who witness and endure the system’s failure firsthand. Geri Jenkins of the newly formed, 150,000-nurses-strong United American Nurses-National Nurses Organizing Committee (nnoc.net) said: “It is the only health-care-reform proposal that can work. … We are currently pushing to have a genuine, honest policy debate, because we’ll win … the health insurers will collapse under the weight of their own irrelevance.”

Dr. Young has now been invited to a Senate meeting along with the “usual suspects:” health-insurance providers, Big Pharma and health-care-reform advocates. I asked Young what he thought of the refrain coming from the White House, as well as from the leading senator on the issue, Max Baucus, that “single-payer is off the table.” “It’s repulsive,” sighed Young. “We are very angry.” But not discouraged. I asked him what he thought about Burn Your Health Insurance Bill Day. “Things are heating up.” he chuckled. “When things are happening that you have nothing to do with, you know it’s a movement.”

http://www.truthdig.com/report/item/20090310_put_single_payer_on_the_table/

Denis Moynihan contributed research to this column.

Amy Goodman is the host of “Democracy Now!,” a daily international TV/radio news hour airing on more than 700 stations in North America. She was awarded the 2008 Right Livelihood Award, dubbed the “Alternative Nobel” prize, and received the award in the Swedish Parliament in December.

A health insurance broker speaks up

A Broker’s Lament: We Brought This On Ourselves

By John Sinibaldi
The Health Care Blog
March 7, 2009
A huge segment of the American population is simply far too strapped to ever afford the premiums and costs associated with health insurance/health care as it is structured today.
It isn’t the employees of government (local, county, state or federal) who will demand immediate change. It isn’t the employees of institutional companies (the Motorolas, GEs, Microsofts of the country) who will demand change. It isn’t those on Medicare or Medicaid or the VA who will demand change. It isn’t the wealthy. It isn’t the poor. And, it isn’t the vast majority of health insurance agents who work with large group clients (because, while that market is becoming ever more difficult and the work more taxing, they’re still selling SOMETHING to these bigger businesses and government entities).
Why don’t these people see what I’m seeing? Simply because, while they are feeling the effects of the rise in health care/health insurance costs and the downturn in the economy, most of these businesses and their employees and dependents (and the affluent) have yet to have a clue about how expensive things really are (or in the case of the rich, they can still afford their out-of-pocket expenses). The agents who market to large employers are still making lots of money (I know, I rub elbows with them at my local Health Underwriters meetings once a month).
That leaves individuals and small businesses and the agents who work primarily in those markets – the very folks most beleaguered by the current situation. While the employee of a regional electric utility is complaining about monthly payroll deductions for his family that now exceed $500 or more on a $60,000 annual salary, the longtime employee of a local small electrician is looking at monthly payroll deductions for his family of $1,500 on a $35,000 annual salary. His apprentice is younger, and so is “fortunate” to have monthly deductions for his family of only $900 on a $20,000 annual salary. The electrician’s helper making $9/hr can’t afford even his half of the premium for just himself.
Individuals on personal health insurance policies are also feeling the “pinch.” Most of my individual clients see increases of 18-25% a year.
It is all of these folks (and there are tens of millions of them), coupled with those who have already been priced out of the market altogether, who will fuel the fire for radical reform. It is these folks who complain – long, loud and bitterly – that the American dream is leaving them behind. It is these folks to whom the politicians will ultimately listen, because they’re the ones making all the noise. It is these folks who will ultimately define what the next set of reforms looks like – and those reforms will NOT be confined only to the small group and individual markets – nor do these folks give a rat’s rear end if the insurance industry is involved. (After all, we’re doing such a wonderful job for them now.)
And, in my opinion, rightfully so. The health insurance industry (with lots of complicity from legislators, lobbyists and industry groups like ours) has let them down. Period. We have chased profits, chased commissions, swallowed every piece of spin the insurance industry has fed us, and generally ignored the growing number of folks who are beyond dissatisfied with the status quo. They’re mad, and they’re not going to take it any more.
We’re not talking about 5 million, or 15 million people. No, when you add together all small group employees and their dependents, with those who have individual coverage, and the 50 million or so who have no coverage, you’re talking about 100 million people or more.
We have brought this upon ourselves, because we (the industry, maybe not each of us individually) have ignored what folks want in favor of what WE want. The industry has ignored calls for more efficient claims and billing, lower bloat, curtailing outrageous CEO and executive salaries, and a more reasonable approach to return on investment. Our industry has ignored any attempt at out-of-the-box thinking to get reasonably priced health insurance to most low-wage Americans, instead focusing on mis-communications to get Americans to buy into what the industry wants (“High Deductible Health Plans are good for you. We don’t care if you can’t afford the deductible. Now accept that fact and shut up.”) Most of all, our industry has simply ignored an ever-louder clamor for us to get our act together. Instead of focusing on a long-term vision for the future of the industry (one that actually includes the very consumers to whom we sell products), the health insurance carriers have instead bellied up to the short-term trough of immediate reward (executive compensation, shareholder value, golden parachutes).
I’m normally not negative, either. I’ve always considered myself a realist. Yet here I am, watching every prediction I’ve made over the past 15 years on forums like this come true.
The saddest part is listening to all of the gnashing of teeth and screeching and wailing, mostly from the very folks who have repeatedly turned a deaf ear to the situation year after year because they were making gobs of money. (Yes, I’m talking about a lot of you on this very forum). In fact, some of you are still wearing your rose-colored glasses, and acting like if you just click your red-sequined shoes together, you’ll be able to get back home.
Well, you ain’t Dorothy, and this ain’t Oz.
Let’s see what the President and Congress come up with, and try to work with it – because it is inevitable that the reforms will be major, because we’ve waited too long to save our current system as we know it.
I will not apologize for the above, and I will probably not respond to the rants, flames and cacophony that are sure to ensue. We brought this upon ourselves, so now we’ll have to deal with it.
Note by Brian Klepper: John Sinibaldi is a St. Petersburg, FL-based health insurance agent – or as his industry association prefers to be called, “Health Underwriters” – catering primarily to small employer groups. He’s posted reality-based columns here in the past, including a particularly pithy one recently on small group coverage in Florida. The fiery comment above was written to colleagues on a national health care brokers’ forum.
http://www.thehealthcareblog.com/the_health_care_blog/2009/03/a-brokers-lament-we-brought-this-on-ourselves.html

John Sinibaldi has provided a consistent voice behind the scenes expressing many of the problems with our private insurance industry and the clear need for reform. His observations have been very helpful to me in providing insight to many of these issues, from the industry’s perspective.
In spite of his personal efforts, along with the efforts of many more of us, the problems grow worse. It has reached the threshold such that he now feels compelled to speak up quite frankly to his colleagues in their health care brokers’ forum.
John Sinibaldi really cares. He believes that health insurance should assist patients in receiving the health care that they need. The system fails far too many today. He sees no other option than to support comprehensive change that places patients first, even though that will be highly disruptive to his own business and that of his colleagues. We need to listen to him.
(For those who would like more of John Sinibaldi’s invaluable insight on brokering health insurance, access his commentary at the link above, and then scroll down to “Posted by: John Sinibaldi | Mar 9, 2009 7:21:02 AM” and read his comment above.)

A health insurance broker speaks up

A Broker's Lament: We Brought This On Ourselves

By John Sinibaldi
The Health Care Blog
March 7, 2009

A huge segment of the American population is simply far too strapped to ever afford the premiums and costs associated with health insurance/health care as it is structured today.

It isn’t the employees of government (local, county, state or federal) who will demand immediate change. It isn’t the employees of institutional companies (the Motorolas, GEs, Microsofts of the country) who will demand change. It isn’t those on Medicare or Medicaid or the VA who will demand change. It isn’t the wealthy. It isn’t the poor. And, it isn’t the vast majority of health insurance agents who work with large group clients (because, while that market is becoming ever more difficult and the work more taxing, they’re still selling SOMETHING to these bigger businesses and government entities).

Why don’t these people see what I’m seeing? Simply because, while they are feeling the effects of the rise in health care/health insurance costs and the downturn in the economy, most of these businesses and their employees and dependents (and the affluent) have yet to have a clue about how expensive things really are (or in the case of the rich, they can still afford their out-of-pocket expenses). The agents who market to large employers are still making lots of money (I know, I rub elbows with them at my local Health Underwriters meetings once a month).

That leaves individuals and small businesses and the agents who work primarily in those markets – the very folks most beleaguered by the current situation. While the employee of a regional electric utility is complaining about monthly payroll deductions for his family that now exceed $500 or more on a $60,000 annual salary, the longtime employee of a local small electrician is looking at monthly payroll deductions for his family of $1,500 on a $35,000 annual salary. His apprentice is younger, and so is “fortunate” to have monthly deductions for his family of only $900 on a $20,000 annual salary. The electrician’s helper making $9/hr can’t afford even his half of the premium for just himself.

Individuals on personal health insurance policies are also feeling the “pinch.” Most of my individual clients see increases of 18-25% a year.

It is all of these folks (and there are tens of millions of them), coupled with those who have already been priced out of the market altogether, who will fuel the fire for radical reform. It is these folks who complain – long, loud and bitterly – that the American dream is leaving them behind. It is these folks to whom the politicians will ultimately listen, because they’re the ones making all the noise. It is these folks who will ultimately define what the next set of reforms looks like – and those reforms will NOT be confined only to the small group and individual markets – nor do these folks give a rat’s rear end if the insurance industry is involved. (After all, we’re doing such a wonderful job for them now.)

And, in my opinion, rightfully so. The health insurance industry (with lots of complicity from legislators, lobbyists and industry groups like ours) has let them down. Period. We have chased profits, chased commissions, swallowed every piece of spin the insurance industry has fed us, and generally ignored the growing number of folks who are beyond dissatisfied with the status quo. They’re mad, and they’re not going to take it any more.

We’re not talking about 5 million, or 15 million people. No, when you add together all small group employees and their dependents, with those who have individual coverage, and the 50 million or so who have no coverage, you’re talking about 100 million people or more.

We have brought this upon ourselves, because we (the industry, maybe not each of us individually) have ignored what folks want in favor of what WE want. The industry has ignored calls for more efficient claims and billing, lower bloat, curtailing outrageous CEO and executive salaries, and a more reasonable approach to return on investment. Our industry has ignored any attempt at out-of-the-box thinking to get reasonably priced health insurance to most low-wage Americans, instead focusing on mis-communications to get Americans to buy into what the industry wants (“High Deductible Health Plans are good for you. We don’t care if you can’t afford the deductible. Now accept that fact and shut up.”) Most of all, our industry has simply ignored an ever-louder clamor for us to get our act together. Instead of focusing on a long-term vision for the future of the industry (one that actually includes the very consumers to whom we sell products), the health insurance carriers have instead bellied up to the short-term trough of immediate reward (executive compensation, shareholder value, golden parachutes).

I’m normally not negative, either. I’ve always considered myself a realist. Yet here I am, watching every prediction I’ve made over the past 15 years on forums like this come true.

The saddest part is listening to all of the gnashing of teeth and screeching and wailing, mostly from the very folks who have repeatedly turned a deaf ear to the situation year after year because they were making gobs of money. (Yes, I’m talking about a lot of you on this very forum). In fact, some of you are still wearing your rose-colored glasses, and acting like if you just click your red-sequined shoes together, you’ll be able to get back home.

Well, you ain’t Dorothy, and this ain’t Oz.

Let’s see what the President and Congress come up with, and try to work with it – because it is inevitable that the reforms will be major, because we’ve waited too long to save our current system as we know it.

I will not apologize for the above, and I will probably not respond to the rants, flames and cacophony that are sure to ensue. We brought this upon ourselves, so now we’ll have to deal with it.

Note by Brian Klepper: John Sinibaldi is a St. Petersburg, FL-based health insurance agent – or as his industry association prefers to be called, “Health Underwriters” – catering primarily to small employer groups. He’s posted reality-based columns here in the past, including a particularly pithy one recently on small group coverage in Florida. The fiery comment above was written to colleagues on a national health care brokers’ forum.

http://www.thehealthcareblog.com/the_health_care_blog/2009/03/a-brokers-lament-we-brought-this-on-ourselves.html

Comment:

By Don McCanne, MD

John Sinibaldi has provided a consistent voice behind the scenes expressing many of the problems with our private insurance industry and the clear need for reform. His observations have been very helpful to me in providing insight to many of these issues, from the industry’s perspective.

In spite of his personal efforts, along with the efforts of many more of us, the problems grow worse. It has reached the threshold such that he now feels compelled to speak up quite frankly to his colleagues in their health care brokers’ forum.

John Sinibaldi really cares. He believes that health insurance should assist patients in receiving the health care that they need. The system fails far too many today. He sees no other option than to support comprehensive change that places patients first, even though that will be highly disruptive to his own business and that of his colleagues. We need to listen to him.

(For those who would like more of John Sinibaldi’s invaluable insight on brokering health insurance, access his commentary at the link above, and then scroll down to “Posted by: John Sinibaldi | Mar 9, 2009 7:21:02 AM” and read his comment above.)