PNHP

Single payer would improve health care for everyone

Single payer would improve health care for everyone

By Madeline Zevon
Lower Hudson Journal News
February 19, 2009

The recession has been taking a toll on New York businesses, but it isn’t the only thing ailing us; the high cost of health care and the lack of access to care dog businesses and individuals. Here is a commentary from the League of Women Voters on single-payer national health insurance, a leading solution to the cost and accessibility problems plaguing health care in New York, where an estimated 1 in 6 people lacks insurance.

What is single payer? It refers to the administration of health-care funds by one payer, rather than by the current multiple insurance companies. This payer would be the federal government. Think of single payer as enhanced and improved Medicare for all. The League of Women Voters of Westchester, New York state and the U.S. League all advocate for single-payer health care.

Can we afford covering the 47 million uninsured and the 50 million underinsured nationwide? Yes, we can. Currently insurance companies have an overhead of approximately 30 percent, which is spent on marketing, administration, shareholders dividends and exorbitant CEO salaries. Medicare’s overhead is approximately 3 percent. We could save about $350 billion annually, enough to cover the 47 million uninsured and the 50 million underinsured. Both the Congressional Budget Office and the General Accounting Office say the U.S. could insure everyone for the money we’re paying now to insure seniors only.

Is this socialized medicine? No, it is not. With socialized medicine, doctors and hospitals are owned by the government. As with Medicare, hospitals would be semi-private just as they are now, and doctors would be in private practice just as they are now. Single payer would replace the costly, inefficient system of private insurance. Paperwork would be greatly reduced because there would be only one entity to deal with.

Fifty-nine percent of physicians support legislation to establish national health insurance; 65 percent of Americans agree that the U.S. should adopt a program like Medicare for all. We spend twice as much on health care as other industrialized nations, and they cover all of their population. Every other industrialized country in the world has national health insurance. We are the only country that uses private, for-profit insurance to finance health care for the majority of our population.

Do we need to improve our current Medicare system? Yes, we do. Medicare is suffering financially because of the intrusion of private health-maintenance organizations, which were initially put into place as a cost-effective system, but were actually less cost effective. HMOs are subsidized by the government, cherry-pick healthy patients, and yet their costs are 12 percent more than traditional Medicare. This system costs the taxpayers $15 billion a year.

Each year, half of all personal bankruptcies are caused by medical bills, and 75 percent of those bankrupted were insured when they got sick. Insurance premiums go up each year for policies that cover less and less. The goal of insurance companies is to make a profit for their shareholders and CEOs.

All of these issues obviously affect residents of the Lower Hudson Valley and New York. More and more groups are petitioning for single payer:

– The Westchester division of the League of Women Voters has a very active group working on this issue.

– Single Payer New York, an Albany group, has urged President Barack Obama to reject a Massachusetts-style plan and it urged Gov. David Paterson to provide leadership for single payer.

– In the Legislature, dozens of lawmakers in both the Assembly and Senate have sponsored single-payer legislation.

– Physicians for a National Health Program, a group of more than 15,000 physicians nationally and more than 1,000 from the New York metro area, has actively campaigned for single payer for several years. It is estimated that today’s physician spends about one-third of his or her time satisfying insurance company regulations and seeking approval for treatment, time that could be better spent with patients.

– Single payer would save New York $5 billion annually in administrative waste.

The government already pays for a significant proportion of our health care. Since 60 percent of our health-care system is financed by public money – Medicare, Medicaid, Veterans Affairs and insurance for public employees. It makes sense to expand this coverage for all.

Major stumbling blocks are the drug and insurance companies. These industries spend more than any other industry lobbying Congress. They succeeded in making Medicare part D a windfall for drug companies. Both former Sen. Hillary Clinton and President Obama have said in the past that single payer makes the most sense but is not “politically feasible” at this time. The flaw in both their proposed health-care reforms (as seen during their respective campaigns) is that they involve insurance companies in the system, making reform financially unaffordable. This approach is not viable, as numerous state-based experiments have shown. Such plans fail because of the cost.

All we need is the political will.

The writer is vice president of the White Plains League of Women Voters and a member of the LWV of Westchester Health Committee.

http://lohud.com/article/20090219/OPINION/902190354/1076/OPINION01

Former journalist crusading for affordable health care

Health care activist visits Fort Collins

BY PAT FERRIER
Fort Collins Coloradoan
February 7, 2009

T.R. Reid is uncharacteristically angry.

He’s angry the richest country in the world cannot provide efficient, affordable health care to all its residents.

He’s angry the World Health Organization ranks the U.S. 37th for the cost, quality and coverage of its health-care system.

And, he’s angry the U.S. health-care system has failed the roughly 47 million Americans who lack health insurance.

Reid, a journalist and author, has lived and worked in England and Japan, experiencing firsthand their health-care systems.

He shares those experiences and interviews from several other countries in his 2008 PBS documentary “Sick Around the World,” and his upcoming “Sick Around America” that will air March 21 on PBS.

On Feb. 19 he will be in Fort Collins to discuss the U.S. health care system and its need for substantive and sweeping changes.

He’s come to the consensus that to create an efficient and fair health-care system that covers everyone, the payment system has to be nonprofit.

“If you have for-profit health insurance as we have today, insurance companies do their best not to cover anyone who might need their product,” he said.

“They employ armies of underwriters to deny claims. It’s cheaper for them to write a letter denying a claim than paying it.”

Like any other publicly held company, the mission of for-profit insurance companies is to pay a dividend to their stockholders, he said. “In other countries … it’s to pay for health care. It’s a fundamental difference between us and everyone else.”

As long as the U.S. relies on existing for-profit health insurance companies, the health-care system can’t work, he said.

Reid, a former bureau chief for the Washington Post stationed in Denver, is well-known for his commentaries on National Public Radio from England and Japan.

He spends much of his time now writing books and making documentaries.

Health care became an interest when he lived in Japan and “got marvelous health care. The bills were so small I thought they just dropped a couple of zeroes by mistake.

“In Britain, we’d call the doctor and say the kid has an earache; the doctor would come to the house, treat the kid and walk out the door, and there’s no bill.

“I’m looking at the two countries saying how come they can do this and the U.S., the richest country in the world, can’t do this?

“I am so angry about the U.S. health-care system. It is shocking what these insurance companies do to people.”

Dr. Janet Seeley, a Fort Collins physician who invited Reid to Fort Collins, said most physicians agree health care in the U.S. needs a major overhaul, but they can’t agree on what form that overhaul should take.

Reid breaks health care around the world into four models, each less expensive and more expansive than the U.S., which spends between 18 and 25 percent of its costs on administration.

Canada, Britain and Japan spend 5 percent and Japan spends 3 percent on administrative costs, he said.

“Our current private health insurance is the cruelest and most expensive in the world. Unless we go after that, we can’t fix it.”

Reid worries the Obama administration, which had hoped to tackle health-care reform in its first 100 days, will get derailed by an economy in shambles and billions of dollars diverted into stimulus packages.

“If a new president takes it on early during the honeymoon period when he still has the political mandate, it’s probably the best time. I’m worried Obama won’t get to it soon enough.”

What Obama can learn from us

David Olive
Business Columnist
Toronto Star
Feb 18, 2009

Ahead of his brief Ottawa visit tomorrow, Barack Obama is getting the message from influential U.S. voices that Canada — and Toronto in particular — are models for the American social and economic renaissance the new U.S. president is pledged to bring about.

“If President Obama is looking for smart government, there is much he, and all of us, could learn from our quiet — okay, sometimes boring — neighbour to the north,” writes Fareed Zakaria, bestselling author (The Post-American World) and chief international columnist for Newsweek.

Zakaria notes that, in the industrialized world, only Canada has experienced no bank failures or government bailouts.

Canada’s Big Five banks made a combined profit of $8.2 billion (U.S.) last year, while the top five U.S. banks lost a total of $8.3 billion.

“One of the things that I think has been striking about Canada is that in the midst of this enormous economic crisis,” Obama told the CBC yesterday, “Canada has shown itself to be a pretty good manager of the financial system in the economy in ways that we haven’t always been here in the United States.

“And I think that’s important for us to take note of, that it’s possible for us to have a vibrant banking sector, for example, without taking some of the wild risks that have resulted in so much trouble on Wall Street.”

For 2008, the World Economic Forum ranked Canada’s banking system the healthiest in the world. The U.S. ranked 40th, and Britain 44th.

In advance of the next Group of 20 summit, in April in London, a G20 working group headed by Tiff Macklem and Rakesh Mohan has been asked to devise a blueprint for more robust regulatory supervision and greater transparency to prevent future global banking crises.

The selection of these two co-chairs is telling. Macklem is Canada’s associate deputy minister of finance. Mohan is deputy governor of the Reserve Bank of India, another nation whose banks did not load up on subprime, or junk, mortgages; collateralized debt obligations (CDOs); and other “toxic waste” now crippling world banks.

The record-sized U.S. housing bubble that burst in 2007 originated with Bush-era policies intended to help people realize the American Dream of home ownership. Regulatory laxity earlier this decade gave rise to a proliferation of subprime mortgage lending. U.S. homeowners also benefit from the longstanding U.S. policy of tax deductibility of mortgage interest, a middle-class entitlement program in everything but name that costs the U.S. government about $100 billion (U.S.) a year. As a result, 68 per cent of Americans own their homes, but that figure predates the millions of home foreclosures anticipated this year and next. In Canada, without those inducements, the home-ownership rate is 68.4 per cent.

But Zakaria points to many other things the Great White North is getting right. A more open-door immigration policy than its “brain-dead” U.S. counterpart that welcomes rather than shuns skilled émigrés. A reformed national pension system now in robust fiscal health compared with a near-insolvent U.S. Social Security system.

And “Canada has been remarkably responsible over the past decade or so,” Zakaria notes, citing 12 years of federal budget surpluses. Which means Ottawa “can now spend money to fuel a recovery from a strong position.” The U.S., by contrast, braced for a $1 trillion (U.S.) federal deficit even before Obama yesterday signed into law a $787 billion (U.S.) economic stimulus package.

Looking further ahead, Richard Florida, the urban economics guru, sees Toronto angling for the same global heft as Chicago and Tokyo. “I sense we are in great shape to move up in the global ranks,” says Florida, now based at the University of Toronto’s Rotman School of Management. Florida followed the example of his mentor, the late urbanologist Jane Jacobs, in relocating two years ago to Canada from his native U.S.

Like New York and London, Toronto is a finance, media and entertainment centre, forecast to be among the fastest-growing business sectors over the next generation. Unlike those cities, Toronto also has an abundance of technological research, and more social stability and ethnic diversity. And in recent years the city’s cultural amenities have expanded considerably.

Florida readily concedes that stubborn problems like income inequality and a deteriorating basic-industry sector have yet to be tackled. But in a cover-story essay in the current Atlantic magazine, the venerable U.S. public issues journal, Florida identifies Toronto among fast-growing “mega-regions” most ideally suited to rapid growth. Atlantic gave Florida’s article four covers, showing the skylines of North American cities with the best prospects for sustained prosperity — Toronto, New York, Chicago and San Francisco.

Yet Florida discourages U.S. comparisons. “Stop looking south for models,” says Florida, based for 17 years at Pittsburgh’s Carnegie Mellon University. “They ain’t there. The U.S. is in very deep crisis. It’s time for Toronto to break out and lead.”

For Zakaria, health care is likely Canada’s high card.

“Canada’s health-care system is cheaper than America’s by far (accounting for 9.7 per cent of GDP, versus 15.2 per cent here),” Zakaria writes, “and yet does better on all major indexes.”

Obama once said if he was designing a U.S. health-care system from scratch, it would be modeled on Canada’s universal single-payer formula. But that model is too easily demonized in the U.S. as “socialized medicine” to be politically viable.

So Obama is instead pushing a clumsy public-private hybrid designed to at least provide coverage for the 46 million Americans without health insurance.

Still, Obama finds the “socialized-medicine” bogeyman risible. In an interview in the liberal U.S. journal Nation three years ago, the then-U.S. senator from Illinois was asked if the single-payer option “is revolutionary or reformist.”

“Anything that Canada does can’t be entirely revolutionary, it’s Canada” Obama laughed. “When I drive through Toronto, it doesn’t look like a bunch of Maoists.”

Insurance industry is intimidating lawmakers

Kennebec Journal / Morning Sentinel
Feb. 19, 2009

Under pressure from the insurance industry, Obama’s health-care reform is poised to completely exclude a single-payer “improved Medicare for all” option. Such a program would save enough money to provide comprehensive benefits for all Americans.

Yet opposition from insurance and drug industry giants continues to intimidate lawmakers. Only the voice of the people, our voices, can fortify our leaders to stand up for the health of the American people rather than the wealth of our richest firms.

Every other developed nation sees health care as a “right” and has some form of national health insurance (NHI). Plus, most spend less than half what we do per person.

Nearly a third of U.S. health-care spending is wasted on administration. In their drive to enroll healthy, profitable patients and screen out the sick, private insurers consume vast sums of money that sustain profits, enrich CEOs and divert resources from patient care. The paperwork they inflict on doctors and hospitals costs billions more each year. This “profit first” mentality has broken our health-care system and led the world into financial crisis.

Only single-payer NHI can fix this broken system and save thousands of lives each year. The concept is popular with the American people and enjoys the support of most doctors.

Right now, “improved Medicare for all” bills are taking shape in the U.S. House and Senate and in the Maine Legislature. Our leaders need to hear from you. Contact them. Voice your support.

Dr. John Benziger
South China

http://kennebecjournal.mainetoday.com/view/letters/5966278.html

Massachusetts is no model for national health care reform

Physicians, public interest group urge Sen. Kennedy to introduce single-payer legislation

For Immediate Release
Feb. 20, 2009

Contacts:
Rachel Nardin, M.D.
Steffie Woolhandler, M.D.
Mark Almberg, (312) 782-6006, mark@pnhp.org

WASHINGTON – The Massachusetts health care system, widely regarded as an example of how to provide universal coverage and keep costs low, is in fact faltering badly and should not be held up as a national model for reform, according to a study released this week by Physicians for a National Health Program (PNHP) and Public Citizen.

The study comes at a time when the health insurance industry is reportedly weighing in heavily in secret talks on Capitol Hill in favor of an individual mandate, a legal obligation requiring persons to have or to buy health insurance. The insurance industry’s position was described in today’s New York Times.

However, such mandates – which have been a cornerstone of the Massachusetts health reform – have failed to assure universal coverage, the new study says. For example, the state’s most recent figures show that it had to exempt 79,000 residents from the mandate in 2007 because they could not afford to buy insurance.

The Massachusetts plan has also failed to make health care sufficiently affordable or to control costs, the report says.

The groups urged Sen. Edward Kennedy (D-Mass.) to reject his home state’s approach and, instead, introduce Senate legislation crafted after the House’s United States National Health Care Act, H.R. 676, which would implement single-payer financing of health care while maintaining the private delivery system. The two groups also released a letter to Kennedy signed by approximately 500 Massachusetts physicians and health professionals urging the senator to embrace single-payer reform.

“Massachusetts physicians have the unique opportunity to observe the effects of this reform on patients every day,” said Dr. Rachel Nardin, president of the Massachusetts chapter of PNHP and lead author of the study. “The nearly 500 doctors who have signed the open letter to Sen. Kennedy see that the reform is deeply flawed.”

PNHP’s study of the Massachusetts model found that the state’s 2006 reforms, instead of reducing costs, have been more expensive than expected. The budget overruns have forced the state to siphon about $150 million from safety-net providers such as public hospitals and community clinics.

Many low-income residents, who used to receive completely free care, now face co-payments, premiums and deductibles under the new system – financial burdens that prevent many of them from receiving necessary medical treatment. Since the state’s reforms passed, premiums under the state insurance program have increased 9.4 percent. The study found that if a middle-income person on the cheapest available state plan got sick, he or she could end up paying $9,872 in premiums, deductibles and co-insurance for the year.

Many residents remain uninsured or have inadequate insurance.

Under a single-payer system, doctors, hospitals and other health care providers are paid from a single fund administered by the government.

“We are facing a health-care crisis in this country because private insurers are driving up costs with unnecessary overhead, bloated executive salaries and an unquenchable quest for profits – all at the expense of American consumers,” said Dr. Sidney Wolfe, director of Public Citizen’s Health Research Group. “Massachusetts’ failed attempt at reform is little more than a repeat of experiments that haven’t worked in other states. To repeat that model on a national scale would be nothing short of Einstein’s definition of insanity.”

The study reported that a national nonprofit single-payer system could save Massachusetts about $8 billion to $10 billion a year in reduced administrative costs. Currently, Americans spend 31 cents of every health care dollar on administrative costs, by far the highest rate in the world and much higher than the 17 cents spent in Canada, which has single-payer universal health care.

“Big hospitals and insurers have gotten rich off reform, but a survey shows that more people directly affected by it have been harmed than helped,” said Dr. Steffie Woolhandler, a PNHP co-founder and associate professor of medicine at Harvard Medical School who helped prepare the study. “We’re seeing patients who now can’t afford vital medications and treatments that they’ve been on for years because of the new co-payments and deductibles imposed by the law.”


Read the report, “Massachusetts’ Plan: A Failed Model for Health Care Reform.”

Read the letter to Sen. Edward Kennedy.

Read the labor letter to President Barack Obama.

Read personal stories from Massachusetts patients.

Single payer – over on the side table

Canada and the Recession: Angles of Deflection

By Nancy Folbre, a professor of economics at the University of Massachusetts Amherst
The New York Times
Economix
February 19, 2009
As the economist (and fellow Economix blogger) Uwe Reinhardt explains, the single-payer Canadian health care system delivers very good results for about half the per-person cost of ours — with huge savings from reduced paperwork. Economic disparities in access to health care are significantly lower there.
President Obama promises to expand health insurance coverage in the United States with little threat or inconvenience to the private sector. But some Democrats in Congress, led by Representative John Conyers, advocate a single-payer “Medicare for All” bill strongly influenced by the Canadian model.
http://economix.blogs.nytimes.com/2009/02/19/canada-angles-of-deflection/?hp

And…

Worthwhile Canadian Initiative

By Fareed Zakaria
Newsweek
February 7, 2009
(Canada’s) health-care system is cheaper than America’s by far (accounting for 9.7 percent of GDP, versus 15.2 percent here), and yet does better on all major indexes. Life expectancy in Canada is 81 years, versus 78 in the United States; “healthy life expectancy” is 72 years, versus 69. American car companies have moved so many jobs to Canada to take advantage of lower health-care costs that since 2004, Ontario and not Michigan has been North America’s largest car-producing region.
http://www.newsweek.com/id/183670

And…

This Won’t Hurt a Bit

by Jonathan Cohn
The New Republic
February 18, 2009
Advocates of single-payer systems complain frequently that the mainstream political debate doesn’t give their idea the attention it deserves. They are right. Public insurance programs enjoy huge economies of scale; they don’t fritter away money on profits or efforts to skim healthier patients from the population. When it comes to billing, they tend to be a lot simpler than, say, a system with dozens of competing insurance plans. All insurance systems require providers to file a lot of paperwork; single-payer systems, though, require just one set. The centralized power of single-payer systems also gives them unparalleled sway over not just the amount of money they pay but how they dole it out; with that kind of leverage, they can push the medical system toward making key improvements in quality.
In an ideal world, then, single-payer would almost certainly be the best option. But is it politically feasible? Single-payer advocates like to point out that Representative John Conyers has a single-payer bill in Congress with close to 100 co-sponsors. But many of those co-sponsors have signed on because, until now, it has been a cheap, meaningless way to win points with liberal interest groups.
http://www.tnr.com/politics/story.html?id=4d41ab07-8c25-4b22-81d2-02b4d149afe2

And…

How the U.S. measures up to Canada’s health care system

Interview of Uwe Reinhardt
Worldfocus
January 28, 2009
We have a Canadian health plan in America. It’s called Medicare. It works. Don’t tell me Medicare doesn’t work. Tell that to the elderly. One way to test it is to say “Let’s take it away.”
You have to, in the end, cover people. And if you, the private health insurance agency, are not able to do it, we can do it. The government can do it. And we’ll discover this more and more.
http://worldfocus.org/blog/2009/01/28/how-the-us-measures-up-to-canadas-health-care-system/3783/

The good news is that individuals from the media and from the policy community are acknowledging, on the side, that single payer would cover everyone, would improve health outcomes, and would cost less than the other current proposals for reform. Today’s quotes are only a few examples of a multitude of such comments. Single payer has not been removed from the national dialogue on reform.
The bad news is that all too often these are only side comments as the discussion then moves forward with the need to support “feasible” approaches that do not cover everyone, waste tremendous resources, and cost far more than would a publicly-administered and publicly-financed system.
Are we such automatons that we need to set aside facts about an approach that would benefit all of us, and reflexly accept deficient, perverse policies that would benefit the private insurance industry? Why is gifting our funds to the private insurance industry feasible, while spending those funds on health care that people need is not?
As Sen. Daniel Patrick Moynihan said, we’re entitled to our own opinions, but not our own facts. Let’s dump the opinions and craft reform based on the actual facts. Seriously!

Single payer – over on the side table

Canada and the Recession: Angles of Deflection

By Nancy Folbre, a professor of economics at the University of Massachusetts Amherst
The New York Times
Economix
February 19, 2009

As the economist (and fellow Economix blogger) Uwe Reinhardt explains, the single-payer Canadian health care system delivers very good results for about half the per-person cost of ours — with huge savings from reduced paperwork. Economic disparities in access to health care are significantly lower there.

President Obama promises to expand health insurance coverage in the United States with little threat or inconvenience to the private sector. But some Democrats in Congress, led by Representative John Conyers, advocate a single-payer “Medicare for All” bill strongly influenced by the Canadian model.

http://economix.blogs.nytimes.com/2009/02/19/canada-angles-of-deflection/?hp

And…

Worthwhile Canadian Initiative

By Fareed Zakaria
Newsweek
February 7, 2009

(Canada’s) health-care system is cheaper than America’s by far (accounting for 9.7 percent of GDP, versus 15.2 percent here), and yet does better on all major indexes. Life expectancy in Canada is 81 years, versus 78 in the United States; “healthy life expectancy” is 72 years, versus 69. American car companies have moved so many jobs to Canada to take advantage of lower health-care costs that since 2004, Ontario and not Michigan has been North America’s largest car-producing region.

http://www.newsweek.com/id/183670

And…

This Won’t Hurt a Bit

by Jonathan Cohn
The New Republic
February 18, 2009

Advocates of single-payer systems complain frequently that the mainstream political debate doesn’t give their idea the attention it deserves. They are right. Public insurance programs enjoy huge economies of scale; they don’t fritter away money on profits or efforts to skim healthier patients from the population. When it comes to billing, they tend to be a lot simpler than, say, a system with dozens of competing insurance plans. All insurance systems require providers to file a lot of paperwork; single-payer systems, though, require just one set. The centralized power of single-payer systems also gives them unparalleled sway over not just the amount of money they pay but how they dole it out; with that kind of leverage, they can push the medical system toward making key improvements in quality.

In an ideal world, then, single-payer would almost certainly be the best option. But is it politically feasible? Single-payer advocates like to point out that Representative John Conyers has a single-payer bill in Congress with close to 100 co-sponsors. But many of those co-sponsors have signed on because, until now, it has been a cheap, meaningless way to win points with liberal interest groups.

http://www.tnr.com/politics/story.html?id=4d41ab07-8c25-4b22-81d2-02b4d149afe2

And…

How the U.S. measures up to Canada’s health care system

Interview of Uwe Reinhardt
Worldfocus
January 28, 2009

We have a Canadian health plan in America. It’s called Medicare. It works. Don’t tell me Medicare doesn’t work. Tell that to the elderly. One way to test it is to say “Let’s take it away.”

You have to, in the end, cover people. And if you, the private health insurance agency, are not able to do it, we can do it. The government can do it. And we’ll discover this more and more.

http://worldfocus.org/blog/2009/01/28/how-the-us-measures-up-to-canadas-health-care-system/3783/

Comment:

By Don McCanne, MD

The good news is that individuals from the media and from the policy community are acknowledging, on the side, that single payer would cover everyone, would improve health outcomes, and would cost less than the other current proposals for reform. Today’s quotes are only a few examples of a multitude of such comments. Single payer has not been removed from the national dialogue on reform.

The bad news is that all too often these are only side comments as the discussion then moves forward with the need to support “feasible” approaches that do not cover everyone, waste tremendous resources, and cost far more than would a publicly-administered and publicly-financed system.

Are we such automatons that we need to set aside facts about an approach that would benefit all of us, and reflexly accept deficient, perverse policies that would benefit the private insurance industry? Why is gifting our funds to the private insurance industry feasible, while spending those funds on health care that people need is not?

As Sen. Daniel Patrick Moynihan said, we’re entitled to our own opinions, but not our own facts. Let’s dump the opinions and craft reform based on the actual facts. Seriously!

Doctors criticize Massachusetts health law

By Lisa Wangsness
Boston Globe
Healthcare
Thursday, February 18, 2009

WASHINGTON — A trio of Boston doctors says the 2006 Massachusetts healthcare law is a poor model for a national system because it leaves too many people without affordable care.

In an analysis issued earlier today and an accompanying letter signed by nearly 500 Bay State physicians, they urged Senator Edward M. Kennedy to push for a Medicare-for-all style national healthcare system, something Congressional leaders and the White House have rejected as politically unworkable as they consider a major overhaul to the healthcare system this year.

“Any plan that retains private insurers will add layers of bureaucracy and fail to control costs, dooming the noble effort to assure good care for all,” the letter said.

The Massachusetts healthcare law essentially builds on the existing health insurance system, where most people obtain coverage through their employers. It requires virtually all people to buy insurance and provides limited assistance to those who cannot afford it. President Obama and Senate Finance Committee Chairman Max Baucus have endorsed aspects of the plan, making it likely to influence any effort to overhaul the national system.

The doctors’ analysis — written by Rachel Nardin, a neurologist and an assistant professor at Harvard Medical School, and Steffie Woolhandler and David Himmelstein, both primary care doctors and associate professors at Harvard Medical School — questions the quality of data showing that all but 2.6 percent of Massachusetts residents have insurance, arguing the number is probably 5 percent or more.

The doctors also say that the new insurance available to lower middle class people imposes unaffordale out-of-pocket costs, particularly on the chronically ill. And they argue that because the new law is more expensive than anticipated, the state has prematurely cut funding for “safety net” providers who help the poor free of charge, leaving them without a last resort.

“Despite having health insurance, many Massachusetts residents cannot afford care,” Nardin said at a press conference in Washington earlier today. She cited the example of a young diabetic from the Boston area whose costs went from nothing under the old “free care” system to $340 per month under the new law, consuming one-quarter of her take-home pay.

Asked how Congress and the White House might avoid Massachusetts’ mistakes to create a better national system, Woolhandler and Nardin said the main lesson was that a Medicare-for-all style system is the only way to achieve universal health reform.

Supporters of the Massachusetts system dismissed the doctors’ analysis as driven by ideology more than by facts.

“They let the perfect be the enemy of the good,” said MIT economist Jonathan Gruber, a board member of the Commonwealth Health Insurance Connector Authority, which administers the Massachusetts law.

Gruber noted that the Connector has capped out-of-pocket costs and premiums for low-income people, ensuring that someone making less than three times the poverty level — about $32,000 for a single person — will pay no more than around 10 percent of their income each year. He acknowledged, however, that those who earn between three and five times the poverty level may have a harder time finding affordable insurance.

Jon Kingsdale, executive director of the Connector, added that out-of-pocket costs for people who earn two to three times the poverty rate are similar to what most people in that income range pay for insurance through their employer.

“Their criticism that we substantially raised cost-sharing for most of the people we’ve helped… is absolutely untrue,” Kingsdale said.

He also noted that while some low-income Boston and Cambridge residents could obtain comprehensive care free of charge before the law passed, most people living outside the metropolitan area then lacked access to drug benefits and broad range of specialist care. Insurance provides access to comprehensive care, he said.

Data on uninsurance is not perfect, he added, but that surveyors went to great lengths to be accurate.

Kingsdale also said the doctors’ analysis did not accurately portray the cost of subsidized insurance for low-income people; Kingsdale said the cost in the 2008 fiscal year was $800 million, not more than $1 billion.

Seattle City Council endorses single payer health

Strange Bedfellows blog
Seattle Post-Intelligencer
Wednesday, February 18, 2009

Since early days of Bill Clinton’s administration, 16 years ago, Rep. Jim McDermott has carried the torch for a national single-payer health program. A Washington Post profile characterized his devotion to the cause as bordering on religious.

At one point in the early 1990’s, McDermott had nearly 90 House cosponsors for a Canada style national health program.

Single payer seemed like a futile cause during the Bush Administration, which put forward ideals for the partial privatization of Medicare.

Now, with a Democrat back in the White House — and a promise of action on health care – McDermott, and Rep. John Conyers, D-Mich., have introduced versions of a single payer plan in the new Congress.

On Wednesday, they received some support — not in Washington, D.C, but in the “other” Washington.

The Seattle City Council voted unanimously to support the McDermott and Conyers proposals.

The legislation would replace private insurance with guaranteed comprehensive coverage, and be paid for through the tax system. Both the McDermott and Conyers bills would cover all Americans.

Seattle, with a reputation as one of America’s most liberal cities, becomes the 49th city and/or municipal government to pass such a resolution.

The resolution of support was sponsored by Councilman Nick Licata.

Massachusetts' plan is the wrong model for the U.S.

Massachusetts’ Plan: A Failed Model for Health Care Reform

Prepared by Dr. Rachel Nardin, Assistant Professor of Neurology, Harvard Medical School, with Drs. David Himmelstein and Steffie Woolhandler (both Associate Professors of Medicine, Harvard Medical School)
February 18, 2009
Executive Summary
The Massachusetts Health Reform Law of 2006 expanded Medicaid coverage for the poor and made available subsidized, Medicaid-like coverage for additional poor and near-poor residents of the state. It also mandated that middle-income uninsured people either purchase private health insurance or pay a substantial fine ($1,068 in 2009). Smaller fines (up to $295 per employee) were also levied on employers who fail to offer insurance benefits.
The reform law has not achieved universal health insurance coverage, although half or more of the previously uninsured now have some type of insurance policy.
The reform has been more expensive than expected, costing $1.1 billion in fiscal 2008 and $1.3 billion in fiscal 2009. In the face of a state budget crisis in fall 2008, Gov. Deval Patrick announced that he will keep the reform afloat by draining money from safety-net providers such as public hospitals and community clinics.
While the number of people lacking health insurance in Massachusetts has been reduced, several recent surveys demonstrate that substantial problems in access to care remain in the state. While the new health insurance improved access to care for some residents, many low-income patients who previously received completely free care under the state’s old free care program now face co-payments, premiums and deductibles that stop them from getting needed care.
In addition, cuts to safety-net providers have reduced health resources available to the state’s remaining uninsured, as well as to others who rely on safety-net providers for services in short supply in the private sector. These safety-net services include emergency room care, chronic mental health care, and primary care. The net effect of this expensive reform on access to care is at best modest, and for some patients, negative.
By mandating that uninsured residents purchase private health insurance, the law reinforced the economic and political power of health insurance firms. Thus, the reform augments the already high administrative costs of health care. Moreover, the agency that administers the new law (the “Connector”) adds an extra 4 to 5 percentage points to the already high overhead of private health insurance policies.
The reform failed to reduce overreliance on expensive, high-technology services. Indeed, some of its provisions such as changes in Medicaid rates and cuts to safety-net providers (who do more primary care) have further tilted health spending toward expensive, high-technology care.
A single-payer system of non-profit national health insurance could save about $8-$10 billion annually in the state through reduced administrative costs. This money could be used to cover all of the state’s uninsured residents and to improve coverage for those who now have insurance, without any increase in total health care costs.
The Massachusetts reform law is not providing universal access to care, even in a state with highly favorable circumstances, including previously high levels of spending on health care for the poor, high personal incomes, and low rates of uninsurance. It is not a model for the nation.
Report: Massachusetts’ Plan: A Failed Model for Health Care Reform
https://pnhp.org/mass_report/mass_report_Final.pdf
Press release: Massachusetts Is No Model for National Health Care Reform
https://pnhp.org/news/2009/february/massachusetts_is_no_.php

Those supporting the leading Democratic model for reform frequently cite the Massachusetts plan as an example of how building on our current system of health care financing is the best path to success. Unfortunately, they use selected positive numbers to define success, while ignoring the fact that Massachusetts has failed in its efforts to achieve the real goals of reform. You can understand how pathological the politics of reform has become when they have to dig into the data of a failed reform effort in order to redefine failure as a success.
Let’s look at some of the goals, and how Massachusetts has fared:
* Everyone should be included – We should quit being dishonest when we say universal, and start demanding that universal means absolutely everyone. The Massachusetts model has left perhaps five percent of individuals without any coverage whatsoever, and there is little likelihood that the numbers of uninsured will be reduced further because of serious flaws in their model.
* The growth in health care costs must be slowed – The Massachusetts model has been ineffective in addressing the primary causes of excess cost escalation.
* Health care must be affordable for each individual – Insurance premiums and cost sharing in private plans have remained unaffordable for many in Massachusetts, impairing access to care. Insurmountable debt or personal bankruptcy from medical bills remains a very real threat in Massachusetts.
* Under-insurance must be eliminated – Massachusetts has expanded the problem of under-insurance in an attempt to make premiums affordable, failing to achieve either goal of adequate plans or affordable premiums.
* Administrative waste must be reduced – Massachusetts has added complexity to an already complex financing system, significantly increasing the administrative waste in their system.
* Coverage should be automatic, portable, and permanent – Massachusetts has provided further confirmation that no model built on our dysfunctional financing system can achieve these goals.
* Health care must be accessible – The Massachusetts model has further exacerbated the deficiencies in the state’s primary care infrastructure, resulting in increased difficulty in accessing their system. Their fragmented financing model has very little capability of realigning resource allocation to improve access.
* Private intermediaries that waste resources and impair access must be eliminated – But isn’t this what the Massachusetts plan is all about? Their view is that we must use our public agencies and tax funds in an all-out effort to protect the private insurance industry, regardless of the harm to patients in the form of physical suffering and financial hardship.
Suppose Congress and the administration accept the message that the Massachusetts plan is the wrong model for reform. Will they then move forward with a single payer national health program – a model that would actually achieve our goals? It is unlikely, based on all signals emitting from Washington. Instead, they will develop a uniquely American plan designed for Americans.
It will be a plan built on our uniquely American, dysfunctional, fragmented system of financing health care. But it won’t be like the Massachusetts plan that was developed in a wealthy state with greater health care resources, and with fewer financing problems than the rest of the nation. No, it won’t be like Massachusetts. It will be much worse… much, much worse.

Massachusetts' plan is the wrong model for the U.S.

Massachusetts' Plan: A Failed Model for Health Care Reform

Prepared by Dr. Rachel Nardin, Assistant Professor of Neurology, Harvard Medical School, with Drs. David Himmelstein and Steffie Woolhandler (both Associate Professors of Medicine, Harvard Medical School)
February 18, 2009

Executive Summary

The Massachusetts Health Reform Law of 2006 expanded Medicaid coverage for the poor and made available subsidized, Medicaid-like coverage for additional poor and near-poor residents of the state. It also mandated that middle-income uninsured people either purchase private health insurance or pay a substantial fine ($1,068 in 2009). Smaller fines (up to $295 per employee) were also levied on employers who fail to offer insurance benefits.

The reform law has not achieved universal health insurance coverage, although half or more of the previously uninsured now have some type of insurance policy.

The reform has been more expensive than expected, costing $1.1 billion in fiscal 2008 and $1.3 billion in fiscal 2009. In the face of a state budget crisis in fall 2008, Gov. Deval Patrick announced that he will keep the reform afloat by draining money from safety-net providers such as public hospitals and community clinics.

While the number of people lacking health insurance in Massachusetts has been reduced, several recent surveys demonstrate that substantial problems in access to care remain in the state. While the new health insurance improved access to care for some residents, many low-income patients who previously received completely free care under the state’s old free care program now face co-payments, premiums and deductibles that stop them from getting needed care.

In addition, cuts to safety-net providers have reduced health resources available to the state’s remaining uninsured, as well as to others who rely on safety-net providers for services in short supply in the private sector. These safety-net services include emergency room care, chronic mental health care, and primary care. The net effect of this expensive reform on access to care is at best modest, and for some patients, negative.

By mandating that uninsured residents purchase private health insurance, the law reinforced the economic and political power of health insurance firms. Thus, the reform augments the already high administrative costs of health care. Moreover, the agency that administers the new law (the “Connector”) adds an extra 4 to 5 percentage points to the already high overhead of private health insurance policies.

The reform failed to reduce overreliance on expensive, high-technology services. Indeed, some of its provisions such as changes in Medicaid rates and cuts to safety-net providers (who do more primary care) have further tilted health spending toward expensive, high-technology care.

A single-payer system of non-profit national health insurance could save about $8-$10 billion annually in the state through reduced administrative costs. This money could be used to cover all of the state’s uninsured residents and to improve coverage for those who now have insurance, without any increase in total health care costs.

The Massachusetts reform law is not providing universal access to care, even in a state with highly favorable circumstances, including previously high levels of spending on health care for the poor, high personal incomes, and low rates of uninsurance. It is not a model for the nation.

Report: Massachusetts’ Plan: A Failed Model for Health Care Reform
https://pnhp.org/mass_report/mass_report_Final.pdf

Press release: Massachusetts Is No Model for National Health Care Reform
https://pnhp.org/news/2009/february/massachusetts_is_no_.php

Comment:

By Don McCanne, MD

Those supporting the leading Democratic model for reform frequently cite the Massachusetts plan as an example of how building on our current system of health care financing is the best path to success. Unfortunately, they use selected positive numbers to define success, while ignoring the fact that Massachusetts has failed in its efforts to achieve the real goals of reform. You can understand how pathological the politics of reform has become when they have to dig into the data of a failed reform effort in order to redefine failure as a success.

Let’s look at some of the goals, and how Massachusetts has fared:

* Everyone should be included – We should quit being dishonest when we say universal, and start demanding that universal means absolutely everyone. The Massachusetts model has left perhaps five percent of individuals without any coverage whatsoever, and there is little likelihood that the numbers of uninsured will be reduced further because of serious flaws in their model.

* The growth in health care costs must be slowed – The Massachusetts model has been ineffective in addressing the primary causes of excess cost escalation.

* Health care must be affordable for each individual – Insurance premiums and cost sharing in private plans have remained unaffordable for many in Massachusetts, impairing access to care. Insurmountable debt or personal bankruptcy from medical bills remains a very real threat in Massachusetts.

* Under-insurance must be eliminated – Massachusetts has expanded the problem of under-insurance in an attempt to make premiums affordable, failing to achieve either goal of adequate plans or affordable premiums.

* Administrative waste must be reduced – Massachusetts has added complexity to an already complex financing system, significantly increasing the administrative waste in their system.

* Coverage should be automatic, portable, and permanent – Massachusetts has provided further confirmation that no model built on our dysfunctional financing system can achieve these goals.

* Health care must be accessible – The Massachusetts model has further exacerbated the deficiencies in the state’s primary care infrastructure, resulting in increased difficulty in accessing their system. Their fragmented financing model has very little capability of realigning resource allocation to improve access.

* Private intermediaries that waste resources and impair access must be eliminated – But isn’t this what the Massachusetts plan is all about? Their view is that we must use our public agencies and tax funds in an all-out effort to protect the private insurance industry, regardless of the harm to patients in the form of physical suffering and financial hardship.

Suppose Congress and the administration accept the message that the Massachusetts plan is the wrong model for reform. Will they then move forward with a single payer national health program – a model that would actually achieve our goals? It is unlikely, based on all signals emitting from Washington. Instead, they will develop a uniquely American plan designed for Americans.

It will be a plan built on our uniquely American, dysfunctional, fragmented system of financing health care. But it won’t be like the Massachusetts plan that was developed in a wealthy state with greater health care resources, and with fewer financing problems than the rest of the nation. No, it won’t be like Massachusetts. It will be much worse… much, much worse.

Single payer: mainstream and 'shovel ready'

The following letter was sent to the editor of The New Yorker on Jan. 22.

In “Getting there from here” (Jan. 26), Atul Gawande suggests that the Massachusetts 2006 mandate plan is a model for national health care reform. He sees his stance as pragmatic, politically feasible, rooted in the particular history of American health care and gifted with the commonsense wisdom that we must start from where we are. Advocates of national health insurance (single payer) are characterized as ideologically driven extremists with “contempt” for pragmatists. I respectfully disagree.

Most Americans, including most physicians, supported national health insurance even before the recent economic collapse, polls show. Endorsers of the single payer bill H.R. 676 (Expanded and Improved Medicare for All) include 93 co-sponsors in the House of Representatives, 450 union organizations in 45 states, and countless others representing a wide range of constituencies. This is not a fringe movement.

High costs are the root cause of Americans’ health insecurity. Gawande’s analysis is flawed by use of a framework centered on insurance coverage rather than the more fundamental issue of health care value. Gawande sees employer-based coverage as the “path-defining” element of our current system because most people are covered by it. Well, it’s all in how you look at it. We need to keep our eyes on the prize, the health care dollar, and follow the money. Government already dominates: tax dollars fund most health care expenditures in the U.S. This is because government covers the sickest and poorest people, tax-favors employer-based private insurance, and covers its own employees. To use Gawande’s metaphor, the lifeboat is already bigger than the “main boat” of American health care. This is where we start.

Gawande asserts that Massachusetts “recently became the first state to adopt a system of universal health coverage for its residents.” As Yogi Berra said, this is like déjà vu all over again. A nearly identical assertion was made twenty years ago by then Gov. Dukakis about Massachusetts’ 1988 reforms. More breathless proclamations heralded reforms in Oregon (1988), Minnesota (1992), Tennessee (1992), Vermont (1992), Washington (1993) and Maine (2003). These plans all had common themes: public spending initiatives, new regulations and mandates, and continued dominance of private insurance in covering low risk populations. None achieved universal coverage. The common denominator of the ultimate failure of all these plans was the absence of effective cost control. Two weeks ago Gov. Deval Patrick of Massachusetts warned that rising costs, “threaten to crush families and businesses and doom Massachusetts groundbreaking experiment with universal insurance.”

In the face of economic collapse and soaring unemployment, with a third of Americans forgoing medical care due to cost, “Job No. 1” is getting value for our health care dollar, not preserving employer-based health insurance. The repetition of failed experiments is not pragmatic, it is part tragedy and part farce. Electronic medical records, chronic disease management and more emphasis on prevention are all important for many reasons but we must admit that short- and long-term cost implications are unknown. Some of these measures may actually increase costs. Medicare is not perfect, but it is demonstrably more cost effective than private insurance and beloved by most Americans. It is “shovel ready.” Single-payer supporters say: everybody in, nobody out. Burned in the fires of the failed Clinton reforms, I believe Gawande misreads the plate tectonics of political possibility at this moment in history, asserting, “No, we can’t” when the opposite is true.

Laura S. Boylan, MD
Clinical Associate Professor of Neurology, New York University School of Medicine
Attending Neurologist, Department of Veteran’s Affairs
Board Member, Physicians for a National Health Program Metro NY