PNHP

Let’s hope Obama doesn’t blow it

Let’s hope Obama doesn’t blow it

By HELEN THOMAS
Seattle Post-Intelligencer
January 19, 2009

WASHINGTON — Barack Obama has the crushing burden of meeting some mile-high expectations that the American public has built up for his presidency.

Even before taking office, Obama has evoked more national support, excitement and high hopes than many of his predecessors. On the other hand, few have faced more problems at the outset of his presidency — two wars and a depressed economy with 7.2 percent jobless rate.

Lawmakers are reeling under the staggering projection of a $1.2 trillion annual budget deficit.

America is also involved in the mayhem in Gaza because of its support of Israel at the U.N. and by providing it heavy weapons.

It’s still a mystery on how Obama intends to approach these problems. He has been silent on most key issues on the ground that we have only one president at a time.

Fair enough, but it seems he could have spoken out against the slaughter in Gaza and embellished his credentials as an incoming peacemaker — and perhaps even saved lives.

If nothing else, the words that describe Obama’s political profile are “super-cautious” and “careful.”

He is treading slowly into the highest office in the land, trying to touch all bases and make new friends. He calls himself a “progressive” but he comes across as center-right, perhaps fearing to be called a “liberal.”

Obama seems intent on leaving his renowned “audacity” to the campaign trail rather than bring it to the White House.

Although there is pressure for a full-scale inquiry into the Bush administration’s use of torture techniques like water-boarding against suspected terrorists, Obama has indicated he has no interest in blaming President Bush or Vice President Dick Cheney for their roles in these despicable policies.

Obama said a week ago Sunday on ABC-TV that if someone has broken the law they should be prosecuted but that his legal advisers were still evaluating interrogation issues and past practices of the Bush intelligence agencies.

During the campaign, Obama sang a different tune, condemning the administration’s harsh interrogation practices. But that was yesterday. Now he says “we need to look forward” as opposed to “looking backwards.”

That flip flop is par for the course. Why should he offend the CIA, which was only following the president’s orders? Incidentally, the following-orders defense was rejected during the post-World War II Nuremberg war crime trials.

The American people certainly deserve to know why we have lost our moral standing in the world — or whether our new president is already in a protective mode of the nation’s dubious national security practices.

Obama acts as if he doesn’t have a dog in this fight. But as president these issues cannot be ignored.

Obama is being wooed by the ultra conservatives, apparently those still hoping they will retain their power position in Washington. Conservative columnist George Will gave a dinner in his honor and invited fellow right-wing columnists and commentators. Reports from insiders say he charmed them.

Obama later met with liberal journalists but not in a fancy social setting.

There is a lot on the incoming president’s plate — to put it mildly. Health care reform is one thing. With the economy in the tank and 47 million people without insurance, Obama should take a bold step and support a single-payer plan a la Social Security. It makes sense — and better still — it works.

Obama should also tear a page out of Franklin D Roosevelt’s book in leading our economic recovery during the Great Depression.

Public works put people to work. Welfare checks were available for the indigent to feed their families and to cope with hard times.

Like today the big problems were traced to Wall Street.

Many current government restrictions and oversight on banks and business were born of FDR’s “New Deal,” which unfortunately were ignored by the free marketers in recent years who apparently thought that prosperity would last forever.

In other words, Obama has a lot to prove. Let’s hope he doesn’t blow it.

Helen Thomas is a columnist for Hearst Newspapers. E-mail: helent@hearstdc.com. Copyright 2009 Hearst Newspapers.

HR 676: “Still the One”

by Tim Foley
Change.org Blog
January 17, 2009

The top vote getter among health care ideas in Change.org’s Ideas for Change competition was “Free Single-Payer Health Care for All.” This no doubt is cause for joy for many of you who frequent this page. Weekends have become something of a “Policy Spotlight” for me, with an extensive look at the VA system and the Wyden-Bennett plan over the past couple of weekends. This weekend, I’m focusing on HR 676 — the “Expanded and Improved Medicare for All Act” or, more popularly, the “United States National Health Insurance Act.” It’s probably going to be reintroduced into the House of Representatives in March, when it will once again take its place as the most viable path to a single-payer system that covers every American with quality care–no premiums, no deductibles and no co-pays.

Many of you who are health care activists will recognize it by bill number alone You’ve been toiling in the vineyards for its passage for years now. So rather than give a standard write-up of the bill, I’m going to post on it three times this weekend: “The Good,” why both the policy and the bill supporting it make so much sense and inspire so much loyalty among health care advocates; “The Bad,” those areas of the bill that could figuratively use a fresh coat of paint to reflect the different circumstances of today compared to when the bill was first written 4 years ago; and “The Ugly” — the purely political calculations (regardless of sound policy) that do or do not make it a palatable option.

The Good

So these are my 5 reasons why HR 676 is, in the words of Shania Twain, “still the one.”

1.) 8 of the 10 best health care systems in the world have single-payer

If you look at the World Health Organization’s 2000 rankings of the top 10 countries in terms of health outcomes — you’re not going to see us. Ditto for the top 25 countries. You’ll find us at 37th — just above Slovenia and Cuba. But if you look at the top 10, 8 have public, single-payer systems where the government collects higher taxes and guarantees quality health care to all of its citizens. The remaining two have huge percentages of the population in a public program as well.

The way that each country implements it is quite different, from the British system where the providers of care are also run by the government, to the system in New Zealand which requires cost-sharing with individuals through income-based co-payments. Some of them, like Taiwan, have figured out how to put together an interoperable and unified Health IT system while we’re still trying to get a national beta program underway. Some of them have been more successful than others in emphasizing primary care and preventative medicine, and some of them have found a way to measure performance based on quality and reimburse accordingly.

There is no doubt that having a unified system for reimbursement — the single-payer solution — has made implementing these major structural changes that lead to better health outcomes significantly easier than it has been to even attempt the same with our patchwork system. It’s easier to change direction while driving one big 10-wheeler truck than it is to maneuver 25 cards, each with their own driver.

Yes, we know the United States is not like other countries. We’ve got a larger, more spread out and more diverse population. We also are fiercely independent and innovative. We’re not going to grab France’s system and say “Wham! We are all Parisians now!” But we can’t forget that medicine is firmly rooted in science and evidence. We know certain cures work better than others because we test, and we test, and we test, and we let the evidence tell us what worked best. Health care professionals do their job when they look at all the evidence and do what they can to make the patient better. In this case, the patient is our broken health care system.

We’re not going to agree with the way every country conducts its internal business. That’s fine. But if you’re willfully ignoring the evidence that a single-payer system can be implemented in a way that allows us to get a grip on the full range of health care issues we face, that’s just ignoring the evidence. Small wonder the patient’s condition worsens.

(And one quick note: you’re going to fear monger about “socialized medicine” when Taiwan — TAIWAN — uses it? Really? I’m pretty sure their “resistance to communism” street cred is equal to ours.)

2.) HR 676 is based on our own experience

Everything about the way lead author Rep. John Conyers (who, by the way, is a righteous dude) has set up his plan for Medicare for All is based on a particularly American experience. He’s content not to reinvent the wheel but pick and choose from what works about the best, most successful and least controversial social programs America has come up with.

Looking through the details of his plan is like a guided tour of American history. Reflecting Social Security, everyone gets a Unites States National Health Insurance card in the mail with a unique ID number. There’s something of the simplicity of voter registration in the no-more-than-2-page application form the law would require (and a far cry from the multi-page paperwork marathon that people expect to go through when applying for benefits for their new job). Of course the root of the program is Medicare, which is currently administered by the Department of Health and Human Services. There’s a slight shifting of accountability, but it’s still recognizably the bureaucratic structure of Medicare. Currently, the Secretary appoints a Director for the Centers for Medicare and Medicaid who run the system. In HR 676, the Secretary appoints a Director for the National Health Insurance. Done and done.

Why is it so important that HR 676 be based on Medicare? Because we already know it works. Patient satisfaction for Medicare trumps patient satisfaction for any other system except for the VA (also a single-payer system). As mentioned, the administrative costs are 14.1% for private insurance and 3.1% for Medicare. (Even Medicaid, which has to navigate a complex maze of 50 different sets of state-based regulations, is only 7%). As mentioned, when Medicare competed with private insurance through Medicare Advantage, it unquestionably kicked its butt in terms of costs and patient satisfaction.

Medicare’s not perfect — there needs to be a lot of reform to the system to reform what we pay for and how much. We need to overhaul payment to include not just fee-for-service but coordinated care and approaches that pay doctors for all the work they do on a patient’s case, not just the 15-minute procedure that’s explicitly billable. But the task of reforming Medicare arguably becomes easier the more clout it has.

Most importantly, we know how to do this. We know how to administer quality care nationwide. We know how to deal with complex and chronic diseases. We know how to work private and public hospitals, primary care and specialist doctors, long-term care and mental health into the system. Government programs already account for 46% of health care spending in the US, and that’s focusing on the sickest and poorest members of society. A national health insurance system modeled on Medicare is adding capacity to a system that has proven over 43 years that it can handle it.

We don’t even need to look to what the Swiss are doing. We just need to focus on our own best practices.

3.) What would we be missing, exactly?

One of the arguments for keeping the private insurance industry is that, as with all things in the free market, it encourages innovation. It’s Business Evolution 101: Change or Die. Make a better product, or convince others that you have the better product and you will prosper and thrive. This “build a better mousetrap” instinct is embedded deep in our national DNA.

So you would think I would have an easier time answering the question, “What benefit does private insurance give over public insurance for patients?”

There are a few anecdotes about private HMOs improving care through better coordination. Maggie Mahar details the innovations at Group Health Cooperative in Seattle. Rather than paying fee for service, doctors are on a salary, since the insurance company is also the management for the care center. “In this case, the key is paying doctors for the time they spend e-mailing patients, returning phone calls, and doing research on their behalf. Because doctors are on salary, they are paid for everything they do–not just for the number of patients they manage to “see” in a given day.” She’s right, that’s a great innovation.

So great that it’s preserved in HR 676. HMOs that employ clinics and physicians and deliver care are the HMOs that are preserved in section 103(c) of HR 676 — provided they’re not for profit.

Look, a private insurance company’s job is to spread around risk — collect money from all to pay for the care of those who need it. The more money you take in that you don’t need to spend on care, the better you do, the higher your profits, the better your stock price. It should be no wonder, then, that all of the most remarkable innovations of the insurance industry have been towards the aggregation of profit. Using “experience rating” to offer better deals for young, healthy customers and making health care more expensive for those who need it; high deductible plans that adapt to the rising cost of health care by offering a plan with less monthly costs, but which provide less care; the HMO model of a network of providers, with its rigid system of paperwork and fees for going outside of network; limiting the amount of care that can be consumed in a year; and the practice of cherry-picking young, healthy patients through rejection based on “pre-existing conditions.” All of these are great profit improvements on the old non-profit Blue Cross Blue Shield models of the mid 20th Century — and all of them are pretty crappy for patient care.

The simple fact is that if private insurance companies were interested in innovating and improving the quality of health care instead of just profit, it would have happened already. But HR 676 is actually interested in innovation based on prevention, changing the structure of provider reimbursement, community based care, negotiating prices on prescription drugs, and health disparities — so much so that it’s written into the law.

4.) Choicus Maximus

Much like the crowd in the Coliseum cheering on Russell Crowe, we tend to instinctively rally around uncompromising notions of individualism. The line that constantly comes up when people argue against any government intervention in health care is, “Do you want a government bureaucrat choosing your doctor?” No we don’t! Freedom! Maximus! Maximus!

Honestly, it’s a non sequitur. There is next-to-no choice in the system we have now. You take what your employer gives you in terms of coverage or you buy your own. In either case, you choose your doctor based on who takes your plan. Sometimes that’s a lot, sometimes that’s a little. I have a pretty good plan myself, but I know I haven’t always been able to go to the specialist referred to by my primary care physician because he didn’t take my insurance. Even keeping my primary care doctor was potentially a little awkward when I switched jobs.

Medicare is better — you choose your primary care doctor, or specialist, or long-term care provider or what have you fairly easily, since the overwhelming number of doctors still take Medicare. A friend of mine recently got her Medicare card and now, as she says, “I have almost too many choices!”

Granted, more doctors stop taking Medicare patients each year because of low reimbursement rates (although I haven’t been able to find hard numbers to back up the anecdotes.) Providers are enabled to do that because they can get a better deal from another plan. But if everyone is covered under the National Health Insurance plan, there are no better deals — most doctors will return to the system. If we’re really serious about wanting a choice, do we want a solution that truly maximizes choice, or just empty rhetoric?

5.) “We’ve got the tools, we’ve got the talent.”

A single-payer system solves coverage, but what about quality and cost — the other two legs of our universal health care stool? After all, none of those well-performing countries have quality, affordable health care through universal coverage alone?

Some cost savings comes from cutting administrative costs, putting the National Health Insurance program into a better negotiating position when it comes to prescription drugs and the economy of bulk purchasing of medical supplies. Conyers estimates these would save $387 billion per year. It would drop the per capita spending in the U.S. from about $7,400 to about $6,100 — a good start, if still much higher than any other country.

Far more intriguing is the National Board of Universal Quality and Access. The major impediment to cutting costs is that there’s no uniform standard for what things should cost. Medicare has a strong influence in setting prices, but the National Board would take it even farther. Comprised of health care professionals, hospitals and long-term care institutions, advocacy groups, labor and patient advocates, the board members would have 6 year terms to insulate them from the demands of the political calendar. They would have two jobs — definite the best practices in care, and define the costs for that care.

Right now, Medicare reimbursement rates are set by the administration, from a combination of political appointments and career bureaucrats. The Secretary of HHS sets rules for reimbursement which can be overruled by Congress. They get advice from a number of groups (the AMA most prominently), but there’s no guarantee this is an evidence-based process so much as a politics-driven process.

Doctors, nurses, hospitals, patient advocacy, health care advocates and labor may or may not be the right combination, but they take the politics out of the system. Maybe… just maybe… they’ll also be immune from the fear of political calculation as well.

Medicare vote, MLK and BHO

H.R. 6675, The Social Security Amendments of 1965

Social Security Online
Legislative History
House of Representatives
Democrats
237 – Yea
48 – Nay
8 – Not Voting
Republicans
70 – Yea
68 – Nay
2 – Not Voting
Senate
Democrats
57 – Yea
7 – Nay
4- Not Voting
Republicans
13 – Yea
17 – Nay
2 – Not Voting
http://www.ssa.gov/history/tally65.html

As we reflect today on Martin Luther King’s gift to the nation, and on tomorrow’s historic inauguration, it seems fitting to look back at the vote that brought us Medicare. This was a vote for health care justice for our seniors, and a first step towards the dream, shared by Martin Luther King Jr then and Barack Obama now, of health care justice for all of us.
In 1965, the 57 Senate Democrats supporting the Medicare bill needed 10 Republicans to be able to invoke cloture if necessary. They received the support of 13 of the 32 Republicans. Opposition within the Democratic ranks was enough to prevent passage had these Republicans not supported the measure.
In 2009, to be able to invoke cloture the Democrats likely will need the support of one Republican plus one for each Democrat (or Independent) who breaks ranks, and that is out of 41 Republicans rather than 32.
Was passage of the Medicare bill feasible in 1965? It happened. Is comprehensive reform feasible now? Many contend that it is not because of the alleged increased polarization of politics.
Is it really true that Barack Obama has shifted from a liberal position to that of a moderate? Is it really true that he is going to try to govern from the middle while likely being frustrated in his efforts to bring about change because of the ability of either extreme to block the agenda of the other extreme?
Is all politics aligned along the bipolar linearity of the liberal/conservative agendas? Is Barack Obama actually positioning himself in the middle of this linear spectrum? Or is something else happening?
Using an analogy in geometry, points along a line are very confining and quite limiting in the realm of possibilities. If that line were rotated around a single point, the plane created certainly expands the possibilities, but is still very confining. Now imagine that plane being rotated around a linear axis to create three dimensions, not confined within a sphere, but extending toward infinity in all directions, with the added fourth dimension of time.
In this model, conservatism is at one point in a linear offshoot. Liberalism is at another point in a linear offshoot in the opposite direction. Moderates may think that they occupy the common meeting ground, but they are confined to a single point in the middle (think Blue Dogs).
Does this infinite four dimensional model represent the future to which Barack Obama is leading us? Is he discarding the old linear model that has caused so much harm and grief, and moving on to an all inclusive model that will work for all us us.
Maybe we are receiving a gift of a new start – a gift that Martin Luther King Jr would want us to have, and a gift that Barack Obama wishes to bring to us.
Today is a good day to take a mere six minutes of quality time to experience the hope that Americans are finally coming together:
Born Again American
http://www.bornagainamerican.org/

Correction and clarification of cloture vote

In 1965, when Medicare was enacted, cloture required two-thirds of those present and voting. My calculation was based on the assumption that the Democrats knew that they had only 57 votes, and would require 10 more if all Senators were present and voting. In fact, 10 did not vote so only 3 additional votes were required. Thus the Republican Senators actually gave them an extra margin of 10 votes (13 yea votes in total), but that could not have been known until the count revealed how many withheld their votes.
In 1975, the cloture rule was changed from two-thirds present and voting to three-fifths of those duly chosen and sworn. That fixes the number at 60 if all seats are filled.
In 2009, there are 56 Democrats duly chosen and sworn, plus Senators Sanders and Lieberman who usually vote with the Democrats. It is improbable that Norm Coleman’s challenge to Al Franken will be upheld, so the Democratic caucus will have 59 of the 60 votes required for cloture. Thus the Democrats will require 1 Republican to cross over, plus 1 more for each Senator that breaks ranks with the Democrats. (Obviously, 11 was in error – pure, simple klutz.)
Today’s message does not change. Let’s end the polarized divide and move on with an all inclusive model that will work for all of us. Let’s all become “Born Again Americans.” Martin Luther King Jr would want that, and tomorrow…
http://www.bornagainamerican.org/

Medicare vote, MLK and BHO

H.R. 6675, The Social Security Amendments of 1965

Social Security Online
Legislative History

House of Representatives

Democrats
237 – Yea
48 – Nay
8 – Not Voting

Republicans
70 – Yea
68 – Nay
2 – Not Voting

Senate

Democrats
57 – Yea
7 – Nay
4- Not Voting

Republicans
13 – Yea
17 – Nay
2 – Not Voting

http://www.ssa.gov/history/tally65.html

Comment:

By Don McCanne, MD

As we reflect today on Martin Luther King’s gift to the nation, and on tomorrow’s historic inauguration, it seems fitting to look back at the vote that brought us Medicare. This was a vote for health care justice for our seniors, and a first step towards the dream, shared by Martin Luther King Jr then and Barack Obama now, of health care justice for all of us.

In 1965, the 57 Senate Democrats supporting the Medicare bill needed 10 Republicans to be able to invoke cloture if necessary. They received the support of 13 of the 32 Republicans. Opposition within the Democratic ranks was enough to prevent passage had these Republicans not supported the measure.

In 2009, to be able to invoke cloture the Democrats likely will need the support of one Republican plus one for each Democrat (or Independent) who breaks ranks, and that is out of 41 Republicans rather than 32.

Was passage of the Medicare bill feasible in 1965? It happened. Is comprehensive reform feasible now? Many contend that it is not because of the alleged increased polarization of politics.

Is it really true that Barack Obama has shifted from a liberal position to that of a moderate? Is it really true that he is going to try to govern from the middle while likely being frustrated in his efforts to bring about change because of the ability of either extreme to block the agenda of the other extreme?

Is all politics aligned along the bipolar linearity of the liberal/conservative agendas? Is Barack Obama actually positioning himself in the middle of this linear spectrum? Or is something else happening?

Using an analogy in geometry, points along a line are very confining and quite limiting in the realm of possibilities. If that line were rotated around a single point, the plane created certainly expands the possibilities, but is still very confining. Now imagine that plane being rotated around a linear axis to create three dimensions, not confined within a sphere, but extending toward infinity in all directions, with the added fourth dimension of time.

In this model, conservatism is at one point in a linear offshoot. Liberalism is at another point in a linear offshoot in the opposite direction. Moderates may think that they occupy the common meeting ground, but they are confined to a single point in the middle (think Blue Dogs).

Does this infinite four dimensional model represent the future to which Barack Obama is leading us? Is he discarding the old linear model that has caused so much harm and grief, and moving on to an all inclusive model that will work for all us us.

Maybe we are receiving a gift of a new start – a gift that Martin Luther King Jr would want us to have, and a gift that Barack Obama wishes to bring to us.

Today is a good day to take a mere six minutes of quality time to experience the hope that Americans are finally coming together:

Born Again American

Mount Fuji: a poet’s dream

Correction and clarification of cloture vote

In 1965, when Medicare was enacted, cloture required two-thirds of those present and voting. My calculation was based on the assumption that the Democrats knew that they had only 57 votes, and would require 10 more if all Senators were present and voting. In fact, 10 did not vote so only 3 additional votes were required. Thus the Republican Senators actually gave them an extra margin of 10 votes (13 yea votes in total), but that could not have been known until the count revealed how many withheld their votes.

In 1975, the cloture rule was changed from two-thirds present and voting to three-fifths of those duly chosen and sworn. That fixes the number at 60 if all seats are filled.

In 2009, there are 56 Democrats duly chosen and sworn, plus Senators Sanders and Lieberman who usually vote with the Democrats. It is improbable that Norm Coleman’s challenge to Al Franken will be upheld, so the Democratic caucus will have 59 of the 60 votes required for cloture. Thus the Democrats will require 1 Republican to cross over, plus 1 more for each Senator that breaks ranks with the Democrats. (Obviously, 11 was in error – pure, simple klutz.)

Today’s message does not change. Let’s end the polarized divide and move on with an all inclusive model that will work for all of us. Let’s all become “Born Again Americans.” Martin Luther King Jr would want that, and tomorrow…

http://www.bornagainamerican.org/

KFF poll on health reform

The Public’s Health Care Agenda for the New President and Congress

Kaiser Family Foundation
January 15, 2009
The public ranks action on health care highly as part of efforts to stem the impact of the economic recession and also views reforming health care as one of the top priorities for President-elect Obama and Congress, according to a new national survey conducted by researchers from the Kaiser Family Foundation and the Harvard School of Public Health.
One of the key questions of health care reform is how to pay for it. The survey suggests that, as has long been the case, the public is split down the middle in its willingness to sacrifice financially in order to cover more individuals: roughly half (49%) say they are not willing to pay higher insurance premiums or taxes, while a similar percentage (47%) say they are. There are big partisan differences here, with most Democrats (59%) saying they are willing to pay, most Republicans unwilling to pay (67%), and independents divided (49% willing, 47% unwilling).
Any debate over health reform options will also involve negotiating the very different views of rank and file Democrats and Republicans. Democrats are significantly more likely to place a priority on action on health care, which ranks second on their priority agenda (61% say it is a top priority), compared to Republicans, who rank it eighth (23%). More than three-quarters (77%) of Democrats think health reform “is more important than ever” due to the economy, while six in ten (62%) Republicans believe the nation “cannot afford to take on health reform now.” Democrats are more likely to favor a big push on coverage, and as noted above, more willing to pay for it.
The survey also suggests that as in the past early support for a number of reform proposals could fade in the face of arguments that opponents might raise in a public debate. For example, seven in ten Americans (71%) say they favor the idea of employer mandates. But when given the argument often made by critics that this may cause some employers to lay off some workers support falls dramatically, to just under three in ten (29%). The same pattern holds on the topic of individual mandates. Roughly two in three (67%) favor requiring all Americans to have health insurance with help for those who could not afford it. When given the criticism that some people may be required to buy health insurance they find too expensive or do not want, support falls to two in ten (19%).
http://www.kff.org/kaiserpolls/kaiserpolls011509nr.cfm
Toplines (24 pages):
http://www.kff.org/kaiserpolls/upload/7853.pdf

There are no real surprises in this new poll on the public’s attitude toward health care reform. Most do believe that we are in a window of opportunity for reform based on the fact that the public ranks health care reform as one of the top priorities for President-elect Obama and Congress. But the feasibility of comprehensive reform comes into question when noting that 62 percent of Republicans believe that the nation cannot afford to take on health reform now, and only 23 percent of them believe that reform is even a priority.
As with all polls, there are concerns in this one as well.
Questions 10, 11 and 12 initially demonstrate public support for both an employer mandate and an individual mandate. But then asking about one trade-off for each (employers laying off workers, or individuals finding insurance to be too expensive) results in a dramatic decline in support for either option. Two lessons here: 1) support for the leading options is very fragile and can easily lead to failure in our efforts to achieve reform, and 2) since support plummets with only a single additional bit of information, it is quite clear that the public is very poorly informed on the fundamental policy issues of reform.
Question 13: “Would you be willing to pay more — either in higher health insurance premiums or higher taxes — in order to increase the number of Americans who have health insurance, or not?” The public is split, 47 percent saying they would, and 49 percent saying they would not. The problem with this question is that it presumes that covering more individuals will cost more money. That is true of the leading proposals under serious consideration, but it is not true of the single payer model.
They need to ask, “Would you support a government-administered insurance program that covered everyone and was financed through the tax system if that meant that most Americans would pay somewhat less than they are now paying for health care and only the wealthy would pay more?” Until now, polls asking only about government and taxes in health reform usually have provided about a 60 percent positive response.
Because this more complete question has not been asked, we can only speculate what the response would be, but the question does need to be asked. We should find out whether working Americans are willing to continue to beat up on themselves in order to provide the rich with financial protection that they don’t even need.

KFF poll on health reform

The Public's Health Care Agenda for the New President and Congress

Kaiser Family Foundation
January 15, 2009

The public ranks action on health care highly as part of efforts to stem the impact of the economic recession and also views reforming health care as one of the top priorities for President-elect Obama and Congress, according to a new national survey conducted by researchers from the Kaiser Family Foundation and the Harvard School of Public Health.

One of the key questions of health care reform is how to pay for it. The survey suggests that, as has long been the case, the public is split down the middle in its willingness to sacrifice financially in order to cover more individuals: roughly half (49%) say they are not willing to pay higher insurance premiums or taxes, while a similar percentage (47%) say they are. There are big partisan differences here, with most Democrats (59%) saying they are willing to pay, most Republicans unwilling to pay (67%), and independents divided (49% willing, 47% unwilling).

Any debate over health reform options will also involve negotiating the very different views of rank and file Democrats and Republicans. Democrats are significantly more likely to place a priority on action on health care, which ranks second on their priority agenda (61% say it is a top priority), compared to Republicans, who rank it eighth (23%). More than three-quarters (77%) of Democrats think health reform “is more important than ever” due to the economy, while six in ten (62%) Republicans believe the nation “cannot afford to take on health reform now.” Democrats are more likely to favor a big push on coverage, and as noted above, more willing to pay for it.

The survey also suggests that as in the past early support for a number of reform proposals could fade in the face of arguments that opponents might raise in a public debate. For example, seven in ten Americans (71%) say they favor the idea of employer mandates. But when given the argument often made by critics that this may cause some employers to lay off some workers support falls dramatically, to just under three in ten (29%). The same pattern holds on the topic of individual mandates. Roughly two in three (67%) favor requiring all Americans to have health insurance with help for those who could not afford it. When given the criticism that some people may be required to buy health insurance they find too expensive or do not want, support falls to two in ten (19%).

http://www.kff.org/kaiserpolls/kaiserpolls011509nr.cfm

Toplines (24 pages):
http://www.kff.org/kaiserpolls/upload/7853.pdf

Comment:

By Don McCanne, MD

There are no real surprises in this new poll on the public’s attitude toward health care reform. Most do believe that we are in a window of opportunity for reform based on the fact that the public ranks health care reform as one of the top priorities for President-elect Obama and Congress. But the feasibility of comprehensive reform comes into question when noting that 62 percent of Republicans believe that the nation cannot afford to take on health reform now, and only 23 percent of them believe that reform is even a priority.

As with all polls, there are concerns in this one as well.

Questions 10, 11 and 12 initially demonstrate public support for both an employer mandate and an individual mandate. But then asking about one trade-off for each (employers laying off workers, or individuals finding insurance to be too expensive) results in a dramatic decline in support for either option. Two lessons here: 1) support for the leading options is very fragile and can easily lead to failure in our efforts to achieve reform, and 2) since support plummets with only a single additional bit of information, it is quite clear that the public is very poorly informed on the fundamental policy issues of reform.

Question 13: “Would you be willing to pay more — either in higher health insurance premiums or higher taxes — in order to increase the number of Americans who have health insurance, or not?” The public is split, 47 percent saying they would, and 49 percent saying they would not. The problem with this question is that it presumes that covering more individuals will cost more money. That is true of the leading proposals under serious consideration, but it is not true of the single payer model.

They need to ask, “Would you support a government-administered insurance program that covered everyone and was financed through the tax system if that meant that most Americans would pay somewhat less than they are now paying for health care and only the wealthy would pay more?” Until now, polls asking only about government and taxes in health reform usually have provided about a 60 percent positive response.

Because this more complete question has not been asked, we can only speculate what the response would be, but the question does need to be asked. We should find out whether working Americans are willing to continue to beat up on themselves in order to provide the rich with financial protection that they don’t even need.

Are AHIP and PhRMA the enemies?

Drug coverage called key to reforming healthcare

By Jeffrey Young
The Hill
January 14, 2009
More generous insurance coverage of prescription drugs should be an essential part of any comprehensive proposal to overhaul the U.S. healthcare system, Big Pharma’s top lobbyist said Wednesday.
“Just getting insurance for everybody doesn’t do a doggone thing if it doesn’t insure the things you need and the things you ought to get in healthcare,” Pharmaceutical Research and Manufacturers of America (PhRMA) President and CEO Billy Tauzin told reporters.
“Let me say it as emphatically as I can: The pharmaceutical industry and the products we make are going to be a major part of the solution to healthcare access and affordability in this country,” said Tauzin, a former Republican House member from Louisiana.
“What we are deeply concerned about is if all of a sudden you decide to move to a single-payer system or you crowd out private competitors,” Tauzin said.
http://thehill.com/business–lobby/drug-coverage-called-key-to-reforming-healthcare-2009-01-14.html

And…

Obama, Reid take dead aim at Medicare HMOs

By Jeffrey Young
The Hill
January 14, 2009
Rep. Pete Stark (D-Calif.)… said last month that while even a Democratic bugbear like the Pharmaceutical Research and Manufacturers of America (PhRMA) should be consulted on health reform, health insurers could twist in the wind, as far as he was concerned.
“We’re not going to pass these plans if we don’t have the American Medical Association, the American Hospital Association — even PhRMA. You’re not going to get the insurance companies on board, I don’t think, but they’re the easiest to roll because nobody likes insurance companies. So, if they don’t like what we’re doing, I guess somebody has to be the bad guy,” said Stark, who chairs the Health Subcommittee of the Ways and Means Committee and will be one of the lead authors of House Democratic health reform legislation.
Stark has a sharper tongue than most of his colleagues, but his comments point up the challenges facing the health insurance industry as the health reform debate approaches.
http://thehill.com/leading-the-news/obama-reid-take-dead–aim-at-medicare-hmos-2009-01-14.html

The lobby organizations, America’s Health Insurance Plans (AHIP) and the Pharmaceutical Research and Manufacturers of America (PhRMA), have been amongst the most visible targets of those of us who have been fighting for comprehensive reform that would best meet the health care needs of all of us.
AHIP represents an administratively burdensome middleman industry that has impaired health care access for their own beneficiaries while failing to provide the financial security that is the very purpose of insurance. There is no moral basis for including them in a health care system designed to best meet the needs of patients.
PhRMA represents an industry that has thrived on over-priced products that often have been marketed to professionals and the public in a dishonest manner, frequently overstating the benefits of their products while failing to adequately reveal the potential for very serious adverse consequences that their products may cause. They have also obstructed efforts for us to be sure that the prices of their products are based on reasonable costs plus fair profits.
Both organizations have earned their tarnished reputations, since their self-serving advocacy has had a serious negative impact on patient/consumers, both financially and health-wise. But there is a very crucial difference between these two entities. Pharmaceuticals are an essential component of the health care system, whereas the private insurance industry is not essential and provides us with only negative value. We need to work with the pharmaceutical industry, but we need to tell the private insurers to go “twist in the wind.”
Pete Stark is right. We do have to sit down with representatives of the health care delivery system: the drug industry (PhRMA), the hospital industry (AHA), and physicians (PNHP instead of the AMA), amongst others. But the process should prohibit up front the trade-off of beneficial policies.
Pete Stark’s Health Committee needs to lay out the policies that will best serve the interests of patients. Then, without any compromise in the fundamentals, they can work with these sectors to refine those policies in order to maintain a vibrant health care delivery system that would best serve the interests of patients. Self-seving measures that don’t benefit patients should be rejected automatically.
While Karen Ignagni is twisting in the wind (AHIP), we should honor Billy Tauzin’s white flag (PhRMA). But as he enters the reform process, he needs to be reminded that single payer isn’t about the pharmaceutical industry; it’s about health care justice for everyone in America. Therefore, it’s not negotiable.

The potential impact of the World Trade Organization's General Agreement on Trade in Services on health system reform and regulation in the United States

By Nicholas Skala
International Journal of Health Services, January 2009

This article illustrates [WTO constraints on domestic policy] through an evaluation of the potential effects of current WTO law and jurisprudence on the implementation of a single-payer national health insurance system in the United States, proposed incremental national and state health system reforms, the privatization of Medicare, and other prominent health system issues.

You can read the article here.

The potential impact of the World Trade Organization’s General Agreement on Trade in Services on health system reform and regulation in the United States

By Nicholas Skala
International Journal of Health Services, January 2009

This article illustrates [WTO constraints on domestic policy] through an evaluation of the potential effects of current WTO law and jurisprudence on the implementation of a single-payer national health insurance system in the United States, proposed incremental national and state health system reforms, the privatization of Medicare, and other prominent health system issues.

You can read the article here.

Are AHIP and PhRMA the enemies?

Drug coverage called key to reforming healthcare

By Jeffrey Young
The Hill
January 14, 2009

More generous insurance coverage of prescription drugs should be an essential part of any comprehensive proposal to overhaul the U.S. healthcare system, Big Pharma’s top lobbyist said Wednesday.

“Just getting insurance for everybody doesn’t do a doggone thing if it doesn’t insure the things you need and the things you ought to get in healthcare,” Pharmaceutical Research and Manufacturers of America (PhRMA) President and CEO Billy Tauzin told reporters.

“Let me say it as emphatically as I can: The pharmaceutical industry and the products we make are going to be a major part of the solution to healthcare access and affordability in this country,” said Tauzin, a former Republican House member from Louisiana.

“What we are deeply concerned about is if all of a sudden you decide to move to a single-payer system or you crowd out private competitors,” Tauzin said.

http://thehill.com/business–lobby/drug-coverage-called-key-to-reforming-healthcare-2009-01-14.html

And…

Obama, Reid take dead aim at Medicare HMOs

By Jeffrey Young
The Hill
January 14, 2009

Rep. Pete Stark (D-Calif.)… said last month that while even a Democratic bugbear like the Pharmaceutical Research and Manufacturers of America (PhRMA) should be consulted on health reform, health insurers could twist in the wind, as far as he was concerned.

“We’re not going to pass these plans if we don’t have the American Medical Association, the American Hospital Association — even PhRMA. You’re not going to get the insurance companies on board, I don’t think, but they’re the easiest to roll because nobody likes insurance companies. So, if they don’t like what we’re doing, I guess somebody has to be the bad guy,” said Stark, who chairs the Health Subcommittee of the Ways and Means Committee and will be one of the lead authors of House Democratic health reform legislation.

Stark has a sharper tongue than most of his colleagues, but his comments point up the challenges facing the health insurance industry as the health reform debate approaches.

http://thehill.com/leading-the-news/obama-reid-take-dead–aim-at-medicare-hmos-2009-01-14.html

Comment:

By Don McCanne, MD

The lobby organizations, America’s Health Insurance Plans (AHIP) and the Pharmaceutical Research and Manufacturers of America (PhRMA), have been amongst the most visible targets of those of us who have been fighting for comprehensive reform that would best meet the health care needs of all of us.

AHIP represents an administratively burdensome middleman industry that has impaired health care access for their own beneficiaries while failing to provide the financial security that is the very purpose of insurance. There is no moral basis for including them in a health care system designed to best meet the needs of patients.

PhRMA represents an industry that has thrived on over-priced products that often have been marketed to professionals and the public in a dishonest manner, frequently overstating the benefits of their products while failing to adequately reveal the potential for very serious adverse consequences that their products may cause. They have also obstructed efforts for us to be sure that the prices of their products are based on reasonable costs plus fair profits.

Both organizations have earned their tarnished reputations, since their self-serving advocacy has had a serious negative impact on patient/consumers, both financially and health-wise. But there is a very crucial difference between these two entities. Pharmaceuticals are an essential component of the health care system, whereas the private insurance industry is not essential and provides us with only negative value. We need to work with the pharmaceutical industry, but we need to tell the private insurers to go “twist in the wind.”

Pete Stark is right. We do have to sit down with representatives of the health care delivery system: the drug industry (PhRMA), the hospital industry (AHA), and physicians (PNHP instead of the AMA), amongst others. But the process should prohibit up front the trade-off of beneficial policies.

Pete Stark’s Health Committee needs to lay out the policies that will best serve the interests of patients. Then, without any compromise in the fundamentals, they can work with these sectors to refine those policies in order to maintain a vibrant health care delivery system that would best serve the interests of patients. Self-seving measures that don’t benefit patients should be rejected automatically.

While Karen Ignagni is twisting in the wind (AHIP), we should honor Billy Tauzin’s white flag (PhRMA). But as he enters the reform process, he needs to be reminded that single payer isn’t about the pharmaceutical industry; it’s about health care justice for everyone in America. Therefore, it’s not negotiable.

Cancer Care, Simplified

“Medicare for All” is long overdue, according to cancer specialist Dr. Lou Balizet, who spoke at a health forum in Pueblo, Colorado on December 8, 2009

By Louis Balizet, M.D.

“Everybody talks about it, but nobody does anything about it.” So said Will Rogers about the weather, but he may as well have been referring to our health care system — roundly decried, but still intact. Finally, however, on both state and national levels, well designed plans have emerged to replace our current wasteful chaotic system with the only workable alternative — a single-payer, tax-financed system that eliminates private health insurance, provides universal coverage, and introduces adult supervision (centralized planning). Like the majority of American physicians, I feel that “medicare for all” is long overdue.

I am a medical oncologist who has practiced in Pueblo for 32 years. This is how I imagine my, and my patients’, lives changing under single-payer health care:

1. It will be easier, and cheaper, to administer intravenous chemotherapy to all patients. Currently, uninsured patients needing intravenous chemotherapy receive it in the hospital — a costly and inconvenient alternative to outpatient therapy.

2. Office overhead, and therefore cost, will be reduced by the elimination of the present complicated adversarial billing system, which pits armies of physicians’ employees against armies of insurance company employees (ties go to the insurance companies).

3. Inpatient cancer care will be consolidated, with benefits for patients, oncology nursing staff, and physicians. Central planning will inevitable force the cooperation,if not outright merger, of Pueblo’s two hospitals — an idea initially proposed by the administration of the two hospitals over a decade ago. (The merger was nixed by Uncle Sam’s anti-trust watchdogs, suspected by some of carrying water for the insurance companies.)

4. Approved oral chemotherapy will be available to all. At present, the indigent uninsured depend on physicians’ offices begging free oral drugs from insurance companies — a wasteful and demeaning process that, more often than not, fails to deliver needed treatment. Obviously, with financial status no longer an issue, compliance with treatment, and therefore treatment outcome, will improve.

5. Everybody, not just the insured, will be able to avail themselves of life-saving screening procedures, such as mammograms and colonoscopies. Treatment of cancer, if discovered, will be covered by single-payer universal health care. This will eliminate dangerous delays in care for fear of financial repercussions, which, believe me, happen in this community, and happen a lot.

6. Some marginally effective but outrageously expensive cancer treatments will not be available. Central planning will require the establishment of an American equivalent of Britain’s National Institute for Health and Clinical Excellence (“NICE”), charged with evaluating the value, not just the effectiveness, of new drugs, procedures, and devices. If a drug offers not cure, but only weeks more to a cancer patient’s life expectancy, and is prohibitively costly, society will not he harmed by its exclusion.

7. Consolidation of medical facilities will reach beyond hospital mergers. Pueblo currently has 6 MRI scanners and 2 CAT/PET scanners. These numbers would almost certainly be reduced under central planning, resulting in some delay, compared to now, in scheduling studies. By any rational standard, however, we have excess capacity in Pueblo; necessary studies, in an acceptable timeframe, should still be achievable.

8. Physician compensation would be determined at a state or national level. This would probably result in decreased income for specialists and increased income for primary care providers, as it has in countries with single-payer care. In addition, it would allow for bonusing doctors to practice in medically underserved areas. Pueblo has a worrisome shortage of some types of specialists but an ominous shortage of primary care providers. The present market-driven model of physician remuneration is not only incapable of addressing this problem, it is in large measure responsible for it. By ensuring that all care is remunerated, and by disproportionately rewarding practice in some areas, single-payer, centrally planned health care can do more than anything achievable under the present system to get doctors where they are needed. Enhanced access to primary care physicians would translate into earlier diagnosis of potentially serious conditions such as cancer. I would expect to see fewer advanced cases of cancer if patients did not have to consult their bank account before seeking help for their breast mass, or hoarseness, or bloody cough.

The most obvious winners under single-payer universal health care are patients, particularly those currently uninsured (now numbering upwards of 40 million, and sure to increase with the coming depression), and, I believe, doctors. However, there will be some adjustments, at times difficult. The hundreds of thousands of employees of insurance companies and hospitals and doctors’ offices who spend their entire workday wrangling over who gets to keep 15% of health care premiums will need to be redirected to more productive work — no small task, and one whose importance should not be minimized. Hospitals will revert to being service institutions instead of profit centers. Business acumen will cease to be a prerequisite for a satisfying medical practice. I have not even touched on the ramifications for the pharmaceutical industry, which will be major. However, for patients, especially cancer patients, and doctors, especially cancer doctors, the current system is unsustainable for much longer. Health Care For All Colorado, which proposes a single-payer system for our state, and Physicians for a National Health Plan, who designed a detailed national system, deserve your interest and support. Perpetuation of the current system is bad for our pocketbook, bad for our national pride, and downright malignant.

U.S. prisoners sicker than believed and have poor access to care

Harvard study also points to high social costs of undertreating mental illness

Embargoed until:
Jan. 15, 2009, 4:00 PM EST

Contacts:
Andrew P. Wilper, MD, MPH
Steffie Woolhandler, MD, MPH
Mark Almberg, (312) 782-6006

An article published today in the online edition of the American Journal of Public Health, based on the first-ever study of the health of all prison and jail inmates nationwide, reports high rates of serious illness and poor access to care among the nation’s inmate population.

The study, carried out by researchers at the Cambridge Health Alliance and Harvard Medical School, analyzed data collected from U.S. inmates in the 2002 Survey of Inmates in Local Jails and the 2004 Survey of Inmates in State and Federal Correctional Facilities.

Nationally, over 800,000 inmates – about 40 percent of the 2 million people in U.S. prisons and jails – reported having a chronic medical condition like diabetes, asthma or persistent heart or kidney problems, an illness rate far higher than other Americans of similar age. For example, the incidence of diabetes among federal inmates is 11.1 percent; among the age-adjusted general U.S. population, it is 6.5 percent.

The overwhelming majority of inmates surveyed were male, were younger than 35, and were disproportionately Black or Hispanic. About 10 percent were military veterans.

The researchers found that sick prisoners have poor access to care. For example, over 20 percent of sick inmates in state prisons and 13.9 percent in federal prisons had not seen a doctor or nurse since their incarceration. The same was true of 68.4 percent of jail inmates with persistent medical problems.

Besides care for physical illnesses, the authors also analyzed mental illness care among inmates both before and during incarceration. While about a quarter of inmates had a history of chronic mental illness like schizophrenia, bipolar disorder, depression or anxiety, two-thirds of them were off treatment at the time of their arrest. Only after their imprisonment did most of these inmates receive treatment.

Other key findings include the following:

* Compared to other Americans of the same age, the 1.2 million state prison inmates were 31 percent more likely to have asthma, 55 percent more likely to have diabetes, and 90 percent more likely to have suffered a heart attack.

* Access to care was worst in local jails and best in federal prisons. One-quarter of jail inmates who had suffered severe injuries had received no medical attention, versus 12 percent in state prisons and 8 percent in federal prisons.

* Inmates with medical problems like diabetes, which requires drug treatment, often had their vital medications stopped after their incarceration, including one-quarter of chronically ill state prisoners and 36.5 percent of inmates in local jails.

Dr. Steffie Woolhandler, a co-author of the study, is an associate professor of medicine at Harvard University and a primary care physician in Cambridge, Mass. She stated: “The U.S. incarcerates more people per capita than any other nation. For many of them, treatment of their mental illness before their arrest might have prevented criminality and the staggering human and financial costs of incarceration.”

Dr. Andrew P. Wilper, the study’s lead author, is currently with the University of Washington School of Medicine. He remarked: “A substantial percentage of inmates have serious medical needs. Yet many of them don’t get even minimal care medical care. These prisoners are denied their constitutionally guaranteed right to care.”

Wilper added: “Twelve million Americans are released from prisons and jails each year. These individuals and the communities to which they return suffer as many carry with them the costs of untreated illness and preventable disability. Inmates are overpaying their debt to society when they are denied access to health care.”

###

Click here for the abstract of the study.

“The Health and Health Care of U.S. Prisoners: A Nationwide Survey,” Andrew P. Wilper, MD, MPH; Steffie Woolhandler, MD, MPH; J. Wesley Boyd, MD, PhD; Karen E. Lasser, MD, MPH; Danny McCormick, MD, MPH; David H. Bor, MD; and David U. Himmelstein, MD. American Journal of Public Health, Vo. 99, No. 4.

The research was supported by a National Service Research Award.

Physicians for a National Health Program, a membership organization of over 15,000 physicians, supports a single-payer national health insurance program.