By Saul Friedman
Newsday
Gray Matters
December 13, 2008

Here’s a question for Medicare beneficiaries and those who will soon become eligible: Why should you care about the estimated 47 million American men, women and children who have too little or no health coverage?

The answer: Because there is some danger that Medicare and the 45 million older and disabled people it serves could become caught in a generational conflict in the coming campaign to extend health coverage to the uninsured – a conflict between those who have and those who have not. What part, if any, will Medicare play in the health care reforms? Medicare’s needs may simply get lost in the smoke of battle. But there is another way, which we’ll get to presently.

Medicare’s costs are $450 billion a year and growing rapidly. Its Part D drug benefit is confusing and more expensive than expected. Critics say Medicare’s growth may overwhelm the federal budget, and its friends acknowledge its shaky finances need to be fixed. As a result of these fears, a new coalition of Medicare defenders has formed the Alliance to Restore Medicare, to roll back the weakening of the public portions of the program during Republican rule.

In addition, Medicaid, the federal-state program for the poor and the elderly, costs around $200 billion a year and places an increasingly heavy budget burden on states, which are cutting benefits and restricting help for the elderly who need Medicaid for long-term care. And congressional Democrats intend next year to add millions to the State Children’s Health Insurance Program (SCHIP), which President George W. Bush opposed as a “step toward socialism.”

With such problems looming among many others facing the new administration, my experience covering Congress tells me that it will be difficult for members to focus on fixing Medicare while they are occupied with the popular cause of providing health insurance for younger workers and their families who have little or no protection.

Another conflict: Medicare is a mostly government-run program, while most of the proposals to cover the uninsured would depend largely on private insurance. That likely will rekindle the ideological struggle in Congress between Democrats who favor a wider government role and Republicans who favor reliance on the market.

In the coming battles, industry lobbyists will crowd the congressional corridors to follow up on contributions they have poured into Capitol Hill, and pay for advertising campaigns like those that killed the 1993 attempt by then-President Bill Clinton to provide universal health care. On the other side, health care and union lobbyists will fight for their views, but they won’t have the financial clout of industry.

In the 2008 elections, according to Opensecrets.org, the insurance industry contributed $38.2 million to presidential and congressional candidates, split between Republicans (54 percent) and Democrats (46 percent).

Senate Finance Committee chairman Max Baucus, (D-Mont.) who had an easy race (he won with 72 percent of the vote) will be a key player in the effort to extend coverage to all Americans. Baucus got $269,000 from the insurance industry. He was eighth among senators, behind John McCain ($2 million). Barack Obama ($1.5 million) and Hillary Clinton ($1.2 million), all of whom supported similar proposals.

Last month, Baucus introduced legislation to provide health care protection for the uninsured. It was widely praised, but Baucus based his proposal on the use of private insurance to be paid for by employers, individuals and/or the government.

At least a dozen other lawmakers, including Sen. Edward Kennedy (D-Mass.), have their own ideas. But all of them would use private insurance companies to provide the coverage, with all the problems consumers face with insurance coverage restrictions. Their administrative costs are nearly 20 percent, including stockholder dividends and executive salaries. Liberal economist Dean Baker said of the insurance industry: “The health care system’s waste is their profit.”

There is another possibility. Some call it single-payer, but more easily understood, is a proposal backed by the 5,000 Physicians for a National Plan (including mine) that would gradually provide Medicare for everyone who wants it and would pay a premium.

Medicare, all polls show, is the nation’s most popular health insurance plan – even among the young. But for me, the most compelling argument for “Medicare for All” is this: Unless the risk pool for Medicare grows and is strengthened to include millions of younger, healthier workers, their families and their kids, Medicare as we know it could die of old age. And with out-of-pocket costs soaring and people leaving Medicare for private, Medicare Advantage plans, the Congressional Budget Office has warned that original Medicare is in danger of becoming another private insurance plan.

Congress has before it a proposal for “Medicare for All,” which I have written about, introduced in February 2007 by Rep. John Conyers Jr., (D-Mich.). He’s been in Congress since 1965, the second- longest-serving House member. I mention this because Conyers, chairman of the House Judiciary Committee, is a liberal of substance and influence.

His proposal, which you may read at johnconyers.com/healthcare or thomas.loc.gov/cgi-bin/bdquery/z?d109:h.r. 00676: has 94 co-sponsors, including some House veterans. Called the U.S. National Health Insurance Act or The Expanded and Improved Medicare for All Act, it also has the endorsement of most labor unions, thousands of doctors, nurses and health care professionals.

The bill does not call for socialized medicine, but rather an extension of the Medicare model to include all Americans. It would absorb such programs as Medicaid, SCHIP and be paid for by taxes and premiums. It could relieve auto manufacturers and other businesses of paying for health insurance for employees and retirees. Its sponsors say it would save $300 billion a year in administrative costs, for it would deny insurance companies a role.

Getting over that hurdle may be why HR 676 has gotten so little publicity, even from alleged friends of older people. There is no mention of it on the Web site of AARP, which earns $700 million a year in royalties on the sale of private health insurance it sponsors. Even the Kaiser Family Foundation, which has the most complete Web site for health care information, has virtually ignored HR 676. It may not pass, but it should have a place in the coming discussion.

WRITE TO Saul Friedman, Newsday, 235 Pinelawn Rd., Melville, NY 11747-4250, or by e-mail at saulfriedman@comcast.net.

http://www.newsday.com/news/columnists/ny-bzsaul5962994dec13,0,6902079.column

by Paul Bass
New Haven Independent
December 10, 2008

Who’s a health care moderate? And what would “Give ‘Em Hell” Harry Truman say today?

Those questions — from health care debates past and present — emerged Wednesday from a presentation at the Greater New Haven Chamber of Commerce’s 2009 Regional Economic Outlook Breakfast at the Lawn Club.

The presentation was made by Martha Wofford, Northeast manager for Aetna’s Consumer Segment.

She filled in hundreds of local businessfolk on where the current political battle over health care reform stands. She made the presentation at a time when activists and politicians from President-Elect Barack Obama on down are promising to overhaul a broken system at both the state and federal levels.

The main new reform plan being advanced in Connecticut was unveiled this week by the Universal Health Care Foundation. It calls for an end to insurers denying coverage based on pre-existing conditions, and limits the size of deductibles and co-pays, among other changes. A centerpiece of the plan is expanding the state employees’ health plan to include people who work for themselves, for not-for-profits, for local governments, or for small businesses. (Click here and here for details.)

By Wofford’s account, “extreme left”ists are pushing government-paid health coverage for all. “Conservatives” consider any government involvement in health care “bad.” Meanwhile “most Americans” — and her insurance company — are the sensible “moderates” working toward a solution to cover at least some of the nation’s 45.7 million uninsured people, with some government help.

Wofford’s presentation began with a mystery quote. Who, she asked the Chamber members in the crowd, said the following?

“Millions of our citizens do not now have a full measure of opportunity to achieve and enjoy good health. Millions do not now have protection or security against the economic effects of sickness. The time has arrived for action to help them attain that opportunity and that protection.”

Wofford revealed the answer at the end of her talk: President Harry S. Truman.

Afterward, she said used the quotation for inspiration, to set the tone for her remarks. She said she wanted “to show that health care has been a challenging issue since 1945.”

The quotation came from a Nov. 19, 1945 speech in which Truman advocated a national government-sponsored universal health care system. Here’s the speech.

She said she didn’t know a lot about the health care plan Harry S. Truman pushed at the time. It was a universal health care plan. Government-run. Business interests like General Motors killed it by arguing that Americans don’t trust government to run health care. They argued that private interests do it better — private insurers, and private companies that offer the insurance plans to employees. Six decades later, companies like GM are struggling to stave off bankruptcy in part because of out-of-control health care costs.

Road Map

Harry Truman would have shown up at one extreme of the ideological road map Wofford presented Wednesday morning. (It’s pictured at the top of this story.)

She divided three main approaches to health care into three camps. On the left was a column headlined “liberal.” In her remarks, she referred to people espousing the positions there as the “far left.”

These people see health care “coverage as a right.” In their view, the “private sector creates market failures.” So they support expanded “government-based solutions” like a “single payer system.” Their mantra: “Regulation is Good.”

At the other end of Wofford’s spectrum are “Conservatives” like the McCain presidential campaign. They see health care “coverage as a commodity.” They trust in “free market,” “private sector solutions,” with a “lean” role for government. Their mantra: “Regulation is Bad.”

In the center? The “moderates.” That’s most of us. And Wofford’s employer. “The American people are right in the middle,” she said. “Aetna is also in the middle.”

This group advocates a “reasonable” public role in health care. It sees universal coverage as a “goal” to work toward. It supports solutions based on “public-private partnerships,” government working in tandem with insurers and employers.

Wofford pointed out that 85 percent of Americans do have health insurance. Most of them get insurance through employers. She argued that the employer-based system works best and should stay in place. She advocated a “pay of play” system for employers, encouraging them to offer employees insurance, fining them if they don’t.

The 15 percent of the country without insurance needs attention, in a variety of ways, she argued.

Of the 45.7 million uninsured, she reported, 11 million are eligible for Medicaid, but are not enrolled. So part of the solution is to figure out how to enroll them. She favors a Massachusetts-style mandate on individuals to have health insurance, the way the law requires that drivers have car insurance.

Another 9.7 million of the uninsured aren’t U.S. citizens, she said. Many of them are here legally, but could use help being plugged into the system.

More than 9 million uninsured adults have annual incomes above $75,000, according to Wofford. That means any health care solution needs to look at controlling spiraling health costs so those people can afford to buy in, she said.

The remaining 13 to 16 million people “need a government plan,” she said.

A Peer Review

Reviewing Wofford’s PowerPoint later on Wednesday, a Yale health care policy historian called the presentation “a desperate attempt to protect and preserve a failed for-profit market for health insurance.” One that benefits private insurers like Aetna.

Harry Truman would be aghast, in the view of the historian, history professor Jennifer Klein. Klein (pictured) wrote the 2003 prize-winning book For All These Rights, which detailed the development of the American system of employer-based health insurance and pension benefits.

Klein said that the presentation left out a key reason so many people can’t afford or find health care: “the for-profit imperatives in the whole system.”

“We’ve had over five decades to see how the commercial insurance market works as
the key means of providing health care access,” Klein said. “The bottom line is that in all that time health care has gotten neither more affordable nor more accessible. Numerous policy fixes have been applied to goad the private health insurance system toward universality or to rein in costs. As we can see, these goals are no more within reach than they were 20 or 30 years ago.”

She added that Wofford’s statistic about the prevalence of employer-offered health insurance is outdated. Employers are raising premiums or eliminating coverage by the day — and in the recession laying off employees en masse.

“The employer providing coverage is a system that’s on the decline. It peaked in the late 1970s,” Klein said.

Harry Truman did in fact propose a “government-run” single-payer plan, Klein said. People often confuse such “government-run” proposals with nationalized medical systems, she said.

“Truman believed in expanding social security to include a universal health plan. He wanted to amend the Social Security Act to include national health insurance. Government would replace private insurance companies,” Klein said.

“You have to be careful about ‘government run.’ People think that means hospitals are government hospitals, and doctors are government doctors. [Rather] it was about the insurance mechanism. It was about the financing.”

Truman would have landed in the blue left-hand column of Wofford’s chart, Klein said. “As he saw it, offering national health insurance was a way of delivering on the New Deal.”

By Rose Ann DeMoro
The Progressive
December 11, 2008

Barack Obama needs to make good on his campaign pledge to reform health care. It is not enough to throw the issue off to former Senator Tom Daschle, Obama’s choice to head the Department of Health and Human Services.

Daschle says he wants to hear from us, the American people, on this issue. So we should oblige him.

Obama and Daschle have a choice: Rely on a private insurance-based plan that does little to mitigate the escalating health care crisis, or solve the problem once and for all and adopt universal, single-payer health care.

Many in Congress, the media, conservative think tanks and some advocacy groups — led by the Service Employees International Union and its business allies — are stumping for piecemeal changes.

Such a path would perpetuate the crisis and deal a cruel blow to the hopes of Americans for real reform. Those in Congress and liberal policy organizations who are embracing caution or promoting more insurance, not more care, are playing a risky game. It could jeopardize the health security of tens of millions of Americans and, in the process, fatally erode public support for the Obama administration.

Hardly a day passes without fresh signs of the health-care implosion.

Just days after the election, the New York Times reported a sharp increase in cost-shifting in employer-paid health plans, with more employers pushing high deductible plans that typically cost workers thousands of dollars in out-of-pocket payments.

Similarly, the Wall Street Journal reported a huge spike in health care premiums for small businesses, which prompted many to raise deductibles or cut coverage.

The consequences are chillingly apparent. In October, the Washington Post cited a study that found one-fourth of Americans are skipping doctors’ visits, and 10 percent could not take their child to the doctor because of cost.

That same month, USA Today reported that one in eight patients with advanced cancer turn down recommended treatment because of the bills.

America is falling embarrassingly behind.

A study by the Commonwealth Fund in November compared adults with chronic conditions, such as high blood pressure, diabetes, or heart disease, in seven major industrialized countries. A stunning 54 percent of the American respondents said they were likely to go without recommended care, compared to just 7 percent of chronically ill patients in the Netherlands. Over 40 percent of the Americans spent more than $1,000 on medical bills, compared to just 4 percent of British and 5 percent of French patients.

If we adopted a universal, single-payer system like these European countries, or if we simply expanded Medicare to all Americans, we would rectify this problem.

The need is urgent. Today 46 million Americans are without health care.

Millions more are at risk of losing it during this recession. And huge numbers of Americans with insurance can’t afford the cost hikes.

At some point, our government must stop subsidizing these private companies and start investing in the American people.

The time to do so is now.

The best way to get it done is to guarantee all Americans health care in a single-payer system.

Tell Obama and Daschle to support improved Medicare for all.

Rose Ann DeMoro is executive director of the 85,000-member California Nurses Association/National Nurses Organizing Committee. She can be reached at pmproj@progressive.org.