The Mystery of Opposition to Single Payer National Health Insurance

by David Bos
Louisville Letter
Published June 9th, 2008

Of course the cynics will say that there is no mystery to the fact that the Single Payer solution to our nation’s health care crisis doesn’t seem to be getting much traction. They will say that our legislators, our presidential candidates and our media are in the pocket of the health insurance companies — bought out by millions of dollars of contributions that come with implicit strings and pressured by hundreds of lobbyists who are paid at least partially with taxpayer monies that go to subsidize these companies rather than provide the health care that we are not getting. Indeed, they will say, even PBS’s Newshour uses Johnson and Johnson as their main consultant for health care issues — a pharmaceutical corporation that lobbies heavily against Single Payer solutions.

Yet, is it really possible that it just takes a lot of money to thwart the public will on an issue as important as this? Hillary Clinton said that she didn’t support Single Payer because it is not “practicable” Is this an admission that indeed the money calls the shots — from someone who took more money from the heath insurance industry than any other person in Washington except George Bush? Barak Obama says that he would have supported Single Payer if we were starting from scratch. Does he really not get the fact that we are starting from scratch? And John McCain says that Single Payer is socialized medicine without bothering to discuss the issue on its merits. Sooner or later a statement such as his will be recognized for what it is — a lie. Such irrationality? Maybe they are right. Maybe it is the money.

But, to me, Its still a mystery why we have 100,000,000 who are either uninsured or underinsured with the numbers and heart-rending stories growing day by day and millions of others with insurance who are just a serious illness away from backruptcy with apparently no political voice. Just think, polls show that over 60%, perhaps 70%, of the people want a Single Payer plan. The most recent polls show that a majority of doctors favor Single Payer. There are 90+ co-sponsors of Single Payer Bill HR 676 in the House of Representatives. Labor union locals are endorsing Single Payer at a rate of several a week. How can it be that these numbers represent no real decision-making power or influence in the political realm?

I wish someone would explain it. Are the party leaders and candidates so gutless that they won’t give the majority of people the time of day on this issue? Maybe it has something to do with the word “privitization”. Could it be that the Reagan/Bush administrations (and to no little extent the Clinton administration) have managed to persuade the people that privitizaton trumps all — so much so that we are willing to sacrifice tens of thousands of lives each year to lack of health care in the name of for-profit, privitized health insurance. Perhaps the people really want to put profits before patients even when those profits are supplied by taxpayer dollars and go to obscenely paid CEO’s and highly paid staffers whose job it is to figure out how not to give you and me the health care we need. Has the ideology of privitization captured the populace to this extent? If so, then the way is clear to privitize everything: the mail, the school, the water. Why not just do away with government by the people and admit that we would be ruled by nonaccountable businesses? I don’t know. As the song goes, “Its a mystery to me.”

By Saul Friedman
Nieman Watchdog blog
Posted at 10:39 am, June 22nd, 2008

I know, it’s a rule of the mainstream press. If the issue is not going anywhere, it’s not worth much of a story. Of course, if it’s not given much of a story, it’s not going anywhere. It’s like that old conundrum about the tree falling in the forest. Here are a couple of trees.

I’m thinking, first, of the June resolution by Rep. Dennis Kucinich, D-Ohio, calling for the impeachment of President Bush. I would venture to guess that most of the reporters who cover Washington, politics or national security probably agree that if any president deserves to be impeached, it’s Bush, for getting the nation into a war on false pretenses, for consenting to the torture of prisoners and innocents, for circumventing the Constitution’s guarantees against illegal searches, wiretaps and the right of habeas corpus.

But Kucinich’s speech introducing his resolution made six paragraphs inside the Washington Post. That was followed by a snotty column by Dana Milbank belittling Kucinich for the more than four hours he spent reading the resolution into the Congressional Record. Another Post blog suggested that his threat to press his resolution would go nowhere and was simply a “fantasy.” He got similar treatment in every other newspaper I read, and even less on television news. Only the British and French press reported it prominently.

But as far as I could see, no one bothered to read or quoted from any of the 35 counts of Kucinich’s resolution, or even tell readers where they might find it. It ran about 70 pages on my printer and I had to get it from the alternative media, like www.buzzflash.com. And it’s worth reading for Kucinich and his staff compiled solid, documented, evidence. Most of it is known, but it’s an impressive compilation, backing up many of the well-reported offenses committed by this president. Much more important than lying about sex.

Why is Bush getting away with it? The Democratic leadership, when it took control of this Congress last year, declared impeachment was “off the table.” And that declaration has remained in force even when new offenses have become known and the prospect of illegally attacking Iran has become possible. So, I wonder what came first, the indifference of the mainstream press, or the decision of the pols (and the president) who read the press?

This indifference and the resulting ignorance of the public, are haunting another issue–the prospect of single-payer, universal health care such as “Medicare for All.” Such a system is now supported by 56 percent of Americans, according to the Associated Press, and, for the first time, by 59 percent of the nation’s physicians. But you would not know that there is such a widely supported proposal awaiting congressional action, if you were reading the mainstream press accounts of a day-long health care forum staged by the Senate Finance Committee at the Library of Congress on June 16.

The Washington Post’s Lori Montgomery was among several reporters, who faithfully recorded the statements of the experts, all agreeing that health-care reform was necessary. But there was no agreement on the solution. Like other reporters, she recounted the possible proposals that were being drafted. By the usual suspects. But there was not a word about the most widely supported piece of legislation that would establish “Medicare for All,” HR 676, introduced early in this session by Judiciary Committee Chairman John Conyers, the veteran Michigan Democrat.

Conyers’ bill, the “U.S. National Health Insurance Act,” would provide health care for all Americans, modeled after Medicare, and would replace other government programs, such as Medicaid, the State Children’s Health Insurance Program, and end need for private insurance and its power over the American health care system. Recently the Conyers bill was endorsed in an overwhelming vote by the New York State Assembly, which has been grappling with health care issues to cover 2.6 million uninsured New Yorkers.

Conyers’ bill, which any reporter can find and read, has the backing of 90 house members, 430 labor unions, including 33 state chapters of the AFL-CIO, and thousands of doctors and nurses. But you wouldn’t know it from the mainstream media, for the possibility of single-payer universal health care, is like a tree that falls without a sound. Which is one reason it has little chance for passage.

Saul Friedman, a 1963 Nieman Fellow, is a former White House correspondent for Newsday and Knight Ridder newspapers and now writes a weekly column, “Gray Matters,” dealing with senior issues, for Newsday.

By Steven Reinberg
HealthDay
Posted June 10, 2008

TUESDAY, June 10 (HealthDay News) — The number of American adults who had inadequate health insurance to cover their medical expenses rose 60 percent from 2003 to 2007, from 16 million to more than 25 million people.

Hardest hit were families with middle and higher incomes, those whose income was 200 percent above the federal poverty level or those with an annual income of $40,000 or more, a new report by The Commonwealth Fund found.

“Insurance coverage is the ticket into the health-care system,” Karen Davis, president of The Commonwealth Fund, said during a Monday teleconference. “For too many, that ticket does not buy financial security or genuine access to care.

“We need to extend effective, affordable health insurance to all,” added Davis. “Shifting costs to patients is not an equitable or effective solution to rising health-care costs. It is time for serious consideration of changes in the way we pay for and deliver health services. Ultimately, we need a national solution to the problem of millions of uninsured and underinsured Americans.”

The report is published in the June 10 issue of Health Affairs.

To make their estimates, the researchers conducted a national survey in 2007 of 3,501 adults. They found that among adults aged 19 to 64, 25.2 million were “underinsured.” That number was based on out-of-pocket health-care costs as a proportion of income.

“Overall, the study finds a startling 60 percent increase in the number of underinsured working age adults over the past four years,” said study co-author Cathy Schoen, a senior vice president at The Commonwealth Fund. “A jump up to 25 million underinsured in 2007, compared to only 16 million in 2003.”

Approximately 42 percent of adults aged 19 to 64 years old — 75 million people — were either underinsured or didn’t have health insurance in 2007. That represents an increase of 33 percent since 2003, when the last survey was done, Schoen said.

People who are underinsured are people who have health insurance but spend 10 percent or more of their income on out-of-pocket medical expenses. For people below 200 percent of the federal poverty level, being underinsured means spending more than 5 percent of income on out-of-pocket medical costs.

Being underinsured also means paying deductibles of 5 percent or more of family income.

The researchers found that people who were underinsured were more likely to go without needed health care and have problems paying medical bills, compared with people who have adequate health insurance.

In fact, 53 percent of the underinsured and 68 percent of those without health insurance had to forgo needed medical care, such as not seeing a doctor when sick, not filling prescriptions, and not getting recommended diagnostic tests or treatments. “The underinsured look a lot like the uninsured,” Schoen said.

Among the underinsured, 45 percent reported having difficulty paying bills, being contacted by collection agencies for unpaid bills, and curtailing their way of life to pay their medical bills, compared with 21 percent of people with adequate health insurance.

Also, underinsured people were more likely to have insurance plans that limit payments. They were also more likely to have high deductibles. For example, one quarter of underinsured people had deductibles of $1,000 or more, the report found.

However, premiums for the underinsured were similar to or higher than those paid by people with adequate insurance, the researchers found.

“Today in the United States you can have health insurance all year long but still go into medical debt or face bankruptcy when you get sick,” Schoen said. “This erosion of insurance protection is putting patients, families and the nation’s health and economic security at risk.”

Kim Bailey, a senior policy analyst at Families USA, a health-care advocacy group, said she thinks the trend toward greater out-of-pocket costs for health care is likely to continue.

“It is clear that American families are facing a growing burden of out-of-pocket costs, and this is consistent with a decay in the comprehensiveness of health benefits being offered,” she said.

Bailey noted that between 2000 and 2007, the average family premium for employer-sponsored insurance rose more than 90 percent. “We are getting to a place were a number of people are feeling the squeeze,” she said. “This report highlights the thinning of benefits on higher income people and that is new. That indicates to me that a call for change is likely to be strengthened.”

Another expert said the new report probably underestimates the problem of underinsurance.

“There are a whole lot of ways to be underinsured that the report does not capture,” said Dr. Steffie Woolhandler, an associate professor of medicine at Harvard Medical School and co-founder of Physicians for a National Health Program.

The deductible is only a fraction of the total amount one has to pay out-of-pocket, Woolhandler said. “In addition to the deductible, there are issues such as co-insurance and the issue of uncovered services, which are not part of the deductible,” she said.

Woolhandler also noted that many people lose their job and their health insurance when they become disabled. “At least 25 percent of employers terminate employment the day you become disabled,” she said.

Middle- and upper-income families find it harder to get needed medical care, report says

By Steven Reinberg
HealthDay
Posted June 10, 2008

TUESDAY, June 10 (HealthDay News) — The number of American adults who had inadequate health insurance to cover their medical expenses rose 60 percent from 2003 to 2007, from 16 million to more than 25 million people.

Hardest hit were families with middle and higher incomes, those whose income was 200 percent above the federal poverty level or those with an annual income of $40,000 or more, a new report by The Commonwealth Fund found.

“Insurance coverage is the ticket into the health-care system,” Karen Davis, president of The Commonwealth Fund, said during a Monday teleconference. “For too many, that ticket does not buy financial security or genuine access to care.

“We need to extend effective, affordable health insurance to all,” added Davis. “Shifting costs to patients is not an equitable or effective solution to rising health-care costs. It is time for serious consideration of changes in the way we pay for and deliver health services. Ultimately, we need a national solution to the problem of millions of uninsured and underinsured Americans.”

The report is published in the June 10 issue of Health Affairs.

To make their estimates, the researchers conducted a national survey in 2007 of 3,501 adults. They found that among adults aged 19 to 64, 25.2 million were “underinsured.” That number was based on out-of-pocket health-care costs as a proportion of income.

“Overall, the study finds a startling 60 percent increase in the number of underinsured working age adults over the past four years,” said study co-author Cathy Schoen, a senior vice president at The Commonwealth Fund. “A jump up to 25 million underinsured in 2007, compared to only 16 million in 2003.”

Approximately 42 percent of adults aged 19 to 64 years old — 75 million people — were either underinsured or didn’t have health insurance in 2007. That represents an increase of 33 percent since 2003, when the last survey was done, Schoen said.

People who are underinsured are people who have health insurance but spend 10 percent or more of their income on out-of-pocket medical expenses. For people below 200 percent of the federal poverty level, being underinsured means spending more than 5 percent of income on out-of-pocket medical costs.

Being underinsured also means paying deductibles of 5 percent or more of family income.

The researchers found that people who were underinsured were more likely to go without needed health care and have problems paying medical bills, compared with people who have adequate health insurance.

In fact, 53 percent of the underinsured and 68 percent of those without health insurance had to forgo needed medical care, such as not seeing a doctor when sick, not filling prescriptions, and not getting recommended diagnostic tests or treatments. “The underinsured look a lot like the uninsured,” Schoen said.

Among the underinsured, 45 percent reported having difficulty paying bills, being contacted by collection agencies for unpaid bills, and curtailing their way of life to pay their medical bills, compared with 21 percent of people with adequate health insurance.

Also, underinsured people were more likely to have insurance plans that limit payments. They were also more likely to have high deductibles. For example, one quarter of underinsured people had deductibles of $1,000 or more, the report found.

However, premiums for the underinsured were similar to or higher than those paid by people with adequate insurance, the researchers found.

“Today in the United States you can have health insurance all year long but still go into medical debt or face bankruptcy when you get sick,” Schoen said. “This erosion of insurance protection is putting patients, families and the nation’s health and economic security at risk.”

Kim Bailey, a senior policy analyst at Families USA, a health-care advocacy group, said she thinks the trend toward greater out-of-pocket costs for health care is likely to continue.

“It is clear that American families are facing a growing burden of out-of-pocket costs, and this is consistent with a decay in the comprehensiveness of health benefits being offered,” she said.

Bailey noted that between 2000 and 2007, the average family premium for employer-sponsored insurance rose more than 90 percent. “We are getting to a place were a number of people are feeling the squeeze,” she said. “This report highlights the thinning of benefits on higher income people and that is new. That indicates to me that a call for change is likely to be strengthened.”

Another expert said the new report probably underestimates the problem of underinsurance.

“There are a whole lot of ways to be underinsured that the report does not capture,” said Dr. Steffie Woolhandler, an associate professor of medicine at Harvard Medical School and co-founder of Physicians for a National Health Program.

The deductible is only a fraction of the total amount one has to pay out-of-pocket, Woolhandler said. “In addition to the deductible, there are issues such as co-insurance and the issue of uncovered services, which are not part of the deductible,” she said.

Woolhandler also noted that many people lose their job and their health insurance when they become disabled. “At least 25 percent of employers terminate employment the day you become disabled,” she said.