PNHP

Support for single-payer system

Support for single-payer system

BY KEVIN DUGGAN
The Coloradoan
KevinDuggan@coloradoan.com

Choking back tears and outrage at the state of health care in the United States, many local residents Friday called for following a different tack in crafting a health insurance program for Colorado.

About 100 people attended a sometimes emotional hearing at the Lincoln Center sponsored by the state’s Blue Ribbon Commission on Health Care Reform regarding proposals the state Legislature is expected to take up next year.

Of the more than 30 people who addressed panel members, all but a few voiced support for a proposal that would establish a single-payer system for the state’s health-care system.

The current system is geared toward making profits for insurance companies and their shareholders rather than providing care for patients, said Dr. Kathy Waller, of Fort Collins.

“Private, for-profit health insurance served its purpose in the early part of the 20th century, but it is obsolete for the 21st century,” she said.

Forcing consumers to buy private health insurance to meet their medical needs does not provide universal coverage and is “legalized extortion,” Waller said.

A single-payer plan would save the state about $1 billion in health-care costs and provide better coverage, she said.

Many audience members told personal stories of dealing with catastrophic medical problems and near financial ruin. Others said the government should play a role in providing universal care.

Rebecca Renz, of Windsor, said she worries every day about her husband losing his job and insurance. The couple’s 3-year-old daughter has a heart condition that might require a heart transplant.

“Working through the current system is humiliating and painful,” she said. “In our beautiful state, we must be willing to say that health care is not a birthright but a human right.”

But Chris Davies, of Fort Collins, said a single-payer system sounded too good to be true.

Under the proposed single-payer system, the residency requirement would be only three months. The state could be inundated with seriously ill patients who can’t get coverage elsewhere, she said.

The costs could be prohibitive, Davies said.

“There are millions of dollars missing in Iraq – who knows where they went,” she said. “The government is administrating that plan. Do we want them to administer our health care that’s so important to us?”

Private insurance system is the problem

Letter to the Editor
Milwaukee Journal Sentinel
Oct. 14, 2007

Regarding the Oct. 7 editorial “Mandating coverage: A sensible solution,” private for-profit insurance is the very cause of our health care crisis — not the solution.

“Private insurers maximize profits mainly by limiting benefits or by not covering people with health problems,” points out Marcia Angell of Harvard Medical School. “The United States is the only advanced country in the world with a health care system based on avoiding sick people.” How will a mandate for individual coverage address this basic yet perverse motive?

Nor will it address the nearly $400 billion from this huge private-sector bureaucracy dedicated expressly to denying insurance to those with pre-existing conditions and refusing coverage to the insured whenever possible. Further, individual mandates will not guarantee coverage of the 47 million uninsured.

The Journal Sentinel editorial contended that a single-payer system — like those in Canada, Taiwan and France — is not “politically doable.” Yet BusinessWeek’s May 17, 2005, poll showed “67% of all Americans think it’s a good idea to guarantee health care for all U.S. citizens, as Canada and Britain do, with just 27% dissenting.”

It’s time to cut out the parasitic middleman — the for-profit insurance industry that is driving up costs, dictating to patients and doctors alike and diminishing quality.

Roger Bybee

How Many Connector Staff Does It Take to Change a Light Bulb?

by David Himmelstein, MD
Posted by CommonHealth
WBUR 90.9
Friday, October 5th, 2007

The Ontario Health Insurance Plan (OHIP), which covers about 12 million residents of that Canadian province, employs roughly 1500 people. The Connector has 35.6 FTEs. It helps arrange coverage for the 30,000 people with private insurance purchased through the Commonwealth Choice program; 23,000 who get partially subsidized coverage under Commonwealth Care; and 92,000 low income individuals signed up for free insurance. That’s a total of 145,000 people. In other words, the Connector employs twice as many (2.5) people per 10,000 enrollees as OHIP (1.2).

That comparison doesn’t sound too bad, until you realize that OHIP actually pays all of the bills for care in Ontario and administers virtually the entire health care financing system. The Connector merely serves as a glorified insurance broker, signing people up for coverage with plans like Blue Cross and Harvard Pilgrim. So on top of the 4% to 5% cut of every premium dollar that the Connector takes, Blue Cross and Harvard Pilgrim take their 15%. (I can’t tell you what Tufts’ share is — their annual report for 2006 left out the figures — though it does let slip that its net worth rose by $96 million even as enrollment fell).

In total we paid more than $800 million for health insurance companies’ overhead last year – $20 million to the Connector (about $145 per person they helped find coverage) $251 million to Blue Cross, $332 million to Harvard Pilgrim, and (my estimate) about $200 million to Tufts. And this figure doesn’t include the overhead of the dozens of smaller insurance plans in our state. If OHIP had been on the job the cost would have been about $75 million — less than one tenth as much.

A few other figures to remember on this first birthday of health reform. According to the U.S. Census Bureau, in 2006 there were 469,733 uninsured residents of Massachusetts with family incomes above $150% of poverty. The Connector says that it now covers 23,083 of them under Commonwealth Care and has enrolled another 30,000 private plans. That’s 11% of the total.

David Himmelstein is an Associate professor of medicine at Harvard Medical School and Co-founder of Physicians for a National Health Program

Ideology and kids’ health

Editorial
The Berkshire Eagle
Monday, October 08

President Bush’s veto of legislation providing an overdue expansion of the State Children’s Health Insurance Program (S-CHIP) is the latest of many examples of the foolishness that can result when ideology is allowed to trump all else, including logic and fairness. Mr. Bush, who worries about creeping socialism as if was still 1957, is beyond hope, but if enough congressional Republicans can set aside the ideology that helped put them in the minority and do what is right, his veto could still be overridden later this month.

The 10-year-old S-CHIP program has done a fine job of providing health insurance coverage for children from low-income families, but because of a growing population and changing demographics, many children are now falling through the cracks. Congress wants to expand the program to include another 3.8 million children, many in middle-income families that cannot afford insurance because modest wage increases cannot keep up with the rising costs of employer-based insurance.

Mr. Bush, who is always willing to mislead when it comes to making an ideological point, asserts that children in families earning $83,000 a year will be covered by the expanded program, which as far as can be determined, is based on a proposal in New York state to extend the plan to families making 400 percent of the poverty level. The actual legislation, however, would cover families earning up to 300 percent of the poverty level, or $51,000 a year. Those families are not wealthy, and with health insurance costs climbing at roughly four times the rate as wages, they need help insuring their children.

Ideology enters the picture with the president’s insistence that the expanded S-CHIP plan will open the door to “socialized medicine.” The word “socialism” doesn’t scare people much anymore, but it isn’t accurate anyway when applied to proposals like single-payer health care, in which the government pays for health care, not patients and their families at the mercy of profit-driven insurance companies. The medicine would not be “socialized” because patients would receive the same treatment and have the same options as they do now. The difference is that working men and women would not have their paychecks gouged by insurance payments and would not risk bankruptcy if hit by a catastrophic illness.

Out on the campaign trail, the Republican presidential candidates have all backed the veto, even though in the case of former Massachusetts Governor Mitt Romney and former New York City Mayor Rudy Giuliani, this involves repudiating stands on health insurance they took as elected officials. Mr. Romney is so tied in knots by his serial flip-flopping that he now finds himself campaigning against the Massachusetts plan to provide insurance for all residents that he signed into law because it constitutes the dreaded “socialized medicine.”

Ideology should never get in the way of good government, as it has with the expansion of the children’s health insurance program. Another 20 legislators are needed to override the veto in the House, and if enough Republicans care about their constituents, and their re-election hopes, to change their votes, this expansion of a valuable program could still overcome ideology and become law.

The Frosts Demonstrate Why We Need Single Payer Health Care

Hale “Bonddad” Stewart
Thu Oct 11, 1:05 PM ET

For economic commentary and market analysis, go to the Bonddad Blog:

From Time:

It turns out, however, that not everything about the Frosts’ life pops up on a Google search. While Graeme does attend a private school, he does so on scholarship. Halsey Frost is a self-employed woodworker; he and his wife say they earn between $45,000 and $50,000 a year to provide for their family of six. Their 1936 rowhouse was purchased in 1990 for $55,000. It was vacant and in a run-down neighborhood that has improved since then, in part because of people like themselves who took a chance. It is now assessed at $263,140, though under state law the value of that asset is not taken into account in determining their eligibility for SCHIP. And while they are still uninsured, they claim it is most certainly not by choice. Bonnie Frost says the last time she priced health coverage, she learned it would cost them $1,200 a month.

The above snippet from Time perfectly illustrate why single-payer health care is really the answer to the health care problem in the US.

1.) Notice the Frost’s already priced insurance. At $1200/month, the Frosts would be looking at $14,000/year in payments. That’s 32% of their income. That assumes those are all the medical costs the Frosts would pay which simply isn’t true. My guess is the $1200/month policy would have some type of deductible, co-pay structure etc…. Considering the Frosts overall situation of two children needing expensive medical care, medical costs could easily become 40%-50% of their annual expenses.

2.) Malkin has argued that assets should be included in the eligibility computation for SCHIP. This is a really stupid idea. According to the article, the Frost’s home is $263,000. According to Malkini’s argument, the Frosts should either take out a home loan (home equity loan) or sell their home. If the Frost’s sell their home, they will take out their equity (assuming they have some). But they’ll eventually spend that. In addition, this assumes the Frosts can sell their home right now — in the worst housing market in the last 20 years. In other words, this argument makes a lot of assumptions that probably won’t play out in reality. When they’re done spending the loan proceeds, they’ll be poorer. In taking out a home equity loan, the Frost’s are simply delaying he inevitable — bankruptcy. The Frosts would then have a note which would provide a drain on their finances until the loan proceeds ran out. At that time, the Frosts would have an additional payment in their monthly nut in addition to medical costs. I’m not sure if Malkin realizes the debt issue in America, but it is pretty severe. For example, foreclosures doubled this month.

Here’s the basic problem. The Frosts aren’t rich and they have children. That means medical expenses are their biggest problem. Under the Malkin theory, either poor people shouldn’t have children because insurance is too expensive, or the poor should go into debt to pay for insurance which under the new bankruptcy laws is tantamount to indentured servitude.

Anyway — now that I’ve weighed in on the Frost debate, I want to bring back the central arguments I have always made (and will continue to make) about single-payer health care.

While I will almost always advocate for a market based economic approach to allocating resources, health care is not an area where the profit motive should dominate decision making. Simply put, the end product is a patient’s health. Private health insurance has a conflict of interest between the insurance company and the insured which will be resolved in favor of the insurance company a majority of the time.

Let me paint a hypothetical picture to illustrate this point. Insured makes a claim with the insurance company, which is a publicly traded company. Because the insurance company is publicly traded they must turn a profit and increase their profits to maintain their share price. In order to make a profit they have every incentive to either

1. Deny the insured’s claim, or
2. Delay payment to increase the possibility the insured will drop his claim

There are numerous stories about an insured making a routine claim only to be inundated with paperwork, or being told the policy doesn’t cover that procedure, or being told the insurance company has to look into the claim to see if the insurance company can make a payment. In any of these situations the central idea of insurance — to provide some safety for the insured at a specific cost — is compromised.

In addition, insurance companies will seek to minimize the amount of money they would have to pay to the insured. Again, remember the product here is the patient’s health. Supposed the insured has a disease where the cure is expensive but a cheaper alternative exists. However, the cheaper alternative would moderately or seriously compromise the insured’s quality of life. Because the insurance company is profit-driven, it will probably opt for the cheaper treatment that compromises the insured’s quality of life.

Here is what the Frost’s ran into in the private health care market:

In a telephone interview, the Frosts said they had recently been rejected by three private insurance companies because of pre-existing medical conditions. “We stood up in the first place because S-chip really helped our family and we wanted to help other families,” Mrs. Frost said.

The profit motive worked to the Frost’s extreme disadvantage. Because covering the Frost’s was expensive, the insurance companies simply denied them coverage.

Secondly, private health care is more expensive the public health care. Here are three charts compiled from the Organization for Economic Cooperation and Development. The figures are from 2004.

First, the US spends the least amount of public money on health care.

However, the US spends the most on health care as a percentage of GDP and on a per capita basis.

Notice the partially inverse relationship between public expenditures and total amount spent on health care. In short, publicly available health care is cheaper.

Finally there is the issue of competitiveness. I’ll let General Motors of Canada make the argument for me.

“The Canadian plan has been a significant advantage for investing in Canada,” says GM Canada spokesman David Patterson, noting that in the United States, GM spends $1,400 per car on health benefits. Indeed, with the provinces sharing 75 percent of the cost of Canadian healthcare, it’s no surprise that GM, Ford and Chrysler have all been shifting car production across the border at such a rate that the name “Motor City” should belong to Windsor, not Detroit. Just two years ago, GM Canada’s CEO Michael Grimaldi sent a letter co-signed by Canadian Autoworkers Union president Buzz Hargrave to a Crown Commission considering reforms of Canada’s 35-year-old national health program that said, “The public healthcare system significantly reduces total labour costs for automobile manufacturing firms, compared to their cost of equivalent private insurance services purchased by U.S.-based automakers.” That letter also said it was “vitally important that the publicly funded healthcare system be preserved and renewed, on the existing principles of universality, accessibility, portability, comprehensiveness and public administration,” and went on to call not just for preservation but for an “updated range of services.” CEOs of the Canadian units of Ford and DaimlerChrysler wrote similar encomiums endorsing the national health system.

Health care costs are killing American business. Our international competitors don’t have to deal with these costs. As a result, private health care is making US business less competitive.

So, public health eliminates a conflict of interest that compromises individual health, is cheaper and makes the US more competitive. And we don’t have a public health system because?

Digby makes the point far more eloquently than I:

Setting aside the total dishonesty of that — surely Steyn has been informed by now that the Frost kids go to private school on scholarship and the house was bought for 55,000 in 1990 — what has become crystal clear in this debate is one that I think needs to be discussed. The Republicans believe that people should be completely destitute, living in a one room shack and working two jobs before they “deserve” subsidized health insurance. The middle class who are one car accident or one cancer diagnosis away from losing their jobs, being unable to afford either the cadillac COBRA plans from their employers (my last one here in California was $1700.00 a month and I’m healthy) must not be allowed to keep ANY assets.They must be, as Steyn’s pal wrote, “dying on the streets with sores on their bodies” before they qualify for aid. …..

If the free-wheeling capitalists of the right wing believe that you can keep an economy dynamic, growing and flexible in a twisted system like this, they are even more blindly ideological than I thought. This is not just a moral crisis, it’s an economic crisis and if these people are determined to continue down this path then I suggest the rest of us start buying land in Costa Rica because this country is going to fail. Hugely. The numbers do not add up.

"Why Not Single Payer?" A Response to Paul Krugman and the Leading Democratic Presidential Contenders.

Miles Mogulescu
The Huffington Post
Posted October 10, 2007
Part I

Faster than you can say the word “Sicko” and turn around 3 times, the Democrats’ promise of health care for all has gone from “Universal Medicare For All” to “Individual Insurance Mandate”. In Monday’s New York Times, Paul Krugman defends that reversal in an article entitled “Why Not Single Payer?”

The possibility, after the 2008 elections, of a Democratic-controlled Congress which could pass Medicare For All (a/k/a Universal Single Payer Health Insurance) and a Democratic President who would sign it, could bring about the best chance to enact Medicare For All since Harry Truman first proposed it in 1948.

Yet without firing a shot and with no debate, the leading Democratic Presidential Contenders–Hillary Clinton, John Edwards and Barack Obama–as well as a good part of the Washington progressive infrastructure of think tanks and lobbying groups–have given up the fight for Medicare For All. Instead they propose variations of an Individual Mandate plan developed over the past 15 years by the “moderate” corporate wing of the Republican Party, a version of which Mitt Romney enacted in Massachusetts and which Arnold Schwarzenegger is proposing in California as an alternative to the single payer plan which the Democratic California legislature passed last year that he vetoed.

The thing is, I can’t quite figure out why the Democrats are in such rapid retreat from Medicare For All before the first battle has even been joined. Is it another example of the political cowardice by which the only Iraq resolutions that can pass the Democratic controlled Senate are a Republican-driven bill condemning MoveOn.Org. and praising Gen. Petraeus and another declaring the Iranian Revolutionary Guards a terrorist organization? Is it because the Democratic candidates are afraid of being accused by Republicans of supporting socialized medicine? (If so, it won’t help because Giuliani, Thompson, and Romney–whose Massachusetts plan Hillary largely imitates–all quickly claimed that Hillarycare 2.0 is socialized medicine, anyway.) Is it because they’ve been bought off by insurance companies and drug companies or fear that too many other Congress and Senate members have?

Or is it because they think that the insurance companies and drug companies are just too politically powerful to take on: Therefore the only way to insure most Americans is to make a deal with the devil that requires profit-making insurance companies to waive pre-existing conditions and charge everyone similar premiums regardless of age or health, in exchange for Congress delivering them 50 million guaranteed new profit-making customers, partly subsidized by the government?

Paul Krugman’s NY Times column is one of the first direct attempts by a liberal former supporter of single payer to try to make the case for adopting the Individual Mandate approach instead. According to Krugman, “basically it looks like something that could actually happen in the next administration, while enacting a single-payer plan…excellent as those plans are, might take a very long time.”

First, Krugman argues than an Individual Mandate would not require a big tax increase, although he admits (thus defeating his own argument) that taxes which most people would pay for single payer would most likely be lower than premiums that an Individual Mandate would require them to pay out of their pockets to buy insurance. Second, he argues than an Individual Mandate won’t make people feel that they’re “being forced into a government plan”. But the essence of an Individual Mandate plan is that the federal government forces the uninsured to buy health insurance. It involves even more government coercion than Medicare For All.

Finally, he argues that the Democrats’ proposals generally include a Medicare-like public insurance alternative which individuals may buy into and which “would evolve into single-payer over time.” Krugman never quite explains how this piece of alchemy will occur. Moreover, he admits that this is the part of the Democrats’ plan that the insurance industry will fight “tooth and nail”. If the Democrats have already surrendered on Medicare For All without firing a shot, isn’t it likely that the public alternative (the “socialized medicine” part) will be the first part of the plan to be compromised away when the legislative battles start in Congress and the insurance lobby starts exercising its muscle with its hundreds of lobbyists and tens of millions of dollars in campaign contributions?

In short, I find Krugman’s notion that an Individual Mandate is somehow more politically pragmatic than Medicare For All unconvincing and I don’t buy his argument that it’s a backdoor way to eventually get there. I even wonder how strongly he believes his own arguments. Only last January, in critiquing Schwarzeneggers’s Individual Mandate plan for California as a complicated “Rube Goldberg” device, Krugman argued that “the plan requires a much more intrusive government role than a single-payer system. Instead of reducing paperwork, the plan adds three new bureaucracies: one to police individuals to make sure they buy insurance, one to determine if they’re poor enough to receive aid, and one to police insurers to make sure they don’t discriminate against the unwell.” If you then add a public Medicare-like alternative that individuals can buy into, you need a fourth bureaucracy to administer that system.

Thus, when Hillary Clinton claims that her plan requires no new government bureaucracy, she’s not being candid with the voters. That lack of candor will quickly be exploited by the Republicans and the insurance and drug lobbies. While Republicans are wrong that her plan amounts to “socialized medicine”, such charges will still ring true since, in fact, her plan will require intrusive government regulation of the private insurance industry and coercive action to be sure that all citizens are obeying the individual mandate to buy health insurance. That’s one of the big reasons why, once the debate really starts, an Individual Mandate will not necessarily be a popular plan with the voters–Using the political pragmatism test, it stands a better chance of being rejected by the public and meeting the same fate as Hillarycare 1.0 than does Medicare For All, for which the political arguments are simple and clean.

Whatever Clinton might claim, Hillarycare 2.0 in fact requires a highly intrusive government presence in the lives of both businesses and individuals. As with Hillarycare 1.0, this is likely to be the biggest club that Republicans and their insurance company allies will use to defeat her or another Democrat as they did in 1994, unless so many compromises are made to water down the plan that insurance and drug companies decide it’s in their interest to accept the 50 million new mandatory government subsidized customers to pad their bottom lines. (Remember that with private insurance, approximately 30% of the healthcare dollar goes to administration, executive salaries and profits, compared to 2%-3% for Medicare; when all the political deals are finally cut, the private insurance and drug industries might find a new government subsidy for their bottom line an attractive deal.) If an Individual Mandate plan is more politically expedient than Medicare For All, it’s not for any of the reasons which Krugman cites and not because it’s likely to be more politically popular with the voters. The real reason is that with a few backroom political compromises, it could become a that plan the insurance and drug industries could learn to love.

Miles Mogulescu is an entertainment attorney and former Senior Vice-President at MGM before it was sold to Sony. In his professional capacity, he recently negotiated the distribution arrangements for the film “Bobby” about the assassination of Bobby Kennedy. He has been a lifelong progressive since the age of 12 when his father helped raise substantial sums of money for Dr. Martin Luther King, who was a guest in his home several times. He will never forget the impression which that extraordinary man made on him, which helped lead to a lifelong commitment to social justice.

The Health Care Crisis in California

Jenny Price
The Huffington Post
Posted October 10, 2007

On December 31, 2006, the health insurance I purchase through a group of freelance artists and writers cost me $4715/year. On January 1, it jumped to $12,268. That’s $1.40 per hour. I watch a Dodgers game, and I’m down $3.50 by the 7th inning. I go to sleep, and I’ve paid another $11.20 for health insurance by the time I wake up.

Like so many people in California, then, I’ve been watching with high hopes this year as the Democratic legislature and the Republican governor both try mightily to pass a health-care reform bill. This is California, after all — the state that’s decided to unilaterally stop global warming. We love to pave the way for everyone else.

The bad news is that Schwarzenegger and the legislature have proposed moderately different plans, and are battling fiercely to prevent passage of the other. The worse news, unfortunately, is that both plans fail miserably to tackle two major causes of the health care crisis — the link between insurance and employment, and the major economic and managerial role for private insurers. These competing plans aren’t worth a seed-spitting contest, much less the raging foot-stomping political brawl.

The governor and the Democrats, rather, are duking it out to add modest regulations to a system that the majority of Americans say is radically broken. California seems dead-set on showing the rest of the country how to continue to keep us all in a state of mass anxiety about how to get and pay for health care.

The centerpiece of both plans is that employers are required to spend a minimum percentage of their payroll to cover their workers — 4 percent in Schwarzenegger’s plan, and a massive 7.5 percent in the other. So both strengthen, rather than sever, the current disastrous reliance on employers — an accidental artifact of the post-World-War-II economy, when companies started to use health coverage to compete for workers. Both pave the way for how to perpetuate a system that restricts Americans’ career choices and discourages self-employment. The plans burden smaller and lower-profit businesses, especially. And Americans who become too sick to work will continue to lose coverage at exactly the moment when they most desperately require health care.

By keeping decisions and profits in the hands of private insurers, the Golden State also aims to demonstrate how this country can continue to tie up the costs of health care in the earnings of companies that maximize profits most efficiently by minimizing health care-CIGNA, for example, which cleared $1.63 billion in profits in 2005 and earned a 37 percent return for shareholders. Which paid its CEO $28.8 million — $54.83/minute, and 6,117 premiums at my rate that year. And which does not bother to prioritize, much less mention, health care in its self-described purpose (in its annual reports) as a company “that focuses on our control environment [whatever that is], risk management and shareholder return.”

Schwarzenegger’s plan does require everyone to buy insurance, while the Democrats’ doesn’t (though to be fair, he vetoed the Democratic single-payer bill last year). And both sides propose to control the cost of premiums, and to prohibit denial of coverage to people with health problems. However, neither plans imposes clear-cut regulations on insurance rates and extent of coverage. It’s a good thing, therefore, that both sides promise to subsidize the poor, since the financial strain of unafforable premiums and uncovered medical costs should make many people sufficiently impoverished to qualify.

Yes, California will lead the way to leave Americans’ health care in these companies’ hands, since, as Assembly Speaker Fabian NuƃĀ±ez has assured us this year, “We’re not trying to turn this state into Cuba or Canada.” They’ll show us how not to do something so un-American as prioritizing the health of many over the profits of a few, which is a priority that other prosperous democratic countries (all of them, actually) embrace. They’ll patriotically lead the charge to support a free-market health-care economy that increasingly has stripped Americans of the basic everyday freedoms of deciding what careers they can pursue, and whether they can move to another town or state, and even how many children they can realistically think about being able to afford.

In sum, California’s political leaders, who are pioneering the way to global re-cooling, are inexplicably and pusillanimously leading the way toward health care reform that will cover some more people and provide moderate cost reductions. And it will energetically preserve a system in which the extreme difficulty of getting and paying for health care will undemocratically restrict the most essential choices in our lives, and will remain an omnipresent source of anxiety.

Or to put it another way — a night of sleep in California might soon cost slightly less than $11.40, but in any state that follows California’s lead, a good night’s sleep will continue to be exceptionally hard to get.

“Why Not Single Payer?” A Response to Paul Krugman and the Leading Democratic Presidential Contenders.

Miles Mogulescu
The Huffington Post
Posted October 10, 2007
Part I

Faster than you can say the word “Sicko” and turn around 3 times, the Democrats’ promise of health care for all has gone from “Universal Medicare For All” to “Individual Insurance Mandate”. In Monday’s New York Times, Paul Krugman defends that reversal in an article entitled “Why Not Single Payer?”

The possibility, after the 2008 elections, of a Democratic-controlled Congress which could pass Medicare For All (a/k/a Universal Single Payer Health Insurance) and a Democratic President who would sign it, could bring about the best chance to enact Medicare For All since Harry Truman first proposed it in 1948.

Yet without firing a shot and with no debate, the leading Democratic Presidential Contenders–Hillary Clinton, John Edwards and Barack Obama–as well as a good part of the Washington progressive infrastructure of think tanks and lobbying groups–have given up the fight for Medicare For All. Instead they propose variations of an Individual Mandate plan developed over the past 15 years by the “moderate” corporate wing of the Republican Party, a version of which Mitt Romney enacted in Massachusetts and which Arnold Schwarzenegger is proposing in California as an alternative to the single payer plan which the Democratic California legislature passed last year that he vetoed.

The thing is, I can’t quite figure out why the Democrats are in such rapid retreat from Medicare For All before the first battle has even been joined. Is it another example of the political cowardice by which the only Iraq resolutions that can pass the Democratic controlled Senate are a Republican-driven bill condemning MoveOn.Org. and praising Gen. Petraeus and another declaring the Iranian Revolutionary Guards a terrorist organization? Is it because the Democratic candidates are afraid of being accused by Republicans of supporting socialized medicine? (If so, it won’t help because Giuliani, Thompson, and Romney–whose Massachusetts plan Hillary largely imitates–all quickly claimed that Hillarycare 2.0 is socialized medicine, anyway.) Is it because they’ve been bought off by insurance companies and drug companies or fear that too many other Congress and Senate members have?

Or is it because they think that the insurance companies and drug companies are just too politically powerful to take on: Therefore the only way to insure most Americans is to make a deal with the devil that requires profit-making insurance companies to waive pre-existing conditions and charge everyone similar premiums regardless of age or health, in exchange for Congress delivering them 50 million guaranteed new profit-making customers, partly subsidized by the government?

Paul Krugman’s NY Times column is one of the first direct attempts by a liberal former supporter of single payer to try to make the case for adopting the Individual Mandate approach instead. According to Krugman, “basically it looks like something that could actually happen in the next administration, while enacting a single-payer plan…excellent as those plans are, might take a very long time.”

First, Krugman argues than an Individual Mandate would not require a big tax increase, although he admits (thus defeating his own argument) that taxes which most people would pay for single payer would most likely be lower than premiums that an Individual Mandate would require them to pay out of their pockets to buy insurance. Second, he argues than an Individual Mandate won’t make people feel that they’re “being forced into a government plan”. But the essence of an Individual Mandate plan is that the federal government forces the uninsured to buy health insurance. It involves even more government coercion than Medicare For All.

Finally, he argues that the Democrats’ proposals generally include a Medicare-like public insurance alternative which individuals may buy into and which “would evolve into single-payer over time.” Krugman never quite explains how this piece of alchemy will occur. Moreover, he admits that this is the part of the Democrats’ plan that the insurance industry will fight “tooth and nail”. If the Democrats have already surrendered on Medicare For All without firing a shot, isn’t it likely that the public alternative (the “socialized medicine” part) will be the first part of the plan to be compromised away when the legislative battles start in Congress and the insurance lobby starts exercising its muscle with its hundreds of lobbyists and tens of millions of dollars in campaign contributions?

In short, I find Krugman’s notion that an Individual Mandate is somehow more politically pragmatic than Medicare For All unconvincing and I don’t buy his argument that it’s a backdoor way to eventually get there. I even wonder how strongly he believes his own arguments. Only last January, in critiquing Schwarzeneggers’s Individual Mandate plan for California as a complicated “Rube Goldberg” device, Krugman argued that “the plan requires a much more intrusive government role than a single-payer system. Instead of reducing paperwork, the plan adds three new bureaucracies: one to police individuals to make sure they buy insurance, one to determine if they’re poor enough to receive aid, and one to police insurers to make sure they don’t discriminate against the unwell.” If you then add a public Medicare-like alternative that individuals can buy into, you need a fourth bureaucracy to administer that system.

Thus, when Hillary Clinton claims that her plan requires no new government bureaucracy, she’s not being candid with the voters. That lack of candor will quickly be exploited by the Republicans and the insurance and drug lobbies. While Republicans are wrong that her plan amounts to “socialized medicine”, such charges will still ring true since, in fact, her plan will require intrusive government regulation of the private insurance industry and coercive action to be sure that all citizens are obeying the individual mandate to buy health insurance. That’s one of the big reasons why, once the debate really starts, an Individual Mandate will not necessarily be a popular plan with the voters–Using the political pragmatism test, it stands a better chance of being rejected by the public and meeting the same fate as Hillarycare 1.0 than does Medicare For All, for which the political arguments are simple and clean.

Whatever Clinton might claim, Hillarycare 2.0 in fact requires a highly intrusive government presence in the lives of both businesses and individuals. As with Hillarycare 1.0, this is likely to be the biggest club that Republicans and their insurance company allies will use to defeat her or another Democrat as they did in 1994, unless so many compromises are made to water down the plan that insurance and drug companies decide it’s in their interest to accept the 50 million new mandatory government subsidized customers to pad their bottom lines. (Remember that with private insurance, approximately 30% of the healthcare dollar goes to administration, executive salaries and profits, compared to 2%-3% for Medicare; when all the political deals are finally cut, the private insurance and drug industries might find a new government subsidy for their bottom line an attractive deal.) If an Individual Mandate plan is more politically expedient than Medicare For All, it’s not for any of the reasons which Krugman cites and not because it’s likely to be more politically popular with the voters. The real reason is that with a few backroom political compromises, it could become a that plan the insurance and drug industries could learn to love.

Miles Mogulescu is an entertainment attorney and former Senior Vice-President at MGM before it was sold to Sony. In his professional capacity, he recently negotiated the distribution arrangements for the film “Bobby” about the assassination of Bobby Kennedy. He has been a lifelong progressive since the age of 12 when his father helped raise substantial sums of money for Dr. Martin Luther King, who was a guest in his home several times. He will never forget the impression which that extraordinary man made on him, which helped lead to a lifelong commitment to social justice.

Nurses are tired of seeing patients left behind

By PHYLLIS BROWN
Napa Valley Register
Tuesday, October 09, 2007

While Michael Bartos is right that the tens of millions of uninsured and underinsured Americans need help (“Single-payer won’t work, but universal care is the goal,” Oct. 2), his opposition to a single-payer style, Medicare-for-all that would guarantee healthcare for all is simply an embrace of our dysfunctional status quo and a broken healthcare system that primarily benefits insurance companies at the expense of the rest of us.

Registered nurses sponsored the billboard on Highway 80 that Bartos cites precisely because we are tired of seeing our patients left behind; infants who can’t get a healthy start because mom can’t afford prenatal care, children who can’t get immunizations and proper dental care because mom and dad can’t afford it, and patients who can’t afford the medications they’ve been prescribed. It doesn’t have to be this way.

Single-payer healthcare, as would be established by HR 676 in Congress and SB 840 in California, is the only effective, genuine cure for our current healthcare nightmare. It is the only health reform that is universal, that assures uniform, comprehensive benefits for all, that guarantees patients’ choice of doctor or medical facility, and that ends the routine, callous denial of care by insurance companies. It’s also the only reform that restores health security for American families by bringing an end to ever-rising insurance premiums, deductibles, co-pays and rising drug and hospital charges.

While Bartos’ experiences with Medicare are unfortunate, they remain unique and anecdotal. The majority of private practitioners who experience difficulty in being paid for services rendered are battling not with Medicare, but with insurance companies. The heart of the claims problem is that insurance companies aim to make a profit. Medicare doesn’t. Insurance companies earn profits by denying payment, therefore, the more payment denied, the greater the profits. Insurance companies have an operating overhead of 30 percent, Medicare, 3 percent. Medicare exists to serve the healthcare needs of American citizens. Insurance companies exist to create attractive portfolios for their stockholders.

We’ve all heard the same tired anecdotes about waiting times in countries with more humane health care systems but studies show that waiting times in the U.S. are as bad as, or worse than, Canada. Unlike the U.S., in Canada no one is denied needed medical care, referrals or diagnostic tests due to cost, preexisting conditions or because it wasn’t pre-approved.

Proponents of preserving market-based healthcare like Dr. Bartos ignore the colossal failure of the system that is collapsing around us. It’s all well and good to talk about public subsidies for our lowest income, but a mountain of evidence is accumulating to document that the crisis now touches more American families every day.

A recent survey by the influential Consumer Reports organization, for example, states that four in 10 Americans can now be classified as “underinsured.” Among those, more than half of the “underinsured” postponed needed medical care due to cost and a third had to dig deep into their savings to pay for medical expenses. Another third of those over 50 said decisions about their retirement were adversely affected by healthcare costs, one quarter had outstanding medical debt, 38 percent postponed home or car maintenance repairs due to medical bills, and only 37 percent said they were prepared to financially handle unexpected major medical costs in the next year.

The point of “Sicko,” and the nurses’ endorsement of the movie, is that the people who live in the wealthiest nation in the world deserve the same standard of care that exists in all of the world’s other industrialized countries. America is a society founded upon the principle of equality, but the message sent by our current healthcare system, or lack thereof, is that you are only entitled to the healthcare you can afford. By redefining health as a commodity, as we have in this nation, we are restricting that fundamental right.

(Brown is a registered nurse who lives in Napa.)

David Lazarus gets personal

Nation's healthcare crisis gets personal

By David Lazarus
Los Angeles Times
October 7, 2007

I write a lot about healthcare reform. Now it’s personal.

I was diagnosed this past week with diabetes. As of Friday, I was injecting myself with insulin, something I’ll be doing four or five times a day, every day, for the rest of my life. Without the injections, I’ll likely die.

Scared? You’re damn right I’m scared. What’s going to happen to me? What’s going to happen to my family?

I got past the shock pretty quickly and am now stuck somewhere between denial and anger. Depression will soon arrive, followed eventually by acceptance. Something to look forward to.

This is an uncertain time for me, but I know this much: I’m more convinced than ever that our medical system is a mess and that a single-payer insurance program is the only realistic way we can achieve universal coverage, promote preventive treatment and make healthcare affordable to all.

And if contracting diabetes is frightening for a relatively well-insured person like myself, what must it be like for any of the 47 million Americans who lack health insurance?

According to the American Diabetes Assn., nearly 21 million U.S. adults and kids have the disease — 7% of the population. About 15 million of this number have been diagnosed. The rest have no idea that they’re afflicted.

With obesity rates soaring, as many as 54 million others are strongly at risk of contracting diabetes in the future.

In my case, diabetes struck not because I stuff my face with Big Macs and fried chicken, which I don’t. I take good care of myself and am not overweight — considerably less so since unexpectedly dropping about 15 pounds over the past couple of months.

No, it’s almost certain I got nailed because a genetic time bomb finally exploded.

My father, Paul N. Lazarus III, who produced the movies “Westworld” and “Capricorn One,” has Type 1 diabetes and is now nearly blind. My younger brother has Type 1 and is doing well enough. My aunt had Type 1 before it blinded and then killed her.

The doctors say diabetes — almost certainly Type 1 — has been lurking in my DNA since I was a child, waiting for its time to strike.

But why now? I’ve lived 46 fairly healthy years, except for certain pharmaceutical pursuits during college. I don’t drink. I don’t smoke. I exercise as regularly as I can. What did I do wrong?

Probably nothing. The stress of my recent move to L.A. and starting a new job didn’t help, but it’s not to blame. This was going to happen no matter what.

I had a good idea something was wrong when I noticed that my weight kept going down no matter what I ate, and that I was consumed with a thirst of biblical proportions (accompanied by a commensurate increase in bathroom breaks).

I visited my doctor and had a blood test. The bad news came just days later. I was immediately referred to a specialist, whom I’ll call Dr. B.

Dr. B was great — knowledgeable, sensitive, empathetic. Problem was, Dr. B didn’t take insurance.

Excuse me? I said.

Dr. B explained that it just wasn’t cost-effective for him to seek reimbursement from insurance companies. It was too much hassle, he said, and he didn’t get paid enough for his efforts. Dr. B said an increasing number of doctors were cutting ties with insurers for the same reasons.

If I wanted to see him at his private practice, which was most convenient to my home, each visit could cost me hundreds of dollars — not the most appealing prospect when one’s facing a chronic disease.

Dr. B said I could try to deal with insurance reimbursements on my own, but that’s the last headache I wanted to inflict on myself at this point.

So I had to quickly find a doctor who would take insurance. My insurer’s website had a directory of possible choices, but you’re essentially pulling a name out of a hat — not the best way to make decisions when your blood-sugar level is three or four times normal.

This led me to Dr. W, who was equally knowledgeable if perhaps a bit lacking in the empathy department. He also had what seemed to me unconventional ideas about how diabetes can be treated with certain drugs and a rigidly monastic diet of his own devising.

This ultimately led me to Dr. D at UCLA’s Gonda (Goldschmied) Diabetes Center, whom I’m very fortunate to have found. Not only does he know what he’s doing, but he also has the resources of a world-class medical facility that focuses exclusively on what’s trying to put me under dirt.

It was Dr. D who finally made the call that I needed to start insulin injections, and it was he who made sure I knew how to handle that first, life-changing moment when needle touched skin.

Clearly I’m receiving the best available treatment, and I’d rather be here than anywhere in the world.

But the quirks and complexities of the insurance system border on madness. Through my employer, I have about as much insurance coverage as anyone. Yet that wasn’t good enough for Dr. B.

I have to wonder where else my private-sector insurance will fail me in years ahead.

And what happens if I get fired tomorrow? With a preexisting condition, I’m virtually uninsurable in the individual insurance market. Will diabetes leave my family destitute?

In the past, I always wrote about the uninsured in a largely abstract way — a faceless mass of millions of people confronted with a broadly defined medical challenge. I know better now.

The terrifying possibility of my own loss of coverage gives me an acute sense of what the uninsured must deal with, the dreadful awareness that you and your loved ones are only one medical misstep from catastrophe.

That’s unacceptable for any person who lives in the wealthiest, most advanced nation in the history of the world.

I’ll have a lot more to say about this in the future, especially as my own situation takes shape. But this much at least is evident:

* Universal coverage must be our goal, and it must allow ready access to all aspects of the medical system at affordable prices.

* The emphasis must be on treatment, not bureaucracy. As it stands, researchers at Harvard University estimate that about a third of the $2 trillion in annual healthcare spending is squandered on bureaucratic overhead.

* Employer-based healthcare is obsolete. As costs continue climbing, businesses can no longer meet their historical obligation of being the primary provider of coverage to American families.

* Quality medical treatment is a right, not a benefit.

Unfortunately, nearly all healthcare-reform proposals on the table center on expanding the existing system and pushing the uninsured into high-cost individual policies that will make private insurers even more profitable.

That can’t be the answer.

Single-payer isn’t perfect. Critics say it can involve long waits for treatment and can stifle innovation.

My belief is that Americans can get it right. We can learn from the examples of other nations and refine things so that our healthcare is second to none. It won’t be easy. Then again, how much worse could it be than the way things are now?

As of this moment, I’m completely dependent on the U.S. healthcare system to keep me alive. I, and you, shouldn’t have to settle for anything but the best.

http://www.latimes.com/business/la-fi-lazarus7oct07,1,7915141,full.column?coll=la-utilities-business&ctrack=2&cset=true

Comment:

By Don McCanne, MD

David Lazarus now not only reports it; he lives it.

Private plans fail Medicare audits

Medicare Audits Show Problems in Private Plans

By Robert Pear
The New York Times
October 6, 2007

Tens of thousands of Medicare recipients have been victims of deceptive sales tactics and had claims improperly denied by private insurers that run the system’s huge new drug benefit program and offer other private insurance options encouraged by the Bush administration, a review of scores of federal audits has found.

The problems, described in 91 audit reports reviewed by The New York Times, include the improper termination of coverage for people with H.I.V. and AIDS, huge backlogs of claims and complaints, and a failure to answer telephone calls from consumers, doctors and drugstores.

Of the audits conducted by the Department of Health and Human Services, 39 focused on drug benefits, 44 focused on managed care plans and 8 examined other types of private plans.

The companies include three of the largest participants in the Medicare market, UnitedHealth, Humana and WellPoint.

The audits document widespread violations of patients’ rights and consumer protection standards. Some violations could directly affect the health of patients — for example, by delaying access to urgently needed medications.

For years, Democrats have complained about efforts to “privatize Medicare,” and they are likely to cite the findings as evidence that private insurers cannot be trusted to care for the sickest, most vulnerable Medicare recipients.

Medicare has taken “vigorous action” to halt marketing violations, said Abby L. Block, a Medicare official.

But David A. Lipschutz, a lawyer at California Health Advocates, a nonprofit group, said that Medicare’s generous payments to private plans still encouraged predatory sales practices.

“Every enrollee in a private Medicare plan is a potential source of substantial profits,” Mr. Lipschutz said.

http://www.nytimes.com/2007/10/07/us/07medicare.html?ref=health&pagewanted=all

Comment:

By Don McCanne, MD

So Democrats “are likely to cite the findings as evidence that private insurers cannot be trusted to care for the sickest, most vulnerable Medicare recipients.” So why do the leading Democratic candidates insist that private insurers be included in their models of health care reform for the rest of us?

Not only can the private insurers not be trusted, but they waste resources that should be redirected to health care. And we all pay for that waste, directly or indirectly.

When is enough enough?

"No Worry" health plan

Health insurers introduce plans with "predictable premiums."

American Medical Association
Morning Rounds
October 9, 2007

The Wall Street Journal (10/9, D3, McQueen) reports, “Guardian Life and Humana Inc. are introducing multiyear plans designed to make health-insurance premiums more predictable from year to year for smaller employers.” However, “workers could face sharply higher deductibles and co-payments for prescriptions and office visits if medical costs rise more than expected.” Guardian Life will make available its “Premium Protect” plan “in the next week or two in five states and the District of Columbia for employers with 51 to 150 employees.” Meanwhile, Humana already introduced its plan, called “No Worry,” in February. “The Humana plans require employers [of 51 to 99 staff] to hand over a large percentage of workers’ phone and email contact information to get annual premium rises of no more than 6%.” The Journal notes, “Guardian achieves its rate-increase lock-in by charging employers an upfront fee of 3% to 4% in return for a guaranteed increase of 0%, 6% or 9% in the second year of a two-year plan.” In contrast, Humana “guarantees annual rate increases won’t exceed 6%.” However, “employers who terminate the contract before the end of the three-year period face a $25,000 penalty.”

http://www.ama-assn.org/

Comment:

By Don McCanne, MD

No worry. Employers can now lock in their premium rates by merely agreeing in advance to pass on health care cost increases to their employees through yet higher deductibles and co-payments.

And you were beginning to think that the private insurance industry was incapable of adressing the problem of escalating health costs.

There is a problem though. If employers really do care about the welfare of their employees, they will need to provide bankruptcy counselors for those whose families actually need medical care.