Saul Friedman
Newsday
April 21, 2007

As we’ve discussed, “Medicare for All” may seem the simplest and most logical path to universal health care. But the nation’s conservative traditions and the entrenched multizillion-dollar for-profit health care establishment will be formidable obstacles on that path.

It took 20 years of political struggle to get Medicare, and it passed only because an overwhelmingly elected Democratic president, Lyndon Johnson, had veto-proof majorities in both houses of Congress. Such one-party control is not the case now, nor will it be after 2008, unless there is a political earthquake.

Thus, any proposal for universal health care will have to reckon with the combined power of the nation’s richest and most powerful lobbies – the insurance industry and drug manufacturers, as well as medical professionals who make out well in the current system. People are easily fooled by misleading ads. Remember the insurance lobby’s “Harry and Louise”?

My mail shows that while most Americans say they favor publicly supported universal health care and social insurance, including Medicare and Social Security, a vocal minority strongly believes that would lead to socialism or worse. The minority will be aided by a network of right-wing think tanks that never supported Medicare but helped kill the Clinton plan in 1994.

Every Democratic presidential candidate favors one form or another of universal health care. Along with several Republican governors, they have proposed what they believe is a more politically palatable path than Medicare for All – a combination of public and private health insurance. They would mandate that individuals buy insurance and, if necessary, raise revenues to subsidize those purchases.

Most of the more pragmatic proposals reject the single-payer approach, fearing it would run afoul of lobbying campaigns against centralized government control of health care. The latest proposal, called AmeriCare, comes from one of the most liberal members of Congress, Rep. Pete Stark (D-Calif.). Like most others, it would depend on private, for-profit insurance companies to provide health care for the non-elderly.

Even AARP, which earned $379 million in royalties in 2005, mostly from health insurance sales, appears to favor universal public and private health care coverage. AARP endorsed and makes millions from Part D, which is based wholly on private coverage. Last month’s AARP Bulletin reported on various state schemes for universal private coverage, but made only passing mention of the Medicare for All proposals in Congress.

The most comprehensive public-private proposal favored by some liberal groups has come from Yale political scientist Jacob S. Hacker. Writing for the liberal Economic Policy Institute, Hacker said he seeks “to avoid the dismal fate of previous reform campaigns” that ran afoul of budget problems, public resistance to change and “the embedded realities of the present system.”

His proposal, Health Care for America, would “extend insurance to all non-elderly Americans through a new Medicare-like program and workplace health insurance…. Every legal resident of the U.S. who lacks access to Medicare or good workplace coverage would be able to buy into the ‘Health Care for America Plan,’ a new public insurance pool modeled after Medicare….Employers would be asked to either provide coverage as good as this new plan or make a relatively modest payroll-based contribution to Health Care for America.

“It would not eliminate private employment-based insurance….It is not single-payer – a vision that, for both political and budgetary reasons, is unlikely to be achieved in the near future. Nonetheless, Health Care for America does embody many of the key virtues of a universal Medicare-like program.”

Hacker’s plan would put private insurance in competition with a Medicare-type plan to provide coverage that would be guaranteed. “Health Care for America,” he writes, would provide “a generous package of benefits…greater choice.” (See epi.org for the full text of Hacker’s proposal.)

Diane Archer, former president of the New York-based Medicare Rights Center, applauded the proposal as a way to create competition between public and private insurers, and predicted that for-profit insurers would not compete because “they would still try as hard as possible to avoid insuring the people with the costliest conditions.”

President George W. Bush, who opposes government involvement in health care, says universal coverage should be provided only by private insurers. Under his recent proposal, government would grant people more tax incentives – greater deductions – to buy health insurance, perhaps through their employers.

But many of the 45 million workers who are uninsured don’t pay enough taxes to benefit from any deductions. Many cannot afford insurance for themselves and their families, and others can’t qualify because of adverse medical histories.

While the president opposes government health insurance for others, he and his immediate family, including his mother and father, have benefitted most of their lives from government-supplied, taxpayer supported health insurance. And they’ll never be without that coverage. They (as well as Vice President Dick Cheney and members of Congress) earned it with government service. If government coverage is good enough for them, what about the rest of us?

The most cogent criticism of the plans offered by Hacker and several governors came in an editorial by the Des Moines Register. It said that requiring the purchase of health insurance, called “individual mandates,” through employers or subsidies, “is far from simple, especially considering the government absolutely must ensure the coverage it makes people buy is adequate.”

Noting that a Register reader who bought an AARP-endorsed plan for $700 a month ended up with $200,000 in bills when he was treated for cancer, the editorial said, “Our greatest concern is that an individual mandate moves this country in the wrong direction by relying too heavily on the private sector to achieve universal coverage.”

Copyright 2007 Newsday Inc.

by Rose Ann DeMoro
The Huffington Post
04.11.2007

Listening to the purveyors of conventional wisdom, you might think only an incremental approach on healthcare reform is possible.

The most comprehensive reform, HR 676 in Congress, (and its state versions, such as SB 840 in California), providing guaranteed healthcare as an expanded and improved Medicare for all, is not politically feasible.

So, the pundits insist, settle for what we can get.

Lower the expectations and turn down the public heat, they advise. Gradualism – extending health coverage to some – is the mantra of the day, fawned over by some politicians and advocacy groups alike. The staged appearance of “bi-partisanship” or “strange bedfellows” for health reform is often the only purpose of grand pronouncements of support for universal health care. Whether the proposals actually solves the health care crisis is irrelevant or secondary to the hype.

Virtually all the gradual reforms being touted would reinforce a dysfunctional system with as many standards of care as there are dollars to purchase them. It would further lock us into a private insurance-based model that holds our health hostage to the HMOs and big insurance companies for years to come.

For the proponents of political expediency, the question remains who will be left behind while we wait?

Every year, 18,000 unnecessary deaths, the equivalent of six times the number who died in the September 11 attacks, are linked to lack of health coverage.

Among those un-covered, lung cancer patients are less likely to receive surgery, chemotherapy, or radiation treatment. Heart attack victims are less likely to receive angioplasty. People without pneumonia are less likely to receive X-rays or consultations. Those with colorectal cancer are 70% more likely to die within three years.

The uninsured receive less preventive care, are diagnosed at more advanced disease stages, and receive less therapeutic care (drugs and surgical interventions). Not only do they incur greater pain and suffering down the road, they also face increased cost, at a time when medical bills already account for half of all personal bankruptcies and one third of credit card debt.

The public is fed up, and they’re ahead of the politicians and policy wonks. A New York Times/CBS poll last month found that 64% said the government should guarantee health insurance for all, 55% identified it as the top domestic priority for Congress and the President.

As the polls show, we have the greatest opportunity in years to achieve fundamental reform. Yet the gradualist approaches would undercut the momentum and squander that opening.

Our most successful national health program, Medicare, provides one of the best arguments against incremental steps. When Medicare was enacted 42 years ago, following a broad grassroots campaign, many believed the dream of a full national health system was right around the corner.

Four decades later, Medicare has not been expanded. Most of the changes have been contractions – higher out of pocket costs for beneficiaries and repeated attempts at privatization by the healthcare industry and its champions in the White House and Congress.

Similarly, incremental healthcare reforms in Maine, Massachusetts, Minnesota, Washington, Vermont, and Tennessee, that were supposed to lead to universal coverage failed to produce any real reduction in the number of uninsured.

Moreover, by pushing further away the day of real reform, we open the door to some of the worst alternatives, from the Bush administration tax schemes to the current fad of forcing everyone to buy insurance.

Both of these schemes end up saddling people with high deductible insurance plans that more and more people are finding accelerate the healthcare crisis.

In January, a vice president of the Kaiser Family Foundation testified to Congress that one in six privately insured adults have “substantial problems paying their medical bills.” And, a new study this week by Harvard Medical School researchers in the Journal of General Internal Medicine documented that the financial burden of such plans is especially onerous for women who typically need more routine medical visits than men, and thus bear double the out-of-pocket costs.

It’s time to stop promoting inferior approaches and insist on real reform.

American history is filled with examples of fundamental, democratic change brought about by mass action and public pressure against the counseling of the go slow crowd. We can and must achieve that in healthcare as well.

Jaime Torres
El Diario
OPINIóN – 04/24/2007

En toda la nación el tema de la crisis en nuestro sistema de salud está candente y la gente está demando a los políticos que la resuelvan. Hay 47 millones de personas sin cobertura médica — 14 millones son hispanos — y más de 50 millones con seguros inadecuados. El Instituto de Medicina reportó que cada año 18,000 personas mueren por falta de cobertura médica.

En salud, los EE.UU. gastan por persona más que cualquier otro país avanzado (casi el doble de Canadá y Francia). Aun así, tenemos la más alta mortalidad infantil y casi la más baja expectativa de vida del mundo desarrollado. Es muy claro que hay mucho sufrimiento y que las propuestas para “mejorarlo” en recientes años han tenido poco resultado.

En mis años como doctor he visto a un hombre perder una pierna porque no pudo pagar por antibióticos para curar una úlcera en un pie; he peleado con aseguradoras por denegar procedimientos necesarios, y he visto niños recibir cuidado deficiente porque tenían Medicaid–un seguro que muchos ven de segunda clase. Es increíble que en el país más rico del mundo haya tanta injusticia y dolor.

Pero los demás países desarrollados brindan atención de salud a todos. La única razón que no tenemos cobertura universal es la espectacular ineficiencia de nuestro sistema. Aunque los EE.UU. gastan $2 trillones en gastos de salud, $600 billones nunca llegan a la gente, pero se usan en gastos administrativos, y para pagar a accionistas y ejecutivos millonarios que nunca han cambiado un vendaje en sus vidas.

Es muy claro que el sistema necesita una cirugía radical. Eli Siegel, el gran filósofo y fundador de la educación Realismo Estético, demostró su falla central cuando explicó que un sistema de salud basado en lucro es inmoral porque está “basado en desprecio por la gente”. El explicó que tan pronto uno está en busca de lucrarse, uno no puede estar muy interesado en lo que otras personas se merecen, lo que sienten, ya que eso restringiría nuestra habilidad de ganar dinero de ellos.

Nuestro sistema no debe depender en que algunos se lucren de las desdichas de otros seres humanos. Cuando aseguradoras, hospitales o médicos ven a pacientes en término de cuánto dinero se puede hacer de ellos es puro desprecio, y es completamente opuesto a desear que se fortalezcan y que sean más saludables

Lo cierto es que podemos dar cobertura a todos en los EE.UU. si expandimos el plan federal Medicare a todas las personas que residan en el país, sin importar su estado migratorio, o su estado de salud. El Medicare es la aseguradora federal sin fines de lucro que ha cubierto eficientemente, y con cuidado de calidad, a nuestras personas mayores.

Esto se lograría pagado con un impuesto que representaría menos de lo que la mayoría de los empleados o de sus empleadores pagan hoy en seguros. Así, en un solo paso, se daría cobertura a los no asegurados, se bajarían significativamente los costos administrativos y se avanzaría en la prevención.

Es por eso que debemos educarnos y demandar a todos los que desean la presidencia de este país a que expandan el Medicare como el seguro médico nacional, donde todos estemos cubiertos, y cuyo único propósito sea mejorar nuestra salud y no obtener ganancias.

es fundador de Latinos por un Seguro Médico Nacional y un Asociado en la Fundación Realismo Estético en NY.

By ROBERT PEAR
The New York Times
April 17, 2007

WASHINGTON, April 16 — AARP, the lobby for older Americans, announced Monday that it would become a major participant in the nation’s health insurance market, offering a health maintenance organization to Medicare recipients and several other products to people 50 to 64 years old.

The products for people under 65 include a managed care plan, known as a preferred provider organization, and a high-deductible insurance policy that could be used with a health savings account.

When the new coverage becomes available next year, AARP will be the largest provider of private insurance to Medicare recipients. In addition to the new H.M.O., AARP will continue providing prescription drug coverage and policies to supplement Medicare, known as Medigap coverage.

William D. Novelli, the chief executive of AARP, said, “In launching these initiatives, we are driven by our mission to create a healthier America.”

The group also said it would use its leverage to reshape the health insurance market. The organization has 38 million members, and Mr. Novelli said it hoped to have 50 million by 2011.

The new Medicare product will be marketed with UnitedHealth Group. Policies for people under 65 will carry the AARP name and will be marketed with Aetna.

Revenues and royalties from the sale of goods and services have, for many years, accounted for a substantial part of AARP’s income. AARP officials insisted that its financial interests do not affect the positions it takes on Medicare, Medicaid, Social Security and dozens of other issues on which it lobbies and litigates.

Representative Pete Stark, Democrat of California and chairman of the House Ways and Means subcommittee on health, welcomed AARP executives to the Medicare managed care market. “If they provide quality care at a fair price,” Mr. Stark said in an interview, “they could be a wonderful addition.”

But Judith A. Stein, director of the Center for Medicare Advocacy, a nonprofit group that counsels people on Medicare, said, “The new arrangements with insurance companies create a tremendous number of potential conflicts for AARP, which is a powerhouse, perceived as the most important voice for older people.”

The role of private insurers in Medicare is one of the most hotly debated issues in American health policy. In general, Republicans want to expand the role of private insurers like UnitedHealth and Aetna, while Democrats want to limit the role of private entities.

Ms. Stein and her organization work closely with AARP.

“AARP will not be perceived as a truly independent advocate on Medicare if it’s making hefty profits by selling insurance products that provide Medicare coverage,” Ms. Stein said. “AARP’s role in this market could give a big boost to the privatization of Medicare.”

AARP has opposed efforts to privatize Medicare or Social Security.

Dawn M. Sweeney, president of AARP Services Inc., the tax-paying business unit of AARP, said, “We will use our collective market power to negotiate” competitive prices for the new health insurance products.

AARP also said it would use $500 million of insurance sales revenue over the next decade to help people navigate the health care system, with a new counseling service.

Payments to UnitedHealth and Aetna will be linked to their performance in improving the health of subscribers, including members of minorities, Mr. Novelli said. The new plans will coordinate care for people with chronic conditions and will develop special programs to treat people with depression. AARP will measure how frequently the companies deliver recommended treatments to people with diabetes, hip fractures and other conditions.

Insurers typically sign one-year contracts with Medicare. Ms. Sweeney said AARP’s H.M.O. was “guaranteed to be in the Medicare marketplace for two years,” though premiums and co-payments could change after the first year.

People ages 50 to 64 often find that health insurance is unavailable or unaffordable when they try to buy it on their own. AARP said its underwriting practices would be less stringent than those of many commercial insurers, but it reserved the right to deny coverage to some sick people ages 50 to 64.

To guarantee issuance of a policy to every applicant in that age group is “just not economically feasible,” Ms. Sweeney said.

About seven million people currently have health insurance of various types, mainly drug coverage or Medigap policies, carrying the AARP brand name. With the new products, Ms. Sweeney estimated, the number will double to 14 million by 2014.

Letter to the Editor
New York Times Magazine
April 15, 2007

Is this what our country has come to? Leading C.E.O.’s, despairing of their ability to limit rising health-care costs and unwilling to bear these costs themselves any longer, will now back legislation that would place every individual and family at the mercy of private insurance companies like UnitedHealth, Wellpoint and the other insurance giants. Do they think John and Jane Doe can achieve what Safeway and General Motors cannot, namely, affordable health care for all of us?

Instead of moving backward to the time before there was employer-based or group health insurance, when people were on their own to get health care any way they could, we should be moving forward, recognizing that health care is a necessary public good that should be treated as a public responsibility. We should be expanding and improving the Medicare program, which we know provides reliable, cost-effective coverage and has been doing so for more than 40 years. Public Medicare-for-All, not private for-profit insurance, is the only path to a future that will truly provide access to health care for all Americans.

Oliver Fein, M.D.
New York
Leonard Rodberg
Flushing, N.Y.

(The authors are, respectively, chairman and research director of the New York chapter of Physicians for a National Health Program)

Letter to the Editor
New York Times Magazine
April 15, 2007

Is this what our country has come to? Leading C.E.O.’s, despairing of their ability to limit rising health-care costs and unwilling to bear these costs themselves any longer, will now back legislation that would place every individual and family at the mercy of private insurance companies like UnitedHealth, Wellpoint and the other insurance giants. Do they think John and Jane Doe can achieve what Safeway and General Motors cannot, namely, affordable health care for all of us?

Instead of moving backward to the time before there was employer-based or group health insurance, when people were on their own to get health care any way they could, we should be moving forward, recognizing that health care is a necessary public good that should be treated as a public responsibility. We should be expanding and improving the Medicare program, which we know provides reliable, cost-effective coverage and has been doing so for more than 40 years. Public Medicare-for-All, not private for-profit insurance, is the only path to a future that will truly provide access to health care for all Americans.

Oliver Fein, M.D.
New York
Leonard Rodberg
Flushing, N.Y.

(The authors are, respectively, chairman and research director of the New York chapter of Physicians for a National Health Program)