Jim Winkler spoke at a January 24, 2007, press conference hosted by Physicians for a National Health Program and the California Nurses Association at the National Press Club in Washington, D.C. Here is his statement.

How to Get Healthy

by Jim Winkler

I speak today as national co-chair of Healthcare-NOW!, a growing movement committed to a national quality healthcare system with single-payer financing and as general secretary of the General Board of Church and Society of the United Methodist Church. Our denomination supports a single-payer health insurance program.

Last night President Bush highlighted the crisis of affordable and available health care in his State of the Union address. He would not have given this matter as much time and attention as he did if we were not in the middle of an unfolding tragedy. He noted that “many” Americans cannot afford a health insurance policy. “Many” is an interesting word choice. I think we’ve reached a point where the use of phrases such as “tens of millions” and “too many” are the only ones that work.

One could argue that instead he chose to focus on solutions. Very well. It may be that his recommendation for a standard tax deduction for health insurance will help. He says this will mean more than 100 million men, women, and children who are now covered–already covered, that is–will benefit from lower tax bills.

The President also says the tax deduction will put a basic, private health insurance plan within the reach of those Americans who cannot purchase health insurance on their own. The question before us today is whether we say, “Thank you, Mr. President, for giving some help to the American people” or do we say, “This is not the time for half or quarter or one-eighth measures?” The answer to that is clear: we must have a better and comprehensive single-payer solution to this problem.

The President says the best health care decisions are made not by government and insurance companies, but by patients and their doctors. Yet, he remains committed to the insurance companies. They have to get their vig, their cut, of the health care dollar. Every city in the United States has one or more tall buildings dotting its skyline built by the insurance companies from the excess money they have collected from ordinary Americans. This is money that could be used for better and less expensive health care, for clinics and doctors and nurses, for education and prevention.

And yet these skyscrapers stand as monuments to corporate egos, undeserved profits, and greed. This wasted money prevents patients and doctors from making the best health care decisions. What we want is to eliminate the middle man, the corporate paper-pushers who have bought up the politicians of both major parties in our land, so that health care can become efficient and trustworthy.

Just last night, I was reading the February 2007 issue of Money magazine. Allyson Ranallo of Westlake Village, Calif., wrote to Ellen McGirt who pens the “Money Helps” column. Ms. Rannallo said her husband was treated at an urgent-care facility last March. Afterward she and her husband called their health insurer to confirm this was covered and they were told it was. They mailed the receipt and waited to be reimbursed. They followed up repeatedly and did not receive a check.

Ms. McGirt intervened on their behalf. PacifiCare spokeswoman Cheryl Randolph investigated and found their paperwork fell into “a bureaucratic black hole.” Randolph was mystified as to why the claim was refused. Eventually, they received their check. There are far, far too many people facing the same insurance company denials and obfuscation who do not have a magazine ombudsperson to intervene on their behalf.

Throughout the scriptures, God warns us that nations and rulers who do not care for the sick and the poor and the widows and the orphans will fall, that those nations are corrupt and rotten. Ours is a nation filled with people who study and believe the Bible, but too many have been seduced by the false gods of the market ideology.

Private health insurance has failed us. “Surging” private health insurance will fail just as “surging” the war in Iraq will fail. When you are going down the wrong road, the answer is not to continue traveling in the wrong direction more forcefully. It is to go down the right road.

Date: 1/24/2007

(c) 2005-2006

Jim Winkler spoke at a January 24, 2007, press conference hosted by Physicians for a National Health Program and the California Nurses Association at the National Press Club in Washington, D.C. Here is his statement.

How to Get Healthy

by Jim Winkler

I speak today as national co-chair of Healthcare-NOW!, a growing movement committed to a national quality healthcare system with single-payer financing and as general secretary of the General Board of Church and Society of the United Methodist Church. Our denomination supports a single-payer health insurance program.

Last night President Bush highlighted the crisis of affordable and available health care in his State of the Union address. He would not have given this matter as much time and attention as he did if we were not in the middle of an unfolding tragedy. He noted that “many” Americans cannot afford a health insurance policy. “Many” is an interesting word choice. I think we’ve reached a point where the use of phrases such as “tens of millions” and “too many” are the only ones that work.

One could argue that instead he chose to focus on solutions. Very well. It may be that his recommendation for a standard tax deduction for health insurance will help. He says this will mean more than 100 million men, women, and children who are now covered–already covered, that is–will benefit from lower tax bills.

The President also says the tax deduction will put a basic, private health insurance plan within the reach of those Americans who cannot purchase health insurance on their own. The question before us today is whether we say, “Thank you, Mr. President, for giving some help to the American people” or do we say, “This is not the time for half or quarter or one-eighth measures?” The answer to that is clear: we must have a better and comprehensive single-payer solution to this problem.

The President says the best health care decisions are made not by government and insurance companies, but by patients and their doctors. Yet, he remains committed to the insurance companies. They have to get their vig, their cut, of the health care dollar. Every city in the United States has one or more tall buildings dotting its skyline built by the insurance companies from the excess money they have collected from ordinary Americans. This is money that could be used for better and less expensive health care, for clinics and doctors and nurses, for education and prevention.

And yet these skyscrapers stand as monuments to corporate egos, undeserved profits, and greed. This wasted money prevents patients and doctors from making the best health care decisions. What we want is to eliminate the middle man, the corporate paper-pushers who have bought up the politicians of both major parties in our land, so that health care can become efficient and trustworthy.

Just last night, I was reading the February 2007 issue of Money magazine. Allyson Ranallo of Westlake Village, Calif., wrote to Ellen McGirt who pens the “Money Helps” column. Ms. Rannallo said her husband was treated at an urgent-care facility last March. Afterward she and her husband called their health insurer to confirm this was covered and they were told it was. They mailed the receipt and waited to be reimbursed. They followed up repeatedly and did not receive a check.

Ms. McGirt intervened on their behalf. PacifiCare spokeswoman Cheryl Randolph investigated and found their paperwork fell into “a bureaucratic black hole.” Randolph was mystified as to why the claim was refused. Eventually, they received their check. There are far, far too many people facing the same insurance company denials and obfuscation who do not have a magazine ombudsperson to intervene on their behalf.

Throughout the scriptures, God warns us that nations and rulers who do not care for the sick and the poor and the widows and the orphans will fall, that those nations are corrupt and rotten. Ours is a nation filled with people who study and believe the Bible, but too many have been seduced by the false gods of the market ideology.

Private health insurance has failed us. “Surging” private health insurance will fail just as “surging” the war in Iraq will fail. When you are going down the wrong road, the answer is not to continue traveling in the wrong direction more forcefully. It is to go down the right road.

Date: 1/24/2007

(c) 2005-2006

Less than a year after Massachusetts’s controversial healthcare initiative was first revealed, evidence is accumulating to bolster critics who said the system is faulty by design.

by Megan Tady
TheNewStandard

Jan. 26 — Members of a panel charged with implementing the Massachusetts “universal” healthcare plan redirected some insurers this week to make their premiums more affordable. But critics of the plan say it’s the government that needs to go back to the drawing board.

In April, the Massachusetts legislature passed what supporters called a universal healthcare initiative: one that forces state residents to obtain health insurance. The plan offers a sliding-scale subsidy for residents who earn up to three times the poverty level. Those who exceed the income-eligibility threshold for subsidies are required to purchase their own health insurance without help or face tax penalties and fines.

Then-Governor Mitt Romney pledged that healthcare plans would be affordable for everyone and predicted that low-cost plans would be offered for about $200 a month. Romney vetoed a provision in the bill that would have penalized employers for not offering affordable healthcare to their employees.

Last Friday, a subcommittee of the Commonwealth Health Insurance Connector Authority (the Connector), reviewed insurance company proposals for Minimum Credit Coverage — plans that are the cheapest consumers can purchase.

Disappointed by the high costs of the minimum insurance plans — which average around $340 to $380 per month — the Connector told insurers to “sharpen their pencils and come back with more affordable options,” said Joe Landolfi, spokesperson for Connector chair Leslie Kirwan.

But critics of the state’s plan have been warning the government that universal health care achieved through the requirement to buy private insurance will lead to bloated premiums and bare-bones coverage for middle-income residents who can only afford the minimum plans.

“We should not let these board members get away with telling us that they’re surprised [about the costs for the minimum plans],” said Steffie Woolhandler, a physician at Cambridge Hospital and the co-founder of Physicians for a National Health Program, a nonprofit organization pushing for comprehensive national health plan.

In an April interview with The NewStandard, Woolhandler predicted: “Many people will be forced to pay thousands of dollars for a policy that is only a piece of paper. If someone actually does get sick, the policy will be so full of gaps — like large co-pays — that they could go bankrupt. They’ll be facing the worst of both worlds: [being] forced to hand over thousands of dollars to the private health-insurance companies, and finding that they’re not actually covered when they get sick.”

Benjamin Day, executive director of Mass-Care, a coalition advocating a single-payer healthcare system for Massachusetts, said making a low-cost but effective private-insurance plan is impossible.

“You can’t just tell insurers to provide more-affordable health insurance,” Day told TNS. “Unless they’re willing to erode the quality of the plan, they’re not going to get an affordable plan because health insurance is just not affordable [through private insurers].”

Day said the US’s fragmented private insurance system keeps administrative costs — such as marketing expenses — too high to offer cheaper insurance. According to analysis by the Kaiser Family Foundation, administrative costs have risen from $85 in 1986 to $421 in 2003.

Day predicted insurers will offset the cheaper plans by raising deductibles and co-payments — the amount consumers have to pay out of pocket before their insurance kicks in. “It’s not making it more affordable,” he said. “It’s just shifting the money around.”

Day and Woolhandler’s predictions are already materializing. At the same time the subcommittee called for lower premium costs, committee members lowered their expectations for what benefits lower-cost plans should offer.

The recommendations include a cap on out-of-pocket medical expenses at $5,000 per year for individual coverage, and between $7,500 and $10,000 for family coverage. According to a chart released by the Connector, in November, the board had discussed a $3,000 – $4,000 cap on out-of-pocket expenses.

However, insurance companies are not even required to follow these downgraded recommendations in order to get a “seal of approval” from the Connector; spokesperson Landolfi said they are simply guidelines for the insurers to follow, not mandates.

Asked what would happen if insurance companies dismissed the guidelines, Landolfi said on behalf of the Connector chair: “We’ll cross that bridge when we come to it. We think everyone wants this plan to succeed.”

He added there were some plans submitted that were affordable and “well within the range that we had anticipated. We’re confident that in the next couple of weeks… the carriers will submit plans that will address most of all of the recommendations.”

But Landolfi would not provide TNS with details of the plans that he said met the recommendations.

Even if insurers follow the Connector’s suggestions, critics say health care will remain unaffordable for many people.

“Most people don’t have $5,000 lying around in a bank account,” said Woolhandler, of the recommended maximum out-of-pocket expenses subscribers could incur.

Judy Dugan, research director of the California-based Foundation for Taxpayer and Consumer Rights (FTCR), predicted that plans like the Massachusetts initiative and one proposed for his state could leave families in dire situations.

“For a family who is just above the limit on subsidized insurance, if they have a family member that falls seriously ill and needs treatment year-after-year, that $10,000 out-of-pocket can be a formula for bankruptcy,” Dugan told TNS.

Several of the committee’s recommendations were not unanimous, possibly giving insurance companies a sense of further discretion on the minimum plans offered. For instance, three members of the committee favored a ceiling on deductibles, while one member opposed such a cap and another member abstained.

The committee also could not decide on a number of covered routine doctor visits the plans should offer.

Critics of the plan say it’s the government, not the insurance companies, that needs to roll up its sleeves to fix the problem, particularly as other states — such as California and Maine — consider copying the Massachusetts model.

FTCR said states implementing individual healthcare mandates need to couple affordable health care with insurer oversight.

“Something has to give: either the big-bucks lifestyle of insurers and the rest of the medical industry or policyholder benefits,” said Carmen Balber, consumer advocate with FTCR, in a press statement. Regulation would rein in “the excesses of the

medical establishment to make benefits affordable,” Balber added.

But both Woolhandler and Day said no matter what controls are in place, states can never achieve meaningful universal health care through the current system of private bureaucracies.
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“It’s asking people to buy their own way out of their predicament — I call it a ‘Marie Antoinette’ policy,” Woolhandler said. “Private insurance is the problem, not the solution.”

By Alice Dembner
Boston Globe
1/25/2007

An advocacy group urged the state Wednesday to delay a key part of the new universal health insurance law, saying that a survey shows that many families cannot afford even subsidized insurance.

The Greater Boston Interfaith Organization, which pressed for passage of the law, said the state should not impose penalties for at least a year on low- and moderate-income people who fail to obtain insurance by the July 1 deadline.

Governor Deval Patrick declined to take a position on the proposed change, but he met with the group Wednesday, signaling growing concern among state leaders about the affordability of health insurance plans being established under the new law.

“We are committed to doing anything we can, working with providers, to deliver affordable options,” Patrick said in a statement after the meeting.

Administration and Finance Secretary Leslie Kirwan, who is overseeing implementation, said, “It’s very premature to talk about changing the law.”

Leaders of the interfaith group want the change to ease pressure on about 300,000 individuals earning up to $49,000 a year, who the advocates said face the greatest challenge in paying for insurance. The one-year delay would allow time to negotiate better, less-expensive insurance and could ultimately help ensure the success of the law, the group’s leaders said.

“You only get to do this once with the public, and if you get it wrong it’s going to blow up,” said the Rev. Hurmon Hamilton, pastor of Roxbury Presbyterian Church and president of the Greater Boston Interfaith Organization, a coalition of 65 religious congregations, labor unions, and community groups. “People will not permit the Commonwealth to force them into deeper debt.”

Senator Richard T. Moore, cochairman of the Legislature’s Committee on Health Care Financing, and Richard Lord, president of Associated Industries of Massachusetts, said the penalty delay is worth considering, particularly if insurers do not cut prices and if many people decline to sign up for subsidized plans.

“Assuming we validate … [the interfaith organization’s] numbers, we might want to ease the penalties for a year or two to see how the market shakes out,” said Moore.

But Representative Patricia A. Walrath, Moore’s counterpart in the House, said she doesn’t think the answer is eliminating the penalty for a majority of people.

The interfaith organization made its case with data from a survey it conducted of 367 people with low and moderate incomes who attended the group’s workshops and shared details of their income and expenses. The information is the first on what state residents can afford, but it’s unclear whether the results are representative of the Commonwealth. Most of the people had insurance, but many were at risk of losing it because of unstable job situations.

Nearly one-half of those with incomes low enough to qualify for state-subsidized insurance did not have enough discretionary income to afford the monthly premiums, which range from $18 to $106 for an individual, the survey found.

Nearly 40 percent of those with incomes between 300 and 500 percent of the poverty level could not afford the $380 per month premium plus out-of-pocket costs discussed by state officials last week. Several state officials said they hoped to bring that cost closer to $250 per month, but the survey found that 28 percent of those eligible could not afford that lower cost either.

Dr. Ann Troy
Marin Independent Journal
Article Launched: 01/12/2007

LAST YEAR, Gov. Arnold Schwarzenegger vetoed a bill that would have established a single-payer system to provide health care for all Californians.

Under SB840, patients would choose their own doctors; doctors would remain private, able to practice the way they want and be paid fairly and simply on a fee for service basis; and California would save billions of dollars.

Instead, the governor has come up with a plan that would keep the insurance industry in health care – to the detriment of us all.

The United States is the only developed nation without a national health program. We spend double per capita what any other nation spends on health care, yet we have 50 million people, including 11 million children, without health insurance and the worst health-care statistics in the developed world.

How can this be? About 50 percent of every health-care dollar is spent on something other than health care. Insurance companies admit they spend about 30 percent of the money we pay in premiums on something other than health care – multimillion dollar salaries for their top executives, profits for their shareholders, advertising and sales, screening applicants and claims, and generating mountains of paperwork and endless hassles for doctors and patients alike. There also is the money we have to spend dealing with them – in the creation of intermediary bodies and in hiring staff to do our billing and to deal with authorizations.

In the 1960s, Canada and the United States spent about the same amount per capita on health care and had similar health-care statistics. By 1971, all of Canada had single-payer. Thirty-five years later, Canada spends less than half of what we spend per capita, and provides health care for all its citizens. On almost every measure, their health-care statistics are better than ours. Our infant mortality rate is 50 percent higher than theirs and our overall mortality rate is 30 percent higher. The World Health Organization ranks the U.S. 37th, at the bottom of the developed world.

If we get the insurance industry out of health care, we will have more than enough money to provide health care for all and to pay doctors and hospitals fairly for their services.

No longer will people have to change doctors every time they change jobs or their employer finds a cheaper health plan. Nor will they have to worry about losing their access to health care if they lose their job or develop a chronic condition. No longer will families struggle to pay astronomical insurance premiums nor worry about paying for prescription drugs. No longer will 50 percent of bankruptcies be due to medical debt.

All patients will have a medical “home.” Continuity of care will be improved and problems will be treated earlier (when easier to treat) or prevented altogether. Rates for vaccinations and health screening will go up. Public health and productivity will improve and social problems associated with untreated mental health problems and addictions will decrease.

If doctors are reimbursed fairly for their services, fewer of them will feel the need to practice at a frenzied pace and will spend more time with patients, providing better quality care.

Smaller companies and small businesses can’t afford to provide health-care benefits and can’t compete for the best workers. A single-payer system would improve all of this and decrease absenteeism and increase productivity. All of these advantages would attract businesses to California, generating more jobs and more tax revenue.

SB840, which was passed by the Legislature last year, will be reintroduced. We have an opportunity to have the best health-care system in the world, to enable all Californians to have access to care that citizens of every other developed nation take for granted, and to lead the country in much needed health-care reform. Let’s be courageous and make it happen.

Dr. Ann Troy is a pediatrician in private practice in San Rafael.