by David Moberg
In These Times
03/7/07

Like the creature from the Black Lagoon, the health insurance monster has returned, creeping back onto the public stage. After President Clinton’s jury-rigged pen to contain the monster collapsed in 1994, it never really went away. Political leaders tried to ignore the beast or deal piecemeal with its ravages, but it pushed more unsuspecting civilians into the uninsured pit, devoured more family budgets, squeezed even giant corporations’ ability to compete globally, and raised fear and insecurity among the populace.

Now its depredations have become too loathsome to ignore for even cautious politicians and business executives — who still are inclined to see the monster as one of their own. After a rebuff in the fall elections, when voters ranked health care as one of their top concerns, President Bush offered a plan that almost certainly would not deliver his promise of “quality, affordable health care for all Americans.”

Recently, chief executives like Lee Scott of Wal-Mart — under attack for its skimpy health insurance coverage of employees — and Steve Burd of Safeway — which endured a long strike by southern California grocery workers to cut their health insurance — joined progressive leaders like Service Employees Industrial Union (SEIU) President Andy Stern, head of the nation’s largest health workers union, to call for major changes in the health care system. Under fire from both other labor unions and many citizen health care groups for joining with strange bedfellows on behalf of very broad principles, Stern argues that “the most essential change is to get everyone in a system where they have health care,” then work to improve it.

Although the war in Iraq is likely to dominate the already energetic Democratic presidential primary race, health care is emerging as the leading domestic issue in both parties. Shortly after announcing his candidacy, John Edwards laid out a comprehensive health care plan. Barack Obama said that the nation should provide universal insurance coverage by the end of the next president’s term, though so far he has mostly advocated for minor and politically easy reforms, like computerizing health records. Republican candidate Mitt Romney signed a flawed plan for universal health care when he was governor of Massachusetts, and California Gov. Arnold Schwarzenegger, after vetoing statewide single-payer legislation passed last year, has his own health insurance plan.

There’s reason for hope when leaders across the political spectrum recognize the problem. But there’s no guarantee that such agreement will lead to a good solution. For more than a decade, conventional wisdom has dictated that only incremental steps should be taken. Now more politicians are willing to consider bolder steps — but the right is still determined to push its agenda. And many progressive reformers are cautious about pursuing their ideals, as they continue to nurse scars from the fight business interests waged against the Clinton plan.

“Overwhelmingly, people are trying to find incremental responses instead of a national response,” says Marilyn Clement, national coordinator of Healthcare-NOW, a coalition advocating a public insurance program as the single payer of health care bills. “They are still putting forward the same proposals as last summer, such as ‘The first step is to get national health care for children.’ Well, that’s good, but we won the election. It’s time to escalate our hopes.”

The first crucial step is to define the problem. For many people, it’s the rising number of Americans without health insurance, now nearly 47 million. But equally problematic is the decline in quality and scope of coverage for those who have insurance. And much of the public ranks the cost of health care as their top medical and economic concern. Focusing primarily on insuring everyone won’t necessarily solve those problems. Indeed, the skyrocketing cost of health care is the main reason that the ranks of the uninsured continue to grow. Faced with rising insurance premiums, businesses have been trying to cut costs by evading responsibility for providing health insurance, leading Stern to declare that “the employer-based health care system is dead.”

But the more fundamental problem is our reliance on private, for-profit corporations to provide health insurance — the real monster in this saga. They’re the main reason for rising costs (making health insurance in the United States about twice as expensive as in most industrial countries), for the growing number of uninsured, and for the inferior health results for the average American. In 2004, the United States spent $6,100 per capita on health care, compared to $2,250 per capita on average by the countries in the Organization for Economic Cooperation and Development, which have national health insurance programs. Because public expenditures cover 60 percent of American health care costs, U.S. taxpayers are paying more than the cost of national health insurance, but not receiving it.

“How much can a new system depend on private insurance companies to provide affordable, good health care for everyone?” asks Roger Hickey, co-director of Campaign for America’s Future, a Washington, D.C.-based progressive advocacy group. “That should be the debate.”

Now the country is faced with two radically different proposals for reform. The first, pushed by conservatives and embraced by Bush in his new plans, would make individuals more responsible for buying their own health insurance. While giving them tax breaks to help pay the premiums, it would push them in the direction of lower-cost, less comprehensive plans (partly by taxing employer-provided insurance as income). As part of this strategy, conservatives have also undermined Medicare, first, by subsidizing private insurance companies to provide Medicare insurance and, second, by establishing a prescription program only available through private insurers.

The Bush strategy would be a boon for wealthy and healthy individuals, as well as employers and insurance companies, but it would ultimately leave most Americans paying more for less health security. The harsh edges of the plan could be softened — by regulating the insurance companies’ attempts to charge more or deny coverage to people seeking insurance, or by offering tax credits or direct subsidies to the poor instead of tax deductions. But these changes still embody what economist Jared Bernstein, of the progressive think tank the Economic Policy Institute, calls YOYO (“You’re On Your Own”) economics.

The diametrically opposite alternative is to recognize that “we’re in this together” (WITT, in Bernstein’s schema) and move towards social insurance, or a plan like Medicare. In this case, the federal government — through a public agency — would provide comprehensive insurance. It would be financed directly by progressive taxes on individuals and business, unlike the current system, which provides $200 billion a year in economically regressive and largely unrecognized tax deductions to subsidize employer-based health insurance. The public insurance agency would then bargain with health care providers, drug companies and others to control prices and improve quality of care.

The Bush YOYO strategy assumes that when health care consumers — otherwise known as patients — confront costs of medical care, they’ll consume less, and overall medical costs will go down. But Americans already spend more out-of-pocket on health care and use doctors and hospitals less than citizens of almost every other industrialized country. Yet, while the overall health cost in the United States is much higher, the outcomes — by virtually every measure of health — are worse. U.S. health care costs more mainly because of private insurance: Overhead at insurance companies runs close to 20 percent of total revenues, compared to less than 4 percent for Medicare. When the extra administrative costs imposed on providers are counted, the overall overhead that private insurance imposes on the system eats up about one-third of what Americans spend on health care. Eliminating those costs, as proposed by Rep. John Conyers (D-Mich.) and supported by Ohio Rep. and Democratic presidential candidate Dennis Kucinich, could finance most of a Medicare expansion to cover all Americans much more comprehensively than the program does now.

MOST PROGRESSIVE REFORMERS acknowledge that Medicare for everyone would best slay the health crisis monster, but many strategists worry that trying to eliminate the private insurers will provoke a withering counterattack. Consequently, many current proposals try, as Hillary Clinton did in 1993, to preserve a more regulated role for the insurance companies and at the same time expand public programs, on the model of Medicare, to provide a competitive alternative to private insurers.

Edwards’ plan would require employers to cover employees or help pay for their insurance (what’s widely known as “pay or play”). Everyone would have to buy insurance, taking advantage of tax credits, expanded programs such as Medicaid and the State Children’s Health Insurance Program, or new regional “health markets” that would provide a choice of competitive private plans and a public plan. Along the same lines, but with a simpler design and more robust public component, Yale political scientist Jacob Hacker proposes that everyone not in Medicare be covered either by insurance at work or a public insurance pool, including both regulated private plans and a Medicare-like plan.

Both these proposals move in the direction of Medicare for all, but strike a compromise with the existing system, losing the potential for better efficiency and more equity in the bargain. Why not push for universal Medicare (aka, a “single payer” plan)? Proponents of compromises say Medicare for all is a political non-starter. Americans, they argue, are suspicious of government, like choices and often like the private insurance they already have. And besides, they say, the insurance industry — along with most business interests and political conservatives — would launch a scorched earth campaign against such a proposal.

“There are a lot of dedicated, smart people who have made the judgment that taking some steps toward a comprehensive system with a public health care plan is better than waiting for the perfect system,” says Hickey, whose organization supports Hacker’s proposal. The labor movement, which was divided over support of a single-payer system in the ’90s, seems even more cautious now. “The political will isn’t there now, but it could get there for single-payer,” says AFL-CIO health care lobbyist JoAnn Volk. A close union ally adds, “Most of the labor movement has already accommodated to the reality that we’re not going to get a pure single-payer system. They have made the judgment that it’s just not within the range of possibility.”

SEIU’s Stern — who has argued that the United States needs an “American” plan, and not a foreign model like Canada’s single-payer system — says, “First we should create [a health care system] in which everyone is covered, then we can figure out how to rationalize it. It will cost more money than if we did it the other way [i.e, pursing the best alternative], but I think we have more chance of getting it done. The perfect cannot be the enemy of the good.”

ALTHOUGH A SMALL but rebounding movement for some form of Medicare-for-all exists, some progressive groups that would be its natural partisans are reluctant to commit themselves to a specific plan. William McNary, president of USAction, a national group of statewide citizen organizations, notes that many of their allies are splintering over proposals. “Things are fracturing,” he says, “it would be best for us to line up behind principles,” and not a plan. Jim Dean, chairman of Democracy for America, a liberal movement within the Democratic Party, thinks the United States is ripe for universal health care, but worries about both infighting over the best plan and the specter of corporate attacks. He wonders, “Can we figure out a way to talk about this so as not to get bogged down, sway, with “Harry and Louise” commercials [that the insurance industry used against President Clinton’s plan]?”

But there’s no guarantee that insurance companies won’t launch a war against these compromises, especially any that curtail insurance industry profits. And corporations that support universal health insurance will almost certainly oppose any plan that doesn’t seriously reduce their financial responsibility, which would threaten to shift costs to individuals. “Everyone says they’re for universal health care,” says Don Bechler, chair of the California Universal Health Care Organizing Project. “But the fundamental question is, ‘Who pays?’ Is [universal health care going to be] a sliding scale health care plan where everyone is entitled to first class health care, or a flat tax to sell junk insurance?”

When Clinton tried to finesse such political opposition by making insurance companies central to his plan, he suffered merciless attacks. No plan worth having will win without a massive grassroots organizing and education campaign. And Medicare for all is the one most likely to do so, while simultaneously strengthening progressives politically.

The American people are at least open to the argument. In a 2003 Washington Post poll, one of the few to pose alternatives fairly, 62 percent of respondents said they would prefer a universal health insurance program like Medicare, run by the government, to the current health insurance program. And support for the Medicare program remained nearly as high even if it limited the choice of doctors or led to waiting lists for non-emergency procedures.

Eventually, Medicare-for-all advocates might have to settle for a compromise. But the opportunity for major change in the health care system doesn’t come around very often. Since any change will require a massive effort, why not fight for the best?

By Jennifer L. Boen
Fort Wayne News-Sentinel
Thu, Mar. 08, 2007

The stories told by the uninsured and underinsured reverberate in the mind of emergency room doctor Robert Stone, who works in Bloomington: People delay care because they don’t have health insurance or skip or stop taking medications because they can’t afford them. A less serious medical problem becomes catastrophic because of the delays or lack of medication.

Nationally, 46.6 million people are uninsured, according to 2005 U.S. census data; 860,000 of those are Hoosiers. Many health-care providers, consumers and their families are calling for a change and will address the problem at a public forum on Monday titled “Citizen’s Hearing on Healthcare for All.”

Stone, who co-founded Hoosiers for a Commonsense Health Plan, is keynote speaker at the event. The organization is promoting the health-care reform agenda laid out by Physicians for a National Health Program. The groups seek universal, comprehensive coverage for everyone through a single-payer health insurance system that is publicly financed but privately delivered. Rather than employer-based health insurance, all people would participate in a plan that would give access to all — similar to the way Medicare works for people 65 and older.

“This is not socialized medicine,” with doctors and hospitals government-owned, Stone said.

A Medicare-like system for all would require raising taxes, but those taxes would take the price of premiums, which continue to escalate for employers and employees, he said.

A 2003 study by Harvard Medical School and the Canadian Institute for Health Information found 31 percent of U.S. health-care dollars are spent on administration and overhead, compared to 17 percent in Canada.

“Medicare runs about 3 percent overhead,” compared to insurance companies’ 20 percent to 30 percent overhead, Stone said.

Park Center President/CEO Paul Wilson calls U.S. health care a “non-system.” “The confusion and fragmentation is so expensive and so wasteful. It’s a real tragedy we spend so much money on health care, and we leave so many people out.

“We see huge numbers of people who don’t have any insurance or don’t have mental-health coverage,” Wilson said about the community mental health center. “What we’ve developed in this country is all kinds of stopgap measures. People in their most vulnerable time running across town to the (township) trustee’s office, or to a church for help.”

The ASK clinic is one of several free clinics in Allen County.

“The numbers here just keep going up,” said ASK director Eve Bratton. “It used to be the generational poor we saw. Then it became people laid off from their jobs. Now we’re seeing people still in college and people among the middle class. We’re seeing sicker people. It’s not uncommon for me to see blood pressures of 260/120 (normal pressure is 120/80), because people can’t take their medicine, and they delay care.

“The health-care system is absolutely collapsing, and people are falling through the safety net,” Bratton said.

Dr. Matthew Farber is an ophthalmologist and surgeon with Allen County Retinal Surgeons. “In talking with physicians, some say things such as, ‘I don’t know if people are going to be happy waiting for care as in Canada,’ which has a single-payer system.

But the reality, Farber says, is even though U.S. health-care spending was nearly $2 trillion in 2004 and is expected to reach $4 trillion by 2015, “In the end, it’s not as if people live longer here,” compared to Canada.

Americans want new medicines and life-saving technologies, yet also want to preserve the free-market system and competition. For example, three medicines are used to treat glaucoma, Farber said. All are costly, and the companies who make them “don’t compete by trying to get a bigger (sales) share by lowering the price. Sure we want the pharmaceutical industry to come up with new therapies, but in the end, there can be only so much spent on pharmaceuticals.”

For too long, the health-care system has not promoted or reimbursed doctors for preventive medicine. Now a growing epidemic of diabetes, chronic lung disease, high blood pressure and other conditions, along with the largest segment of the population entering their senior years, is overwhelming the system.

“There aren’t any easy answers,” Farber said, “but the current system isn’t working. We have to get Congress to be willing to stand up and try and improve things.”

The economic ramifications of health-care costs are far-reaching, Stone said. Big industries wanting to compete internationally find themselves at a disadvantage because of American health insurance costs. People running small businesses cannot afford to pay premiums. Wilson says he has found 7,200 health insurance plans exist in the United States. “It’s bizarre, craziness. I suppose we could have a more wasteful system — but I don’t know how.”

AFL-CIO Executive Council statement
Health Care
March 06, 2007
Las Vegas

The nation is once again focused on the crisis in health care and the American people are looking for a comprehensive solution, instead of the inaction and incredibly ineffective piecemeal approach of the past 10 years.

Nearly forty-seven million U.S. citizens are uninsured. Tens of millions more worry about losing the coverage they have. Workers fear changing or losing jobs because they are at risk of losing their health care coverage. American businesses that provide adequate health benefits are at a significant disadvantage, competing in the global marketplace with foreign companies that do not carry health care costs on their balance sheets. The same is true for businesses in domestic competition against employers that provide little or no coverage.

As a society, we all benefit from improvements in public health. We are a more creative, vibrant, productive and democratic nation because of it. We are all at risk of illness, injury or poor health, and we all suffer when individuals are denied needed care. The shortcomings of the American health care system–which ignores these fundamental realities–strain our nation’s social and economic fabric.

The time for talking about this crisis is past. All families deserve the security of a universal health care system that guarantees access based on need rather than income. Health care is a fundamental human right and an important measure of social justice.

As a nation, we need to exert the political will to enact comprehensive health care reform nationwide. There is strong evidence the crisis can be solved with tools at hand and at a cost that pales in comparison to the toll in human lives the current system exacts.

It is time to mobilize America behind a concrete plan to enact universal health care and the AFL-CIO commits its full resources to asserting leadership in this historic effort.

Universal health care does not mean mandating that everyone must buy a health insurance policy and then handing them the bills. Meaningful health care reform must be measured by the following tests:

Universal Coverage

* Everyone should have health care coverage, without exclusions or penalties.

* While the market has an important role to play, our government–as the voice of all of us–must play the central role in regulating, financing and providing health care.

* Coverage should be accessible through the largest possible groups that pool risk to ensure coverage regardless of gender, age, health status or other factors.

Comprehensive, Affordable Coverage

* Coverage should be affordable and comprehensive.

* Unions and employers should continue to play a role and retain the ability to supplement coverage.

Choice of Providers

* Individuals should retain the ability to select their own doctors and other health care providers.

Financing Through Shared Responsibility

* Because everyone faces the possibility of poor health, risks should be shared broadly to ensure fair treatment and equitable rates, and everyone should share responsibility for contributing to the system through progressive financing.

* A level playing field should be provided for all businesses. Every employer must participate in ensuring health coverage and no employer should be disadvantaged because of the age or health of its workforce or number of retirees.

Effective Cost Control

* Reform efforts must include effective mechanisms for controlling costs, requiring information on provider performance and enhancing efficiency.

* Investments should be made in systems and technology to reduce medical errors and costs, streamline administration and promote best practices.

* Employees who are frontline caregivers should have a protected voice in improving health care.

Do No Harm

* Until we have a comprehensive alternative for all Americans, reform efforts should not undermine existing coverage or put people at risk of unmet health care needs.

Our approach should be to build on what’s best in American health care. At the same time, we should draw from the best experiences of other countries that have achieved universal coverage at a fraction of U.S. health care costs.

One concrete plan that meets the test of comprehensive, universal health coverage would build on our nation’s successful universal health coverage plan for seniors: Medicare.

In its 40-year history, Medicare has delivered substantial advances for the health care of older Americans and people with disabilities. Medicare has guaranteed coverage, made health care more affordable, included a form of shared financial responsibility, significantly reduced administrative costs compared with those of private plans and has been the largely unheralded financer of America’s medical science advances. Medicare also has been a leader in advancing quality care and improvements in health care service delivery in the United States.

Such an approach would require updating and expanding Medicare benefits to fit the working population and children, as well as negotiating prices with physicians and providers that families–and the country–can afford. It would encourage innovation in health care services and medical technology. Employers’ responsibility for health care financing would be broadly and equitably shared, substantially reducing burdens on all businesses and reducing disadvantages currently faced in the global marketplace. In building on Medicare to move toward a universal program, we can find a practical, achievable and affordable solution to our country’s health care crisis.

We call on congressional leaders to unite behind such a plan.

Unlike our fragmented and flawed health care system, a successful universal health care system would provide benefits and cost savings for all stakeholders. The leadership to make comprehensive reform possible, then, must come from all quarters:

* Governments will have to forge the tough consensus that commits necessary public funding while paying only for care that is effective and efficient, based on the best science available.

* Employers must provide strong political support for a transition away from the current employment-based system and be willing to provide continuing financial contributions sufficient to responsibly contribute to the new funding requirements.

* Unions and other organizations that represent users of health services must make enactment of comprehensive health reform legislation a top priority and make a long-term commitment to improving health care service delivery.

* Health care providers and practitioners need to commit their leadership and lend their knowledge and experience to achieving necessary improvements in the quality and effectiveness of care, and use their considerable political clout to support the effort.

We will mobilize our members to build support for bold, meaningful and comprehensive reform and work to pass legislation that assures everyone affordable, comprehensive coverage. We will recruit employers to join us in achieving universal coverage. And we will evaluate the health proposals of candidates for president in 2008 based on the test we have outlined and their capacity to make meaningful change to meet this urgent goal.

Until comprehensive national reform is enacted, we will continue to defend the health benefits workers have fought and sacrificed to establish over the past 50 years, and we will strongly oppose President George W. Bush’s changes in the tax treatment of existing employer-provided coverage.

We also will continue to fight to preserve and expand the State Children’s Health Insurance Program (SCHIP) and Medicaid coverage, improve the Medicare drug benefit and alleviate the legacy health care costs that threaten coverage for millions of workers and retirees, as well as the health of the economy. And we will continue to push for comprehensive reforms at the state level, with the knowledge that other nations have built the political consensus for national reform by first enacting comprehensive care region by region.

Business First of Buffalo
Monday, March 5, 2007

The New York State Academy of Family Physicians has called on Gov. Eliot Spitzer and the state Legislature to create a single payer health-care system.

Family physicians from across the state gathered in Albany Monday to lobby lawmakers. Their concerns include the fact that nearly 3 million New Yorkers are uninsured and many more are underinsured, while others have insurance that does not cover significant items like medications.

Rising costs have a growing number of employers either dropping or reducing coverage. The doctors also complain that dealing with multiple insurance plans, with their different rules, forms, and procedures, wastes an estimated 20 percent to 30 percent of the health care dollar.

The Academy, which represents about 3,000 family doctors and more than 700 medical students, would like have all payments funneled through a single payer, eliminating multiple rules and procedures, enrollment and eligibility problems.

“A single payer health plan is the best way to control costs and reduce administrative waste and thereby insure long-term survival of universal, affordable coverage,” said Dr. Linda Prine, chair of the Academy’s Commission on Public Health.

“In Albany, the attempts at expanding coverage and cost control, though laudable, only tinker with the current system. The weakness we all witness with tinkering is that New York has achieved neither universal coverage nor
effective cost control. Instead, we are bankrupting ourselves, making small dents only in adding broader coverage, and implementing even more administrative procedures. Moving to universal coverage is a big step. The current system is not working; we should not take a failed system and make it a bigger failure.”

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