PNHP

Private insurer nightmare

Private insurer nightmare

Effects of health overhaul will take time to become clear

By Duke Helfand
Los Angeles Times
March 22, 2010

(The industry’s Washington lobbying arm, America’s Health Insurance Plans) ran ads in national newspapers last week criticizing the overhaul for failing to adequately contain costs. Without bolder action, it warned in its “Open Letter to the American People,” the country could face a healthcare cost “crisis similar to the financial crisis that has rocked our economy.”

“Virtually everyone believes that we have a huge number of issues that remain to be addressed,” said Jay Gellert, chief executive of Woodland Hills-based Health Net Inc. “If anyone thinks that just by passing this we’re going to solve the problems, they are seriously mistaken.”

http://www.latimes.com/business/la-fi-insure22-2010mar22,0,3396267.story

Comment: 

By Don McCanne, MD

I had a nightmare last night. I dreamed that we reformed the financing of health care in America, but that we left the private insurance industry in charge. Oh, wait… Oh, no!

Private insurer nightmare

Effects of health overhaul will take time to become clear

By Duke Helfand
Los Angeles Times
March 22, 2010
(The industry’s Washington lobbying arm, America’s Health Insurance Plans) ran ads in national newspapers last week criticizing the overhaul for failing to adequately contain costs. Without bolder action, it warned in its “Open Letter to the American People,” the country could face a healthcare cost “crisis similar to the financial crisis that has rocked our economy.”
“Virtually everyone believes that we have a huge number of issues that remain to be addressed,” said Jay Gellert, chief executive of Woodland Hills-based Health Net Inc. “If anyone thinks that just by passing this we’re going to solve the problems, they are seriously mistaken.”
http://www.latimes.com/business/la-fi-insure22-2010mar22,0,3396267.story

I had a nightmare last night. I dreamed that we reformed the financing of health care in America, but that we left the private insurance industry in charge. Oh, wait… Oh, no!

Arizona shuts down CHIP, slashes Medicaid

Governor signs Ariz. budget-balancing bills

By Casey Newton
The Arizona Republic
March 18, 2010

Gov. Jan Brewer signed the fiscal 2011 budget on Thursday, enacting $1.1 billion in spending cuts and program eliminations.

The budget, passed last week by the Republican-led Legislature on largely party-line votes, drew criticism from opponents for what they called a disproportionate impact on the poor.

“I’m not sure how cutting three-quarters of a billion dollars from public education and kicking 300,000 people off of health care puts our state on the back on the road to recovery,” said Rep. Kyrsten Sinema, D-Phoenix. “In fact, it dismantles what we have been working for years to build in Arizona — a vibrant, healthy state where people want to live and work.”

One aspect of the budget expected to be challenged is a cut of $385 million to the state’s Medicaid program, the Arizona Health Care Cost Containment System.

The budget bills also eliminate KidsCare, which provided health care to 38,599 children of low-income parents.

Hours after she signed the budget, Brewer appeared at a news conference to urge opposition to federal health-care reform. Asked by reporters what the hundreds of thousands of Arizonans set to lose coverage this year should do, Brewer said they should use community health clinics and emergency rooms.

http://www.azcentral.com/news/election/azelections/articles/2010/03/18/20100318brewer-signs-budget-bills-arizona.html

Comment: 

By Don McCanne, MD

Programs benefiting low income individuals and families, such as Medicaid and CHIP, are politically vulnerable to the whims of conservatives wielding budget cleavers. Gov. Jan Brewer of Arizona has just provided us with a prime example of that.  Yet popular programs benefiting everyone, such as Medicare, are relatively impenetrable to the weapons of the conservatives.

The reform proposal likely to be enacted by Congress is heavily dependent on the expansion of Medicaid. Since it is a federal/state program, it requires the support of the government on both levels. In spite of the proposed increases in federal support, Gov. Brewer continues to urge opposition to the reform proposal. Low income families will remain vulnerable in her state as long as she and her Republican colleagues remain in charge.

Suppose Congress had included single payer in their deliberations and eventually decided that the benefits were too great to pass up ,and so enacted an improved Medicare program that covered everyone. Gov. Brewer and her ilk on the state level would be powerless to stop it. It would be so popular that conservatives who managed to take over the federal government would never be able to shut the program down.

Whether or not the current bill passes, we need to make every effort to replace our expensive, fragmented, often cruel, and relatively ineffectual system of health care financing with one that works for all of us – a single payer national health program – an improved Medicare for everyone.

Or failing that, as Gov. Brewer says, we could all just go to the emergency room when we can’t get into the clinic.

Vermont lawmakers hear about single-payer health care

By Terri Hallenbeck, Free Press Staff Writer
Burlington Free Press, March 19, 2010

MONTPELIER — An economist who helped Taiwan and other nations create their health care systems told Vermont lawmakers Thursday that a single-payer plan can lower costs, but is not necessarily a foolproof remedy.

William Hsiao, an economics professor at Harvard University, testified before House and Senate health committees as Vermont legislators look for ways to broaden health care coverage while also curbing escalating costs.

“Single-payer can actually lower the level of health spending,” he said of a system where there is a single insurance provider. “Single-payer is probably the most effective tool to reform health care delivery.”

Taiwan was able to shrink the number of uninsured residents from 45 percent to 5 percent in a year after creating a single-payer plan, Hsiao said. In the first two years, costs dropped 8 percent to 10 percent, he said.

A bill from the Senate Health and Welfare Committee would create a panel to come up with three options for a health care plan for Vermont. Committee Chairman Doug Racine, D-Chittenden, noted that that’s the approach Hsiao and others used in Taiwan.

The bill is pending before the Senate Appropriations Committee, which will decide whether to come up with $400,000 to pay for the panel’s work, as the bill seeks.

The bill carries an interesting political dynamic, as Racine, Appropriations Committee Chairwoman Susan Bartlett, D-Lamoille, and Senate President Pro Tempore Peter Shumlin, D-Windham, are all seeking the Democratic nomination for governor and seeking to distinguish themselves among likely Democratic voters for whom health care reform is a key topic. They all have a role in how this legislation proceeds.

Shumlin has ideas about the health care bill that vary slightly from Racine’s and said he would seek to amend Racine’s bill. Instead of a panel producing three options, Shumlin wants the Legislature to hire Hsiao to advise whether the state can create a system that provides universal access, curbs costs, offers quality care and is detached from a person’s employment. of one’s pay 15 years ago to 5.09 percent this year, he said.

Rep. George Till, D-Jericho, asked Hsiao whether a national system could work in a single state where many hospital patients come from neighboring states. Hsiao said he didn’t think the system would create as much savings, but thought it could produce some savings.

Taiwan’s system is different than Racine was expecting. Thirty percent of the cost is paid by the government, 35 percent by payroll taxes on employers and 35 percent by payroll taxes on employees, Hsiao said. Those without an employer pay a premium, except for low-income people, he said. There are co-pays for doctor, clinic and hospital visits and prescriptions, he said.

Shumlin said Hsiao’s trip to Vermont on Thursday came at no cost to the state.

Contact Terri Hallenbeck at 651-4887 or thallenb@bfp.burlingtonfreepress.com.

http://www.burlingtonfreepress.com/article/20100319/NEWS03/3190304/Vermont-lawmakers-hear-about-single-payer-health-care

What's In, What's Out in Health Care Reform Bill

Associated Press
The Huffington Post, March 19, 2010

WASHINGTON (AP) — Bye bye, Cornhusker Kickback. Hello, special treatment for Tennessee and North Dakota.

Democrats unveiling revisions Thursday to their health care overhaul bill decided to kill the extra $100 million in Medicaid funds for Nebraska that has become a symbol of backdoor deal making.

But the 153 pages of changes to the massive health care package include extra money for hospitals in Tennessee that serve large numbers of low-income patients. And though the bill would revamp the nation’s student loan system to make the government the only lender, one bank – the state-owned Bank of North Dakota – would be allowed to continue making student loans.

That provision ended up rubbing Sen. Kent Conrad, D-N.D., the wrong way. Fearing it would become a target by Republicans in what he said is “an overly heated partisan environment,” he asked the House late Thursday to remove it from the legislation.

Still alive is special spending for Louisiana, Connecticut, Montana and other states that was included in the health care bill that the Senate approved in December. The House may give it final approval this weekend.

Senior White House officials have sent mixed signals about the special deals. They initially demanded that they be eliminated, but by Sunday senior White House adviser David Axelrod said they only objected to provisions affecting just one state.

White House spokesman Robert Gibbs last week singled out projects from Montana and Connecticut as items President Barack Obama wanted removed. There was resistance, however, from two influential committee chairmen, Democratic Sens. Max Baucus of Montana and Christopher Dodd of Connecticut, and their projects have survived.

To help win the vote of Sen. Ben Nelson, D-Neb., the massive measure the Senate passed on Christmas Eve had included $100 million that only Nebraska would get in added federal Medicaid assistance.

Immediately mocked as the Cornhusker Kickback, critics called it the epitome of special Washington dealing, and even Nelson advocated ending his state’s special treatment. Under the changes announced Thursday, the Nebraska provision would be deleted and all states would get additional Medicaid help from Washington.
Story continues below

Also eliminated from the Senate measure was a provision allowing about 800,000 elderly Floridians to keep enhanced Medicare benefits that are being cut for residents of other states.

The changes also include an additional $99 million in 2012 and 2013 for Tennessee hospitals that treat many poor people.

Retiring Rep. Bart Gordon, D-Tenn., has fought for the funds for years to bring the state’s aid up to par with the rest of the country, spokeswoman Emily Phelps said. She said their inclusion had nothing to do with his announcement Thursday that he will vote for the final health legislation after opposing an earlier version in November.

The new package also promises new aid for colleges serving minority students, using money the government is supposed to save by no longer paying banks to make student loans. Included are annual payments of $100 million for schools with large numbers of Hispanic students, the same amount for colleges with many black students, and millions more for schools with large numbers of native Americans and other minorities.

Based on Thursday’s changes, the health legislation also:

-Retains $300 million in extra Medicaid aid for Louisiana, which had helped win support for the Senate health bill from Sen. Mary Landrieu, D-La. The state is still struggling to recover from Hurricane Katrina.

-Keeps $100 million included in the Senate bill that is expected to go for a public hospital in Connecticut sought by Dodd, who is retiring.

-Preserves language won by Baucus permitting many of the 2,900 residents of Libby, Mont., to qualify for Medicare benefits. Some of them have asbestos-related diseases from a now-shuttered mine.

-Provides an additional $8.5 billion over the next decade for 11 states and the District of Columbia to help them pay for the more generous Medicaid assistance they have been providing low-income residents. These states are Arizona, Delaware, Hawaii, Maine, Massachusetts, Minnesota, New York, Pennsylvania, Vermont, Washington and Wisconsin.

-Maintains a Senate-approved provision giving extra money for hospitals and doctors in North and South Dakota, Montana and Wyoming.

http://www.huffingtonpost.com/2010/03/19/whats-in-whats-out-in-hea_n_505288.html

What’s In, What’s Out in Health Care Reform Bill

Associated Press
The Huffington Post, March 19, 2010

WASHINGTON (AP) — Bye bye, Cornhusker Kickback. Hello, special treatment for Tennessee and North Dakota.

Democrats unveiling revisions Thursday to their health care overhaul bill decided to kill the extra $100 million in Medicaid funds for Nebraska that has become a symbol of backdoor deal making.

But the 153 pages of changes to the massive health care package include extra money for hospitals in Tennessee that serve large numbers of low-income patients. And though the bill would revamp the nation’s student loan system to make the government the only lender, one bank – the state-owned Bank of North Dakota – would be allowed to continue making student loans.

That provision ended up rubbing Sen. Kent Conrad, D-N.D., the wrong way. Fearing it would become a target by Republicans in what he said is “an overly heated partisan environment,” he asked the House late Thursday to remove it from the legislation.

Still alive is special spending for Louisiana, Connecticut, Montana and other states that was included in the health care bill that the Senate approved in December. The House may give it final approval this weekend.

Senior White House officials have sent mixed signals about the special deals. They initially demanded that they be eliminated, but by Sunday senior White House adviser David Axelrod said they only objected to provisions affecting just one state.

White House spokesman Robert Gibbs last week singled out projects from Montana and Connecticut as items President Barack Obama wanted removed. There was resistance, however, from two influential committee chairmen, Democratic Sens. Max Baucus of Montana and Christopher Dodd of Connecticut, and their projects have survived.

To help win the vote of Sen. Ben Nelson, D-Neb., the massive measure the Senate passed on Christmas Eve had included $100 million that only Nebraska would get in added federal Medicaid assistance.

Immediately mocked as the Cornhusker Kickback, critics called it the epitome of special Washington dealing, and even Nelson advocated ending his state’s special treatment. Under the changes announced Thursday, the Nebraska provision would be deleted and all states would get additional Medicaid help from Washington.
Story continues below

Also eliminated from the Senate measure was a provision allowing about 800,000 elderly Floridians to keep enhanced Medicare benefits that are being cut for residents of other states.

The changes also include an additional $99 million in 2012 and 2013 for Tennessee hospitals that treat many poor people.

Retiring Rep. Bart Gordon, D-Tenn., has fought for the funds for years to bring the state’s aid up to par with the rest of the country, spokeswoman Emily Phelps said. She said their inclusion had nothing to do with his announcement Thursday that he will vote for the final health legislation after opposing an earlier version in November.

The new package also promises new aid for colleges serving minority students, using money the government is supposed to save by no longer paying banks to make student loans. Included are annual payments of $100 million for schools with large numbers of Hispanic students, the same amount for colleges with many black students, and millions more for schools with large numbers of native Americans and other minorities.

Based on Thursday’s changes, the health legislation also:

-Retains $300 million in extra Medicaid aid for Louisiana, which had helped win support for the Senate health bill from Sen. Mary Landrieu, D-La. The state is still struggling to recover from Hurricane Katrina.

-Keeps $100 million included in the Senate bill that is expected to go for a public hospital in Connecticut sought by Dodd, who is retiring.

-Preserves language won by Baucus permitting many of the 2,900 residents of Libby, Mont., to qualify for Medicare benefits. Some of them have asbestos-related diseases from a now-shuttered mine.

-Provides an additional $8.5 billion over the next decade for 11 states and the District of Columbia to help them pay for the more generous Medicaid assistance they have been providing low-income residents. These states are Arizona, Delaware, Hawaii, Maine, Massachusetts, Minnesota, New York, Pennsylvania, Vermont, Washington and Wisconsin.

-Maintains a Senate-approved provision giving extra money for hospitals and doctors in North and South Dakota, Montana and Wyoming.

http://www.huffingtonpost.com/2010/03/19/whats-in-whats-out-in-hea_n_505288.html

Arizona shuts down CHIP, slashes Medicaid

Governor signs Ariz. budget-balancing bills

By Casey Newton
The Arizona Republic
March 18, 2010
Gov. Jan Brewer signed the fiscal 2011 budget on Thursday, enacting $1.1 billion in spending cuts and program eliminations.
The budget, passed last week by the Republican-led Legislature on largely party-line votes, drew criticism from opponents for what they called a disproportionate impact on the poor.
“I’m not sure how cutting three-quarters of a billion dollars from public education and kicking 300,000 people off of health care puts our state on the back on the road to recovery,” said Rep. Kyrsten Sinema, D-Phoenix. “In fact, it dismantles what we have been working for years to build in Arizona — a vibrant, healthy state where people want to live and work.”
One aspect of the budget expected to be challenged is a cut of $385 million to the state’s Medicaid program, the Arizona Health Care Cost Containment System.
The budget bills also eliminate KidsCare, which provided health care to 38,599 children of low-income parents.
Hours after she signed the budget, Brewer appeared at a news conference to urge opposition to federal health-care reform. Asked by reporters what the hundreds of thousands of Arizonans set to lose coverage this year should do, Brewer said they should use community health clinics and emergency rooms.
http://www.azcentral.com/news/election/azelections/articles/2010/03/18/20100318brewer-signs-budget-bills-arizona.html

Programs benefiting low income individuals and families, such as Medicaid and CHIP, are politically vulnerable to the whims of conservatives wielding budget cleavers. Gov. Jan Brewer of Arizona has just provided us with a prime example of that.  Yet popular programs benefiting everyone, such as Medicare, are relatively impenetrable to the weapons of the conservatives.
The reform proposal likely to be enacted by Congress is heavily dependent on the expansion of Medicaid. Since it is a federal/state program, it requires the support of the government on both levels. In spite of the proposed increases in federal support, Gov. Brewer continues to urge opposition to the reform proposal. Low income families will remain vulnerable in her state as long as she and her Republican colleagues remain in charge.
Suppose Congress had included single payer in their deliberations and eventually decided that the benefits were too great to pass up ,and so enacted an improved Medicare program that covered everyone. Gov. Brewer and her ilk on the state level would be powerless to stop it. It would be so popular that conservatives who managed to take over the federal government would never be able to shut the program down.
Whether or not the current bill passes, we need to make every effort to replace our expensive, fragmented, often cruel, and relatively ineffectual system of health care financing with one that works for all of us – a single payer national health program – an improved Medicare for everyone.
Or failing that, as Gov. Brewer says, we could all just go to the emergency room when we can’t get into the clinic.

Keep your insurance? Ask locked-out employees in Boron

Labor War in the Mojave

By Mike Davis
The Nation
March 29, 2010

The biggest hole in California, with the exception of the current state budget, is Rio Tinto’s huge open-pit mine at the town of Boron, near Edwards Air Force Base, eighty miles northeast of Los Angeles.

The Boron pit, which replaced an underground mine, produces almost half the world’s supply of refined borates.

Once upon a time, there were several thousand mining communities in North America; perhaps fewer than a hundred still exist. Boron (unincorporated, population 2,000) is one of the survivors.

In last year’s contract negotiations, Rio Tinto (the British-Australian multinational acquired its Boron facility, U.S. Borax, in 1968 and renamed it Rio Tinto Borax) stunned members of the International Longshore and Warehouse Union, ILWU, Local 30 (Boron), by demanding abolition of the contractually enshrined seniority system and the surrender of any worker voice in the labor process.

The company wants a contract that would allow it to capriciously promote or demote; to outsource union jobs; to convert full-time to part-time positions with little or no benefits; to reorganize shift schedules without warning; to eliminate existing work rules; to cut holidays, sick leave and pension payments; to impose involuntary overtime; and to heavily penalize the union if workers file grievances against the company with the National Labor Relations Board.

“The company’s proposal,” union negotiators emphasize, “would destroy our union, lower our living standards, and give Borax total control over our jobs.” On January 30, Local 30 members unanimously rejected the concessions demanded by Rio Tinto.

The company deadline expired the next morning, when Terri Judd set off for work as usual with her lunchbox and thermos. At the locked front gate she and other day-shift workers encountered a phalanx of nervous Kern County sheriff’s deputies in full riot gear. Inside the plant, an elite “strike security team” hired by Rio Tinto had taken control of operations.

“Being locked out,” says Terri, “is different from going on strike. Initially there’s disbelief that the company is actually serious about booting you out the door. Hey, my granddad worked in this mine. But then you see that caravan of scabs coming to take your jobs, and the betrayal cuts like a knife in your heart.”

http://www.thenation.com/doc/20100329/davis/single

Comment: 

By Don McCanne, MD

Empathetic souls will find the full version of this article to be very tough reading. When the 560 wage earners unanimously rejected the demands of Rio Tinto to give up much of their job security, the company terminated all of them in a job lockout. The impact on their small community of Boron is devastating.

Even though this story is not about health care, there is a very important health policy lesson here.

These people lost company support of their health benefits program at termination. With loss of their paychecks, many of these individuals are struggling to pay their rent and to buy food. Extension of health coverage through COBRA, even with subsidies, is of no benefit if they don’t have the funds to pay for it.

And President Obama’s promise of being able to keep the insurance you have if you want to? He left off the part that says you can keep it until your COBRA runs out, and at that only if you can pay your share (and all of the other reasons why hardly anyone still has the insurance they had twenty years ago, even if they wanted to keep it).

The policy lesson is that a health care financing system should be designed to cover absolutely everyone automatically throughout life. Individuals unfortunate enough to lose their jobs shouldn’t be further penalized by losing their health care as well.

For gender-equal health care, enact Medicare for All

By Dr. Sheila Leavitt
The Progressive, March 16, 2010

President Obama’s health reform proposal is not good for women, so it’s ironic he’s pushing it through during Women’s History Month.

His plan amounts to “a giant leap backward for women,” says the National Organization for Women (NOW).

This assessment is based on three main problems: a failure to ban gender rating in a timely fashion, a failure to ban age rating, and a real threat to abortion coverage.

Gender rating refers to the practice in which insurance companies charge women more for their premiums than men for identical coverage. This applies not only to individual women policyholders, but also insured groups with a predominantly female work force.

This discriminatory practice is widespread, being banned in only 11 states. The National Women’s Law Center, as part of its campaign entitled “Being a woman is not a pre-existing condition,” describes how women constitute a special group in the actuarial tables of for-profit insurance companies.

On average, women under 55 are charged premiums up to 48 percent higher than those for men of the same age – and this is with maternity coverage excluded.

Obama’s health care reform bill would only partially remedy this. On his Web site, the president claims, “Once the [insurance] exchanges are up and running, insurance companies will be banned from setting different premiums based on gender.”

But not right away. Although insurance exchanges (which would not begin until 2014) would prohibit the sale of policies that discriminate on the basis of gender, this ban would not apply to companies with more than 100 employees. For these groups, gender rating will remain legal at least until 2017.

For-profit insurance companies regard gender rating as good business practice. Women cost these companies, on average, more than men. Women have babies, Pap smears and mammograms, and they generally visit the doctor more during youth and middle age than do men.

Lawmakers who see health care as an individual responsibility rather than a collective right tend to share with the insurance companies this “pre-existing condition” view of women. Sen. Jon Kyl, R-Ariz., infamously asked why he should be forced pay for a policy with maternity coverage when he didn’t need it.

Another serious flaw in the president’s proposal is the retention of age rating, NOW says. Middle-age and older women could be charged up to three times more than their younger counterparts for the same coverage.

Then there’s reproductive choice. Obama’s proposal would require that women write a separate premium check to their private insurer for an abortion rider on their policy. Payments would go into separate accounts.

This cumbersome segregation of funds, experts predict, would cause many insurers to restrict or drop abortion coverage, denying coverage to millions of women who have it now.

Instead of the president’s proposal, we need a single-payer health care plan. It would end the view of women as expensive liabilities who get in the way of maximizing profit. Under an improved Medicare for All, women and men would get the full range of medical services whenever they need it.

The savings from eliminating wasteful paperwork and bureaucracy – estimated at $400 billion annually – would be more than enough to cover everybody.

All women, and every man born of woman, even senators, must ultimately admit the fairness of this approach. It’s the remedy we need.

Dr. Sheila Leavitt is a retired physician in Newton, Mass., and a member of Physicians for a National Health Program (www.pnhp.org). She can be reached at pmproj@progressive.org.

http://www.progressive.org/mpleavitt031610.html

Keep your insurance? Ask locked-out employees in Boron

Labor War in the Mojave

By Mike Davis
The Nation
March 29, 2010
The biggest hole in California, with the exception of the current state budget, is Rio Tinto’s huge open-pit mine at the town of Boron, near Edwards Air Force Base, eighty miles northeast of Los Angeles.
The Boron pit, which replaced an underground mine, produces almost half the world’s supply of refined borates.
Once upon a time, there were several thousand mining communities in North America; perhaps fewer than a hundred still exist. Boron (unincorporated, population 2,000) is one of the survivors.
In last year’s contract negotiations, Rio Tinto (the British-Australian multinational acquired its Boron facility, U.S. Borax, in 1968 and renamed it Rio Tinto Borax) stunned members of the International Longshore and Warehouse Union, ILWU, Local 30 (Boron), by demanding abolition of the contractually enshrined seniority system and the surrender of any worker voice in the labor process.
The company wants a contract that would allow it to capriciously promote or demote; to outsource union jobs; to convert full-time to part-time positions with little or no benefits; to reorganize shift schedules without warning; to eliminate existing work rules; to cut holidays, sick leave and pension payments; to impose involuntary overtime; and to heavily penalize the union if workers file grievances against the company with the National Labor Relations Board.
“The company’s proposal,” union negotiators emphasize, “would destroy our union, lower our living standards, and give Borax total control over our jobs.” On January 30, Local 30 members unanimously rejected the concessions demanded by Rio Tinto.
The company deadline expired the next morning, when Terri Judd set off for work as usual with her lunchbox and thermos. At the locked front gate she and other day-shift workers encountered a phalanx of nervous Kern County sheriff’s deputies in full riot gear. Inside the plant, an elite “strike security team” hired by Rio Tinto had taken control of operations.
“Being locked out,” says Terri, “is different from going on strike. Initially there’s disbelief that the company is actually serious about booting you out the door. Hey, my granddad worked in this mine. But then you see that caravan of scabs coming to take your jobs, and the betrayal cuts like a knife in your heart.”
http://www.thenation.com/doc/20100329/davis/single

Empathetic souls will find the full version of this article to be very tough reading. When the 560 wage earners unanimously rejected the demands of Rio Tinto to give up much of their job security, the company terminated all of them in a job lockout. The impact on their small community of Boron is devastating.
Even though this story is not about health care, there is a very important health policy lesson here.
These people lost company support of their health benefits program at termination. With loss of their paychecks, many of these individuals are struggling to pay their rent and to buy food. Extension of health coverage through COBRA, even with subsidies, is of no benefit if they don’t have the funds to pay for it.
And President Obama’s promise of being able to keep the insurance you have if you want to? He left off the part that says you can keep it until your COBRA runs out, and at that only if you can pay your share (and all of the other reasons why hardly anyone still has the insurance they had twenty years ago, even if they wanted to keep it).
The policy lesson is that a health care financing system should be designed to cover absolutely everyone automatically throughout life. Individuals unfortunate enough to lose their jobs shouldn’t be further penalized by losing their health care as well.

Sen. Snowe's policy advisor: Single payer in a decade

The Health Care Letdown

By William F. Pewen
The New York Times
March 15, 2010

Should they succeed in blocking reform, Republicans should take no consolation. When Congress next attempts reform, in a decade or more, health costs and the number of uninsured and underinsured will have escalated — and the likely outcome will be the single-payer system that Republicans most abhor.

(William F. Pewen is a former senior health policy adviser for Senator Olympia Snowe, Republican of Maine.)

http://www.nytimes.com/2010/03/16/opinion/16pewen.html

Comment: 

By Don McCanne, MD

William Pewen expresses the view of the majority of well informed moderates and conservatives: The likely eventual outcome of further deterioration in health care financing will be a single payer system, like it or not.

Although they may be opposed to single payer based on ideology, they understand simple math. A decade from now a family with an income of $100,000 will not be able to pay an insurance premium of $25,000 plus a $25,000 deductible plus a coinsurance of 30% of the balance of the medical expenses.

The private insurance industry never has been and never will be capable of reining in health care costs. Health care costs are now so high that the reliance on pure market forces can never be effective in ensuring that everyone receives the health care that they should have. Only the government has the capability of slowing spending and improving the allocation of our health care resources so that everyone is taken care of.

A decade from now costs will be so high that almost every informed individual will recognize that we can no longer afford the additional waste inherent in our fragmented, dysfunctional financing system. In all reality, only a single payer system will work. Opposition will be limited to the “I got mine” folk who do not accept the enlightened, civilized view that we are all in this together.

We likely are now about to begin an experiment to see if a combination of greater government regulation of private insurers along with a system of government subsidies can provide everyone with the health care that they need without busting the budgets of families, businesses and the government. It is an unfortunate delay since the results are in before the experiment has even begun. Tens of millions will be left out of the system, and by selecting the most expensive model of reform, budget busting will only compound.

So as William Pewen states, if the bill before Congress is blocked, the likely outcome a decade from now will be a single payer system. But health policy science tells us that, if this bill passes, the likely outcome a decade from now will be a single payer system.

We really don’t have to wait another decade. People already understand that health care costs are too high. What they need to understand is that they cannot rely on being able to keep the insurance they have if it becomes unaffordable for themselves or their employers, and they cannot rely on being able to purchase it though an exchange if the premiums are too high and the subsidies are too low. They also need to understand that, even if they have insurance, the relatively low actuarial value of basic coverage will leave them exposed to financial hardship should they develop significant health care needs, so the insurance they have won’t work as it should.

Regardless of the results of the vote on the reform bill, we need to intensify our efforts to inform the public. Health care justice in America is ultimately their decision.

Sen. Snowe’s policy advisor: Single payer in a decade

The Health Care Letdown

By William F. Pewen
The New York Times
March 15, 2010

Should they succeed in blocking reform, Republicans should take no consolation. When Congress next attempts reform, in a decade or more, health costs and the number of uninsured and underinsured will have escalated — and the likely outcome will be the single-payer system that Republicans most abhor.

(William F. Pewen is a former senior health policy adviser for Senator Olympia Snowe, Republican of Maine.)

http://www.nytimes.com/2010/03/16/opinion/16pewen.html

Comment: 

By Don McCanne, MD

William Pewen expresses the view of the majority of well informed moderates and conservatives: The likely eventual outcome of further deterioration in health care financing will be a single payer system, like it or not.

Although they may be opposed to single payer based on ideology, they understand simple math. A decade from now a family with an income of $100,000 will not be able to pay an insurance premium of $25,000 plus a $25,000 deductible plus a coinsurance of 30% of the balance of the medical expenses.

The private insurance industry never has been and never will be capable of reining in health care costs. Health care costs are now so high that the reliance on pure market forces can never be effective in ensuring that everyone receives the health care that they should have. Only the government has the capability of slowing spending and improving the allocation of our health care resources so that everyone is taken care of.

A decade from now costs will be so high that almost every informed individual will recognize that we can no longer afford the additional waste inherent in our fragmented, dysfunctional financing system. In all reality, only a single payer system will work. Opposition will be limited to the “I got mine” folk who do not accept the enlightened, civilized view that we are all in this together.

We likely are now about to begin an experiment to see if a combination of greater government regulation of private insurers along with a system of government subsidies can provide everyone with the health care that they need without busting the budgets of families, businesses and the government. It is an unfortunate delay since the results are in before the experiment has even begun. Tens of millions will be left out of the system, and by selecting the most expensive model of reform, budget busting will only compound.

So as William Pewen states, if the bill before Congress is blocked, the likely outcome a decade from now will be a single payer system. But health policy science tells us that, if this bill passes, the likely outcome a decade from now will be a single payer system.

We really don’t have to wait another decade. People already understand that health care costs are too high. What they need to understand is that they cannot rely on being able to keep the insurance they have if it becomes unaffordable for themselves or their employers, and they cannot rely on being able to purchase it though an exchange if the premiums are too high and the subsidies are too low. They also need to understand that, even if they have insurance, the relatively low actuarial value of basic coverage will leave them exposed to financial hardship should they develop significant health care needs, so the insurance they have won’t work as it should.

Regardless of the results of the vote on the reform bill, we need to intensify our efforts to inform the public. Health care justice in America is ultimately their decision.