PNHP

‘There is a better health plan, Mr. President’

‘There is a better health plan, Mr. President’

Medicare-for-All doctors available for comment on State of the Union speech

FOR IMMEDIATE RELEASE:
Jan. 28, 2010

Contact:
Margaret Flowers, M.D.
Steffie Woolhandler, M.D., M.P.H.
David Himmelstein, M.D.
Oliver Fein, M.D.
Mark Almberg, PNHP, (312) 782-6006, mark@pnhp.org

Rising to President Obama’s challenge to others in his State of the Union address that they come up with a better approach to health care reform than his own, physicians who advocate for a single-payer program stepped forward this morning to again make the case for their alternative, which they say has solid public support.

Among them is Dr. Margaret Flowers, a pediatrician and congressional fellow for Physicians for a National Health Program, an organization of 17,000 physicians who support a single-payer system, who is traveling to the White House today to deliver an open letter to the president calling on him to meet with her and other Medicare-for-All advocates.

Also speaking out today are Drs. Steffie Woolhandler and David Himmelstein, co-founders of PNHP, primary care physicians in Cambridge, Mass., and professors at Harvard Medical School, who provided commentary in a blog in today’s New York Times.

In her letter to Obama, Flowers notes how surprised she and others were when single-payer advocates were excluded from the early stages of the discussions on health reform. Flowers was one of several physicians, nurses and reform advocates who were arrested at Senate Finance Committee hearings last spring for standing up and asking in a dignified way why the Medicare-for-All option was “off the table.”

Flowers writes: “I am asking you to meet with me because the solution is simple. Remove all of the industries who profit off of the American health care catastrophe from the table. Replace them with those who are knowledgeable in designing health systems and who are without ties to the for-profit medical industries. And then allow them to design an improved Medicare-for-All national health system.”

Flowers then itemizes the advantages of adopting such a system, saying that it would cover everyone, save thousands of lives, relieve medical debt, control costs, help the economy, and restore the physician-patient relationship. Obama himself is on record noting only a single-payer plan would provide universal coverage: “The truth is unless you have what’s called a single-payer system in which everyone’s automatically covered, you’re probably not going to reach every single individual.”

The full text of Flowers’ letter is available here, and the blog commentary by Woolhandler and Himmelstein is available here.

All three, plus several other physicians, are available for comment on the president’s speech last night.

Physicians for a National Health Program is an organization of 17,000 doctors who advocate for single-payer national health insurance. To contact a physician-spokesperson near you, visit www.pnhp.org/stateactions or call (312) 782-6006.

There is Still Time For Real Reform, Listen to the American People

Open Letter to President Obama on Health Care Reform

By Margaret Flowers, M.D.
Op-Ed News
January 28, 2010

President Barack Obama|
1600 Pennsylvania Avenue
Washington, D.C. 20500

Dear President Obama,

I was overjoyed to hear you say in your State of the Union address last night:

“But if anyone from either party has a better approach that will bring down premiums, bring down the deficit, cover the uninsured, strengthen Medicare for seniors, and stop insurance company abuses, let me know.”

My colleagues, fellow health advocates and I have been trying to meet with you for over a year now because we have an approach which will meet all of your goals and more.

I am a pediatrician who, like many of my primary care colleagues, left practice because it is nearly impossible to deliver high quality health care in this environment. I have been volunteering for Physicians for a National Health Program ever since. For over a year now, I have been working with the Leadership Conference for Guaranteed Health Care/ National Single Payer Alliance. This alliance represents over 20 million people nationwide from doctors to nurses to labor, faith and community groups who advocate on behalf of the majority of Americans, including doctors, who favor a national Medicare-for-All health system.

I felt very optimistic when Congress took up health care reform last January because I remember when you spoke to the Illinois AFL-CIO in June, 2003 and said:

“I happen to be a proponent of a single-payer universal health care program.” (applause) “I see no reason why the United States of America, the wealthiest country in the history of the world, spending 14 percent of its Gross National Product on health care cannot provide basic health insurance to everybody. And that’s what Jim is talking about when he says everybody in, nobody out. A single-payer health care plan, a universal health care plan. And that’s what I’d like to see. But as all of you know, we may not get there immediately. Because first we have to take back the White House, we have to take back the Senate, and we have to take back the House.”

And that is why I was so surprised when the voices of those who support a national single-payer plan/Medicare for All were excluded in place of the voices of the very health insurance and pharmaceutical industries which profit off the current health care situation.

There was an opportunity this past year to create universal and financially sustainable health care reform rather than expensive health insurance reform. As you well know, the United States spends the most per capita on health care in the world yet leaves millions of people out and receives poor return on those health care dollars in terms of health outcomes and efficiency. This poor value for our health care dollar is due to the waste of having so many insurance companies. At least a third of our health care dollars go towards activities that have nothing to do with health care such as marketing, administration and high executive salaries and bonuses. This represents over $400 billion per year which could be used to pay for health care for all of those Americans who are suffering and dying from preventable causes.

The good news is that it doesn’t have to be this way. You said that you wanted to “keep what works” and that would be Medicare. Medicare is an American legacy of which we can feel proud. It has guaranteed health security to all who have it. Medicare has lifted senior citizens out of poverty. Health disparities, which are rising in this nation, begin to disappear as soon as patients reach 65 years of age. And patients and doctors prefer Medicare to private insurance. Why, our Medicare has even been used as a model by other nations which have developed and implemented universal health systems.

Mr. President, we wanted to meet with you because we have the solution to health care reform. The United States has enough money already and we have the resources, including esteemed experts in public health, health policy and health financing. Our very own Dr. William Hsiao at Harvard has designed health systems in five other countries.

I am asking you to meet with me because the solution is simple. Remove all of the industries who profit off of the American health care catastrophe from the table. Replace them with those who are knowledgeable in designing health systems and who are without ties to the for-profit medical industries. And then allow them to design an improved Medicare-for-All national health system. We can implement it within a year of designing such a system.

What are the benefits of doing this?

* It will save tens of thousands (perhaps hundreds of thousands) of American lives each year, not to mention the prevention of unnecessary suffering.

* It will relieve families of medical debt, which is the number one cause of bankruptcy and foreclosure despite the fact that most of those who experienced bankruptcy had health insurance.

* It will relieve businesses of the growing burden of skyrocketing health insurance premiums so that they can invest in innovation, hiring, increased wages and other benefits and so they can compete in the global market.

* It will control health care costs in a rational way through global budgeting and negotiation for fair prices for pharmaceuticals and services.

* It will allow patients the freedom to choose wherever they want to go for health care and will allow patients and their caregivers to determine which care is best without denials by insurance administrators.

* It will restore the physician-patient relationship and bring satisfaction back to the practice of medicine so that more doctors will stay in or return to practice.

* It will allow our people in our nation to be healthy and productive and able to support themselves and their families.

* It will create a legacy for your administration that may someday elevate you to the same hero status as Tommy Douglas has in Canada.

Mr. President, there are more benefits, but I believe you get the point. I look forward to meeting with you and am so pleased that you are open to our ideas. The Medicare-for-All campaign is growing rapidly and is ready to support you as we move forward on health care reform that will provide America with one of the best health systems in the world. And that is something of which all Americans can be proud.

With great anticipation and deep respect,

Margaret Flowers, M.D.
Maryland chapter, Physicians for a National Health Program

http://www.opednews.com/articles/There-is-Still-Time-For-Re-by-Margaret-Flowers–100127-703.html

Did Obama Move Health Care Forward?

Going Down the Same Old Tunnel

By Steffie Woolhandler and David Himmelstein
Room for Debate Blog, New York Times
January 28, 2010

Having surrendered in advance to the private insurers and drug companies who profit from our dysfunctional health financing system, President Obama and the Democrats who lead Congress couldn’t rally the American people to support their woeful plan against Republican attacks.

In the end, the Democrats’ back room deals produced a scheme reminiscent of the ones crafted by Mitt Romney (in Massachusetts, 2006) and Richard Nixon (Washington, 1972) – but even less effective than those.

A simple single payer program could save $400 billion annually on insurance-related bureaucracy and profits, and tens of billions more by driving down drug prices. That’s more than enough to cover the uninsured and to upgrade coverage for insured Americans, without increasing health spending.

But the Democrats’ efforts to appease insurers and pay off the pharmaceutical industry made covering the uninsured unaffordable. Once they’d rejected single payer (and its savings on useless bureaucracy), the Democrats could only offer unpalatable funding options; stick consumers with ever-higher health costs, raise taxes, or drain money from care. In the end, the Democrats chose all three.

Their individual mandate would force millions to pay private insurers’ outrageous premiums for coverage so skimpy that a major illness would still lead to bankruptcy. (And if you currently have coverage you don’t like, they’d force you to keep it). They added a steep excise tax on workers lucky enough to still have good coverage. And their massive Medicare cuts included a plan to take billions from already-strapped public hospitals (and other safety net providers) and give it to private insurers. In sum, the Democrats asked middle class Americans to pay more, and get little in return.

The president can regain his footing by reconnecting with the hopes of Americans who elected him and rejecting the sordid corporate compromises that signify Washington politics as usual. A single-payer, Medicare-for-All reform would lower costs, cover the uninsured, and upgrade coverage for most insured Americans. Leading a crusade for such a plan, he’d mobilize vast popular support; enough to overwhelm Republican obstructionism. But instead, he seems intent on looking for light at the end of the same old tunnel.

During his campaign, President Obama declaimed that he’d back single payer – if we were starting from scratch. One thing’s clear from the recent Massachusetts election upset: it’s time to start from scratch.

Steffie Woolhandler  is a professor of medicine and David Himmelstein is an associate professor of medicine, both at Harvard Medical School. They are co-founders of Physicians for a National Health Program.

http://roomfordebate.blogs.nytimes.com/2010/01/28/did-obama-move-health-care-forward/#steffie

President Obama is eager to see a better approach

State of the Union Address

President Barack Obama
The White House
January 27, 2010
But if anyone from either party has a better approach that will bring down premiums, bring down the deficit, cover the uninsured, strengthen Medicare for seniors, and stop insurance company abuses, let me know.  (Applause.)  Let me know.  Let me know.  (Applause.)  I’m eager to see it.
http://www.whitehouse.gov/the-press-office/remarks-president-state-union-address

And…

Illinois AFL-CIO

Barack Obama
June 30, 2003
I happen to be a proponent of a single payer universal health care program. (applause) I see no reason why the United States of America, the wealthiest country in the history of the world, spending 14 percent of its Gross National Product on health care cannot provide basic health insurance to everybody. And that’s what Jim is talking about when he says everybody in, nobody out. A single payer health care plan, a universal health care plan. And that’s what I’d like to see. But as all of you know, we may not get there immediately. Because first we have to take back the White House, we have to take back the Senate, and we have to take back the House.
https://pnhp.org/news/2008/june/barack_obama_on_sing.php

Well?

SilverSneakers benefit for Medicare Advantage plans

Blue Shield of California to Offer Award-Winning Fitness Program to Medicare Beneficiaries in San Bernardino

Blue Shield of California
January 18, 2010

Blue Shield of California announced today that it will expand its contract with Healthways, Inc. to offer the SilverSneakers® Fitness Program to Blue Shield Medicare Advantage members in San Bernardino County. SilverSneakers, which Blue Shield already offers in Los Angeles and Orange counties, is the nation’s leading exercise program for older adults.

Using the SilverSneakers premier network, Blue Shield of California members get access to a variety of participating fitness and wellness facilities throughout the country, including such popular locations as Curves® and Bally Total Fitness®. Many sites offer amenities such as exercise equipment, treadmills and free weights, and the signature SilverSneakers fitness classes.

https://www.blueshieldca.com/bsc/newsroom/pr/sneakers_011810.jhtml

SilverSneakers: http://www.silversneakers.com/Home.aspx

Comment: 

By Don McCanne, MD

Healthways SilverSneakers is a membership fitness program for seniors provided as a free benefit by many Medicare Advantage programs throughout the nation. It is not a benefit that is allowed in the traditional Medicare program.

We certainly applaud seniors who participate in programs designed to maintain physical fitness and general wellness. But there are two features of this program that should outrage taxpayers.

1) These programs are funded by government overpayments made to the private Medicare Advantage plans. Though some of the overpayments are used for additional benefits, much is wasted in excessive administrative costs and profits. Not only should taxpayers object to the waste, they should also object to a program that provides extra benefits limited to private plan enrollees but not available to those in the traditional Medicare program. If the extra benefits are appropriate, then all Medicare beneficiaries should receive them. If they are not appropriate, then no taxpayer funds should be used for these benefits. In either case, the overpayments directed to the private plans should either be redistributed amongst all Medicare beneficiaries or retained in our Medicare reserves. Regardless, the private Medicare Advantage plans should be eliminated as the wasteful intermediaries that they’ve proven to be.

2) Which of our seniors would find the SilverSneakers program to be an attractive benefit? Obviously only the healthiest without infirmities that would prevent them from participating in the exercise programs. SilverSneakers is being selectively marketed to the healthiest, lowest-cost seniors, even though their private plans are being paid much more than we spend taking care of patients in the traditional Medicare program which includes a disproportionate share of chronically ill patients. The taxpayers take care of the sick, while they doubly overpay the private plans to take care of the lower-cost healthier individuals.

The Republicans are feigning outrage by protesting that the proposal before Congress would “cut Medicare spending” by partially reducing some of the overpayments to the Medicare Advantage plans. Well, the Democrats actually are wrong. In a brave show of timidity, they suggest tweaking the Medicare Advantage overpayments, when they should show the temerity to throw those crooks out and use the funds to improve benefits in the traditional Medicare program.

While they’re at it, they should throw out the crooks running the rest of the private plans, and establish an improved Medicare program for all of us.

What about the seniors who would lose their SilverSneakers membership? They can buy a program directly from Curves or Bally Total Fitness, thereby eliminating both the SilverSneakers and the Medicare Advantage middlemen. Or better yet, they can organize their own fitness groups and continue to exercise – for free!

SilverSneakers benefit for Medicare Advantage plans

Blue Shield of California to Offer Award-Winning Fitness Program to Medicare Beneficiaries in San Bernardino

Blue Shield of California
January 18, 2010
Blue Shield of California announced today that it will expand its contract with Healthways, Inc. to offer the SilverSneakers® Fitness Program to Blue Shield Medicare Advantage members in San Bernardino County. SilverSneakers, which Blue Shield already offers in Los Angeles and Orange counties, is the nation’s leading exercise program for older adults.
Using the SilverSneakers premier network, Blue Shield of California members get access to a variety of participating fitness and wellness facilities throughout the country, including such popular locations as Curves® and Bally Total Fitness®. Many sites offer amenities such as exercise equipment, treadmills and free weights, and the signature SilverSneakers fitness classes.
https://www.blueshieldca.com/bsc/newsroom/pr/sneakers_011810.jhtml
SilverSneakers: http://www.silversneakers.com/Home.aspx

Healthways SilverSneakers is a membership fitness program for seniors provided as a free benefit by many Medicare Advantage programs throughout the nation. It is not a benefit that is allowed in the traditional Medicare program.
We certainly applaud seniors who participate in programs designed to maintain physical fitness and general wellness. But there are two features of this program that should outrage taxpayers.
1) These programs are funded by government overpayments made to the private Medicare Advantage plans. Though some of the overpayments are used for additional benefits, much is wasted in excessive administrative costs and profits. Not only should taxpayers object to the waste, they should also object to a program that provides extra benefits limited to private plan enrollees but not available to those in the traditional Medicare program. If the extra benefits are appropriate, then all Medicare beneficiaries should receive them. If they are not appropriate, then no taxpayer funds should be used for these benefits. In either case, the overpayments directed to the private plans should either be redistributed amongst all Medicare beneficiaries or retained in our Medicare reserves. Regardless, the private Medicare Advantage plans should be eliminated as the wasteful intermediaries that they’ve proven to be.
2) Which of our seniors would find the SilverSneakers program to be an attractive benefit? Obviously only the healthiest without infirmities that would prevent them from participating in the exercise programs. SilverSneakers is being selectively marketed to the healthiest, lowest-cost seniors, even though their private plans are being paid much more than we spend taking care of patients in the traditional Medicare program which includes a disproportionate share of chronically ill patients. The taxpayers take care of the sick, while they doubly overpay the private plans to take care of the lower-cost healthier individuals.
The Republicans are feigning outrage by protesting that the proposal before Congress would “cut Medicare spending” by partially reducing some of the overpayments to the Medicare Advantage plans. Well, the Democrats actually are wrong. In a brave show of timidity, they suggest tweaking the Medicare Advantage overpayments, when they should show the temerity to throw those crooks out and use the funds to improve benefits in the traditional Medicare program.
While they’re at it, they should throw out the crooks running the rest of the private plans, and establish an improved Medicare program for all of us.
What about the seniors who would lose their SilverSneakers membership? They can buy a program directly from Curves or Bally Total Fitness, thereby eliminating both the SilverSneakers and the Medicare Advantage middlemen. Or better yet, they can organize their own fitness groups and continue to exercise – for free!

Message from Massachusetts

By Marcia Angell, MD
Former editor-in-chief, New England Journal of Medicine | Senior Lecturer, Harvard Medical School
Huffington Post, January 21, 2010

Well, that was a game-changer! But don’t misinterpret it (and don’t blame Martha Coakley’s lackluster campaign). Scott Brown’s victory was not about the principles of either party, nor was it about the size of government, nor even about health reform, except indirectly. It was about disillusionment and anger with government.

When Obama became president, there was a euphoric sense that we really would see “change you can believe in.” Yes, there were unrealistic expectations — in the words of John Stewart’s “senior black correspondent,” a belief in “miracle Negroes,” even though they’re “just guys.” But for the most part, people did not expect overnight solutions. What they counted on was that Obama would set to work keeping his campaign promises, and do so in a forthright and transparent way.

So what happened? Right out of the chute, he signaled that there might be very little change. After appointing the usual Goldman Sachs crowd as advisors, he showered money on Wall Street unconditionally, while doing relatively little for people who were losing their houses and jobs. Nor did he do much for the states, whose budget woes people feel directly and are a big part of what happened on Tuesday. He did some good things, of course, but they were mostly small and on the margins.

And the campaign promises? We still have both wars raging, with about the same number of troops, just re-distributed from Iraq to Afghanistan. We still have Guantanamo, we still have indefinite imprisonment without charges, and we almost certainly still have torture. As for transparency, there’s still not much of it. And the federal deficit continues to climb, despite the lack of palpable relief for Main Street. Not everyone knows all of this, or cares, but some people know each of these things, and together, they add up to a lot of disillusioned people.

As for health care, not many of the angry voters understand all the provisions of the Senate bill (who does?). But they do know that Obama has “pissed away” a year on it, as Theda Skocpol says, much of it devoted to obsequious courting of the likes of Ben Nelson and Joe Lieberman and Olympia Snow. That raised real questions about his abilities as a leader. And most people under 65 know that the reform would require them to buy commercial insurance, a prospect nearly everyone dislikes. Finally, they almost certainly have some inkling that the bill was written by lobbyists. After all, last spring the White House hosted a highly publicized photo-op and jamboree with the health industries, at which they pledged to work together.

Liberals are wrong to think that opposition to health reform is a rejection of big government. If health reform consisted of extending Medicare to everyone, people would be delighted. There are millions of 64-year-olds out there who can hardly wait to be 65. (And if the government created lots more jobs, they would be delighted by that, too.)

It’s not the size of government; it’s how well it works and on whose behalf. Many people no longer trust Obama to work in their interests, or even to tell the truth. They vote for Republicans mainly because they’re the only other game in town. But I don’t think that means they subscribe to Republican principles. In Massachusetts, Republicans constitute about 11 percent of voters, and I doubt whether that number will increase by much. People are rejecting both parties in droves and becoming independents, because they no longer believe government works for them, no matter which party is in charge. The same dynamic that swept Obama into office might well sweep him out.

It’s also mistake to lump all the protesters together as Sarah Palin yahoos. There are many of those, of course, but in addition there are many people who, even if they’re confused enough to vote Republican, have legitimate concerns, not all of them the same — including Ron Paul libertarians who want out of Iraq and Afghanistan, deficit hawks who worry about saddling their kids with more debt, and ordinary people who are just worried or desperate and don’t see any relief coming from government.

If they don’t draw the wrong lessons from the Scott Brown debacle, the Democrats might still recover. The problem is not that Obama tried to do too much, but that he compromised away his principles.

http://www.huffingtonpost.com/marcia-angell-md/message-from-massachusett_b_432074.html

President Obama is eager to see a better approach

State of the Union Address

President Barack Obama
The White House
January 27, 2010

But if anyone from either party has a better approach that will bring down premiums, bring down the deficit, cover the uninsured, strengthen Medicare for seniors, and stop insurance company abuses, let me know.  (Applause.)  Let me know.  Let me know.  (Applause.)  I’m eager to see it.

http://www.whitehouse.gov/the-press-office/remarks-president-state-union-address

And…

Illinois AFL-CIO

Barack Obama
June 30, 2003

I happen to be a proponent of a single payer universal health care program. (applause) I see no reason why the United States of America, the wealthiest country in the history of the world, spending 14 percent of its Gross National Product on health care cannot provide basic health insurance to everybody. And that’s what Jim is talking about when he says everybody in, nobody out. A single payer health care plan, a universal health care plan. And that’s what I’d like to see. But as all of you know, we may not get there immediately. Because first we have to take back the White House, we have to take back the Senate, and we have to take back the House.

https://pnhp.org/news/2008/june/barack_obama_on_sing.php

Comment: 

By Don McCanne, MD

Well?

Now, let's talk a real health care reform

By Clark Newhall
Salt Lake Tribune
01/22/2010

It has long been apparent that there was no consensus among progressives on the best way to achieve universal health care. From the very beginning, MoveOn and the labor movement gave lip service (sometimes) to single-payer ideas, but put their money behind whatever the president proposed.

As we now know, what the president proposed changed daily, shifting each time one or another well-heeled lobbying group demanded a “compromise.” Eventually there was no legislation that addressed health care, only legislation addressing health insurance. The Obama administration shifted its labeling from “health reform” to “health insurance reform.” After that, the supporters of President Barack Obama’s plan began to talk about jumping ship, but never got up the courage to actually do so.

Instead, despair at ever achieving universal equitable health care led to disgust with the blatant purchase of congressional votes and then disarray among those who voted and worked for Obama’s election.

The result is a Democratic senatorial candidate intended to replace Teddy Kennedy, but who lost to a Republican whom no one had ever heard of. The next result will be a dramatic loss of the Democratic majority in the Senate and probably in the House during the midterm elections. The final result will be the likely emergence of a challenger to Obama from within the Democratic Party and, ultimately, the election of a Sarah Palin lookalike (if not Palin herself) as the next president in 2012.

What a horror show!

At this point, despair, disgust and disarray may be all that will save us from driving over a cliff with the Palinistas. How so?

With a Republican elected in Massachusetts, say goodbye to any health legislation that can be styled as reform. Even without a new Republican senator, health reform may never have been enacted. No matter how much Obama pushes Congress, the disarray among progressives guarantees that no one on the left will like what is proposed for passage. Even those who say “something is better than nothing” only say so out of a forlorn loyalty to the idea that a defeat for Obama’s health legislation is a defeat for Obama.

I think not. The best thing that could happen to Obama (and America) is for the Congress to fail at passing any health legislation. That would give Obama the chance to do now what he should (and could) have done at the beginning. That will give everyone the chance to say “OK, we now know that the system is beyond any rational attempt to repair it. We are starting from scratch.”

That will give Democrats, Republicans, progressives and Tea Partyers the chance to talk about health care rather than health insurance. That will give citizens the chance to reconsider, regroup and perhaps even join together to promote the one plan that could conceivably gain the approval of most Americans, whatever their ideology — Medicare For All.

Don’t laugh at the idea of a progressive sitting down at a Tea Party. The opportunity is there. We have to change the dialogue from health insurance to health care. And then we have to show the Tea Partyers that they are better off when they enjoy the same type of health care that everyone else (rich and poor) also enjoys. Because very few of them (or of us, or of anyone) can be sure of equitable and reliable health care now, regardless of what kind of insurance anyone has. That is, very few of us except those already getting Medicare.

So it is time to show the Tea Partyers that we progressives can reject despair, disarray and disgust.

It is time to show them and ourselves that health care is what we should have been talking about all along. The argument is not about money. The argument is about whether we should all get health care — you, me, the guy next door, everybody.

Clark Newhall is a Salt Lake City physician and attorney.

Now, let’s talk a real health care reform

By Clark Newhall
Salt Lake Tribune
01/22/2010

It has long been apparent that there was no consensus among progressives on the best way to achieve universal health care. From the very beginning, MoveOn and the labor movement gave lip service (sometimes) to single-payer ideas, but put their money behind whatever the president proposed.

As we now know, what the president proposed changed daily, shifting each time one or another well-heeled lobbying group demanded a “compromise.” Eventually there was no legislation that addressed health care, only legislation addressing health insurance. The Obama administration shifted its labeling from “health reform” to “health insurance reform.” After that, the supporters of President Barack Obama’s plan began to talk about jumping ship, but never got up the courage to actually do so.

Instead, despair at ever achieving universal equitable health care led to disgust with the blatant purchase of congressional votes and then disarray among those who voted and worked for Obama’s election.

The result is a Democratic senatorial candidate intended to replace Teddy Kennedy, but who lost to a Republican whom no one had ever heard of. The next result will be a dramatic loss of the Democratic majority in the Senate and probably in the House during the midterm elections. The final result will be the likely emergence of a challenger to Obama from within the Democratic Party and, ultimately, the election of a Sarah Palin lookalike (if not Palin herself) as the next president in 2012.

What a horror show!

At this point, despair, disgust and disarray may be all that will save us from driving over a cliff with the Palinistas. How so?

With a Republican elected in Massachusetts, say goodbye to any health legislation that can be styled as reform. Even without a new Republican senator, health reform may never have been enacted. No matter how much Obama pushes Congress, the disarray among progressives guarantees that no one on the left will like what is proposed for passage. Even those who say “something is better than nothing” only say so out of a forlorn loyalty to the idea that a defeat for Obama’s health legislation is a defeat for Obama.

I think not. The best thing that could happen to Obama (and America) is for the Congress to fail at passing any health legislation. That would give Obama the chance to do now what he should (and could) have done at the beginning. That will give everyone the chance to say “OK, we now know that the system is beyond any rational attempt to repair it. We are starting from scratch.”

That will give Democrats, Republicans, progressives and Tea Partyers the chance to talk about health care rather than health insurance. That will give citizens the chance to reconsider, regroup and perhaps even join together to promote the one plan that could conceivably gain the approval of most Americans, whatever their ideology — Medicare For All.

Don’t laugh at the idea of a progressive sitting down at a Tea Party. The opportunity is there. We have to change the dialogue from health insurance to health care. And then we have to show the Tea Partyers that they are better off when they enjoy the same type of health care that everyone else (rich and poor) also enjoys. Because very few of them (or of us, or of anyone) can be sure of equitable and reliable health care now, regardless of what kind of insurance anyone has. That is, very few of us except those already getting Medicare.

So it is time to show the Tea Partyers that we progressives can reject despair, disarray and disgust.

It is time to show them and ourselves that health care is what we should have been talking about all along. The argument is not about money. The argument is about whether we should all get health care — you, me, the guy next door, everybody.

Clark Newhall is a Salt Lake City physician and attorney.

Malpractice lessons from Texas

Liability Limits in Texas Fail to Curb Medical Costs

by David Arkush, Peter Gosselar, Christine Hines and Taylor Lincoln
Public Citizen
December 2009

Supporters of limiting health providers’ liability have touted Texas’ medical malpractice experiment as the solution for improving national health care. For example, Minnesota Rep. Michele Bachmann held up Texas as a successful liability “pilot program” in an address in September, stating, “The state of Texas did a wonderful job of lawsuit reform and actually saw medical costs come down. We know it works.”

But most of the claims touting positive effects of the Texas law – which took effect in September 2003 and included a $250,000 per defendant liability cap – are flatly contradicted by the data.

By the measures commonly used to evaluate health care – such as cost, the uninsured rate, and access to care – Texas has regressed since its liability law took effect. Collectively, these measures show that Texas has one of the worst health care systems in the United States. Moreover, since 2003 Texas has either failed to improve or grown even worse compared to other states on almost every measure.

Since the liability laws took effect:

* The cost of health care in Texas (measured by per patient Medicare reimbursements) has increased at nearly double the national average;
* spending increases for diagnostic testing (measured by per patient Medicare reimbursements) have far exceeded the national average;
* the state’s uninsured rate has increased, remaining the highest in the country;
* the cost of health insurance in the state has more than doubled;
* growth in the number of doctors per capita has slowed; and
* the number of doctors per capita in underserved rural areas has declined.

http://www.citizen.org/documents/Texas_Liability_Limits.pdf

Comment: 

By Don McCanne, MD

The malpractice system does not serve injured patients well. It needs to be reformed. It needs to be redesigned with incentives to reduce exposure to error, and to appropriately compensate patients when error does occur, all in a non-hostile environment that serves the interests of both patients (compensation for injury) and health care professionals (performance enhancement). This is not the topic of today’s message.

The Republican grandstanding has been sending a message calling for a blanket rejection of any reform advanced by the Democrats, and instead substituting the opening of insurance markets across state borders and the enactment of malpractice reform.

Since expanding insurance markets across state borders is not the topic of today’s message, we’ll quickly dismiss it as an unsound policy that would flood the market with less expensive underinsurance products that would fail to provide financial security for those who need health care. That is the worst possible way to expand health care coverage.

Regarding malpractice, when Republicans and some Democrats (except those beholden to trial attorneys) call for reducing health care spending through malpractice reform, they don’t really mean reform. They are merely calling for a cap on general damages (pain and suffering), such as the $250,000 cap enacted in Texas. They contend that this would reduce costs by eliminating excessive awards for “junk lawsuits,” and especially by reducing the pressure on physicians to order unnecessary tests. Many contend that the excess CYA testing is a major cause of our very high health care spending.

So what has happened in Texas after the cap was applied? Health care costs have increased at double the national average! Spending increases for diagnostic testing have far exceeded the national average! The cost of health insurance has more than doubled!

As an isolated policy, malpractice caps were ineffective in reducing spending and diagnostic testing in Texas. The issue of general damages needs to be addressed as part of a process leading to comprehensive malpractice reform, but it should be dismissed as the be all and end all for comprehensive health system reform.

The debate over malpractice should not distract us from our mission to support comprehensive reform that would ensure that absolutely everyone receives the health care that they need, under a financing system that eliminates the burden of medical debt. (Hint: a single payer national health program – an improved Medicare for all)

Malpractice lessons from Texas

Liability Limits in Texas Fail to Curb Medical Costs

by David Arkush, Peter Gosselar, Christine Hines and Taylor Lincoln
Public Citizen
December 2009
Supporters of limiting health providers’ liability have touted Texas’ medical malpractice experiment as the solution for improving national health care. For example, Minnesota Rep. Michele Bachmann held up Texas as a successful liability “pilot program” in an address in September, stating, “The state of Texas did a wonderful job of lawsuit reform and actually saw medical costs come down. We know it works.”
But most of the claims touting positive effects of the Texas law – which took effect in September 2003 and included a $250,000 per defendant liability cap – are flatly contradicted by the data.
By the measures commonly used to evaluate health care – such as cost, the uninsured rate, and access to care – Texas has regressed since its liability law took effect. Collectively, these measures show that Texas has one of the worst health care systems in the United States. Moreover, since 2003 Texas has either failed to improve or grown even worse compared to other states on almost every measure.
Since the liability laws took effect:
* The cost of health care in Texas (measured by per patient Medicare reimbursements) has increased at nearly double the national average;
* spending increases for diagnostic testing (measured by per patient Medicare reimbursements) have far exceeded the national average;
* the state’s uninsured rate has increased, remaining the highest in the country;
* the cost of health insurance in the state has more than doubled;
* growth in the number of doctors per capita has slowed; and
* the number of doctors per capita in underserved rural areas has declined.
http://www.citizen.org/documents/Texas_Liability_Limits.pdf

The malpractice system does not serve injured patients well. It needs to be reformed. It needs to be redesigned with incentives to reduce exposure to error, and to appropriately compensate patients when error does occur, all in a non-hostile environment that serves the interests of both patients (compensation for injury) and health care professionals (performance enhancement). This is not the topic of today’s message.
The Republican grandstanding has been sending a message calling for a blanket rejection of any reform advanced by the Democrats, and instead substituting the opening of insurance markets across state borders and the enactment of malpractice reform.
Since expanding insurance markets across state borders is not the topic of today’s message, we’ll quickly dismiss it as an unsound policy that would flood the market with less expensive underinsurance products that would fail to provide financial security for those who need health care. That is the worst possible way to expand health care coverage.
Regarding malpractice, when Republicans and some Democrats (except those beholden to trial attorneys) call for reducing health care spending through malpractice reform, they don’t really mean reform. They are merely calling for a cap on general damages (pain and suffering), such as the $250,000 cap enacted in Texas. They contend that this would reduce costs by eliminating excessive awards for “junk lawsuits,” and especially by reducing the pressure on physicians to order unnecessary tests. Many contend that the excess CYA testing is a major cause of our very high health care spending.
So what has happened in Texas after the cap was applied? Health care costs have increased at double the national average! Spending increases for diagnostic testing have far exceeded the national average! The cost of health insurance has more than doubled!
As an isolated policy, malpractice caps were ineffective in reducing spending and diagnostic testing in Texas. The issue of general damages needs to be addressed as part of a process leading to comprehensive malpractice reform, but it should be dismissed as the be all and end all for comprehensive health system reform.
The debate over malpractice should not distract us from our mission to support comprehensive reform that would ensure that absolutely everyone receives the health care that they need, under a financing system that eliminates the burden of medical debt. (Hint: a single payer national health program – an improved Medicare for all)