PNHP

Gawande’s Rx is no solution

Gawande’s Rx is no solution

[The following letter to Washington Post columnist David Broder from Dr. Ray Bellamy of Florida discusses not only Broder’s recent arguments, but also those of Dr. Atul Gawande at The New Yorker.]

December 11, 2009

Mr. David Broder
Washington Post Writers Group
1150 15th Street NW
Washington, DC 20071

Dear Mr. Broder,

I read with interest your column titled “Health Care Brings Freshman Senators to the Forefront” in today’s edition of the Tallahassee Democrat. I agree cost control is the key issue in health reform and has not been addressed in current congressional efforts. The output from Congress seems focused mostly on what is politically possible and increasingly on what can be supported by 60 votes, not true reform.

The mainstream media seems to have bought into the notion that, since the Republicans are trying to block reform and perhaps make health reform “Obama’s Waterloo,” the House and Senate output should be supported. Although allowing for deep flaws in the legislation, there is the feeling that incremental steps toward a better system are good. You and the excellent writer you reference, Dr. Atul Gawande, have apparently bought into this mindset. Allow me to disagree.

Gawande, in his latest article in The New Yorker titled “Testing, testing,” speaks of small-scale pilot projects in the proposed legislation with hope they will show the way toward cost savings.

Yet we already have pilot projects all over the world that have met with dramatic success: nearly every other developed country has universal coverage with higher citizen satisfaction and far higher medical outcomes at roughly half the per-capita cost as U.S. health care. Half the cost.

Why do we need new pilot projects? We have the knowledge that the only two successful health care models in these countries are either (1) highly regulated nonprofit insurers who sell health policies as an inducement to the purchase of profitable property, fire and auto insurance, or (2) some version of single payer.

We know no country utilizes a system like the model Congress is proposing and that none like it has ever been successful. Eight prior state efforts using this model all failed, usually within a few years. Massachusetts, currently starting its third year with a similar model, is not able to control costs, and has the most expensive health insurance in the world. This is the model for what Congress has proposed.

Medicare for All is criticized for being a “government takeover.” Really, we have entrusted health care to private insurance long enough to know that their business model of avoiding the sick, then dumping those who do need care rather than spreading the risk as insurance is supposed to do, does not work. Medicare has a 92 percent enrollee satisfaction rate. Private insurance cannot approach that.

Critics also charge that Medicare is bankrupt. What do you expect when the funding is provided by a dwindling collection of payroll taxes from fewer and fewer workers to support current Medicare enrollees who are swelling in numbers? Funding Medicare with a 2 percent or 3 percent progressive income tax would be the answer – an amount that would certainly be less than what most people pay today for premiums, co-pays, deductibles, uncovered services and other out-of-pocket health care costs.

The individual mandate to have insurance, as proposed by the House, is an effort to avoid adverse risk selection, which occurs when those who are currently young and healthy wait to purchase insurance until they get sick. Insurance obviously works best with the largest possible risk pool and that is why health savings accounts and skimpy coverage for different groups are bad ideas. What would work best is every American covered in the same risk pool. We could have comprehensive coverage, all with the same policy as every member of Congress – truly egalitarian – for what we currently pay in health care in this country now: $2.4 trillion annually.

Gawande mentions the benefits of improved information about what works, comparative effectiveness, and the problem of overutilization (which he headlined in his previous New Yorker article). Yet look what instant information would be available if we had single payer: instant data on comparative effectiveness, overutilization, and disease outbreaks anywhere in the country.

Gawande has also written about a Texas border town, McAllen, with high utilization and cost. His information was obtained through Medicare data, which is the best nationwide health care data we have available. Single payer would give us such high-quality information instantly for the entire nation, not just the Medicare population.

Gawande also speaks of the need for tort reform, of which there is essentially none in current congressional proposals. If we had truly universal comprehensive, egalitarian Medicare for All, we would eliminate the cost of future medical expenses from all personal injury lawsuits, not just Med-Mal. This is a major component of economic damages in personal injury lawsuits.

Current congressional proposals retain the main low-hanging fruit for cost cutting and reward it: the wasteful administrative expense, marketing cost, profits of the for-profit insurance industry. To the current 31 percent administrative waste in the system, Congress proposes to add additional bureaucracy and a czar so we are likely to reach 35 percent overhead and waste. That figure, the highest in the world almost by a factor of two, could be lowered for a saving of $400 billion a year within our current budget, with the savings used to cover every one of us without raising costs.

The additional opportunity to sensibly manage our nation’s health budget with the inevitable rationing decisions necessary in the future, with global budgeting and so on, would also stem from a single-payer system.

Now one last word on true reform: if we moved away from fee-for-service reimbursement for physicians and instead provided incentives for them take salaried positions, like those in the Veterans Administration and the U.S. military (along with those at the Mayo Clinic), there would likely be huge additional savings. Socialized medicine? No. By and large, you’d still private physicians working in private hospitals.

Under a single-payer arrangement, patients would have more free choice of physician and hospital than we have now. Every American would have the choice to go to the Mayo Clinic, so the competition would surely result in improvements for all facilities and caregivers.

I read what you write and what Dr. Gawande writes with interest, but in this case I strongly disagree. Congress needs to start over on health reform, and this time it needs to compare single-payer Medicare for All with other options. I guarantee you that single payer will win hands down.

Sincerely,

Ray Bellamy, M.D.

Dr. Ray Bellamy is an orthopedic surgeon in Tallahassee, Fla.

Evidence Based Talking Points

Talking Point 1: Administrative costs consume 31 percent of health spending, most of it unnecessary.

“Costs of Health Care Administration in the U.S. and Canada.” Woolhandler, S., Campbell, T., & Himmelstein, D.U. (2003), N Engl J Med, 349, 768-775.

Talking Point 2: Nearly two-thirds of all bankruptcies are caused by medical bills. Three-fourths of those bankrupted had health insurance at the time they got sick or injured. 

“Medical Bankruptcy in the United States, 2007: Results of a National Study.” Himmelstein, D.U., Thorne, D., Warren, E., Woolhandler, S. (2009), Am J Med, 122, 741-746.

“Medical Bankruptcy Fact Sheet.” Himmelstein, D.U., Thorne, D., Warren, E., Woolhandler, S. (2009).

“Medical Bankruptcy Q&A.” Himmelstein, D.U., Thorne, D., Warren, E., Woolhandler, S. (2009).

Talking Point 3: Taxes already pay for more than 60 percent of US health spending Americans pay the highest health care taxes in the world. We pay for national health insurance, but don’t get it.

“Paying for National Health Insurance – And Not Getting It.” Woolhandler, S. & Himmelstein, D.U. (2002), Health Affairs 21(4), 88-98.

Talking Point 4: Despite spending far less per capita for health care, Canadians are healthier and have better measures of access to health care than Americans. Taiwan’s new single payer system (adopted in 1996) has improved access to care (before its adoption, 40 percent of the population was uninsured), controlled costs, and is model of efficiency. Despite having the highest per capita health spending in the world, the U.S. health system ranks very poorly in international comparisons of quality, outcomes, patient satisfaction, and other measures.

“Access to Care, Health Status, and Health Disparities in the United States and Canada: Results of a Cross-National Population-Based Survey.” Lasser, K., Himmelstein, D.U., & Woolhandler, S. (2006), Am J Public Health, 96, 1300-1307.

“Does Universal Health Insurance Make Health Care Unaffordable? Lessons from Taiwan.” Lu, J.F.R. & Hsiao, W.C. (2003), Health Affairs, 22(3), 77-88.

“Learning from Taiwan: Experience with Universal Health Insurance.” Davis, K. & Huang, A.T. (2008), Ann Intern Med, 148, 313-314.

“It’s The Prices, Stupid: Why The United States is So Different From Other Countries.” Anderson, G., Reinhardt, U.E., Hussey, P.S., & Petrosyan, V. (2003), Health Affairs, 22(3), 89-105.

Talking Point 5: Business pays less than 20 percent of our nation’s health bill. It is a misnomer that our health system is “privately financed.” 60 percent is funded by taxes and the remaining 20 percent is out-of-pocket payments.

“A Reappraisal of Private Employers’ Role in Providing Health Insurance.” Carrasquillo, O., Himmelstein, D.U., Woolhandler, S., & Bor, D.H. (1999), N Engl J Med, 340, 109-114.

Talking Point 6: For-profit, investor-owned hospitals, HMOs, and nursing homes have higher costs and score lower on most measures of quality than their non-profit counterparts. For-profit hospitals have higher death rates.

“The high costs of for-profit care.” Himmelstein, D. & Woolhandler, S. (2004), Can Med Assoc J, 170, 1814-1815.

“Payments for care at private for-profit and private not-for-profit hospitals: a systematic review and meta-analysis.” Devereaux, P.J., et. al. (2004), Can Med Assoc J, 170, 1817-1824.

“A systematic review and meta-analysis of studies comparing mortality rates of private for-profit and private not-for-profit hospitals.” Devereaux, P.J., et. al. (2002), Can Med Assoc J, 166, 1399-1406.

“Costs of Care and Administration at For-Profit and Other Hospitals in the United States.” Woolhandler, S., & Himmelstein, D.U. (1997), N Engl J Med, 336, 769-775.

“Quality of Care in Investor-Owned vs. Not-for-Profit HMOs.” Himmelstein, D.U., Woolhandler, S., Hellander, I., & Wolfe, S.M. (1999), J Am Med Assoc, 282, 159-163.

“Does Investor Ownership of Nursing Homes Compromise the Quality of Care?” Harrington, C., Woolhandler, S., Mullan, J., Carrillo, H., & Himmelstein, D.U. (2001), Am J Public Health, 91, 1452-1455.

“Quality of care in for-profit and not-for-profit nursing homes: systematic review and meta-analysis.” Vikram R Comondore, P J Devereaux et al,  BMJ 2009;339:b2732, doi: 10.1136/bmj.b2732, Aug. 4, 2009.

Talking Point 7: Immigrants and emergency department visits by the uninsured are not the cause of high and rising health care costs.

“Health Care Expenditures of Immigrants in the United States: A Nationally Representative Analysis.” Mohanty, S., et. al. (2005), Am J Public Health, 95, 1431-1438.

“US Emergency Department Costs: No Emergency.” Tyrance, P.H., Himmelstein, D.U., & Woolhandler, S. (1996), Am J Public Health, 95, 1527-1531.

Talking Point 8: The uninsured do not receive all the medical care they need: one-third of uninsured adults have chronic illness and don’t receive needed care. Those most in need of preventive services are least likely to receive them.

“A National Study of Chronic Disease Prevalence and Access to Care in Uninsured U.S. Adults.” Wilper, A., et. al. (2008), Arch Intern Med, 149, 170 – 176.

Talking Point 9: The U.S. could save enough on administrative costs (almost $400 billion in 2009) with a single-payer system to cover the uninsured.

“Costs of Health Care Administration in the U.S. and Canada.” Woolhandler, S., Campbell, T., & Himmelstein, D.U. (2003), N Engl J Med, 349, 768-775.

“Proposal of the Physicians’ Working Group for Single-Payer National Health Insurance.” Woolhandler, S., Himmelstein, D.U., Angell, M., & Young, Q.D. (2003), J Am Med Assoc 290, 798-805.

“Summary of Fiscal Studies: How Much would Single Payer Cost?”

“Canadian Health Insurance: Lessons for the Unites States.” U.S. General Accounting Office. (1991), GAO/HRD-91-90 Canadian Health Insurance.

Talking Point 10: Competition among investor-owned, for-profit entities has raised costs reduced quality in the U.S.

“Competition in a publicly funded healthcare system.” Woolhandler, S. & Himmelstein, D.U. (2007), Brit Med J, 335, 1126-1129.

“Market-Based Failure – A Second Opinion on U.S. Health Care Costs.” Kuttner, R. (2008), N Engl J Med, 358, 549-551.

Talking Point 11: The Canadian single payer healthcare system produces better health outcomes with substantially lower administrative costs than the United States.

“A systematic review of studies comparing health outcomes in Canada and the United States.” Guyatt G.H., et al. (2007), Open Medicine, 1, E27-36.

“Access to Care, Health Status, and Health Disparities in the United States and Canada: Results of a Cross-National Population-Based Survey.” Lasser, K., Himmelstein, D.U., & Woolhandler, S. (2006), Am J Public Health, 96, 1300-1307.

“Who administers? Who cares? Medical Administrative and Clinical Employment in the United States and Canada.” Himmelstein, D., Lewontin, J.P., & Woolhandler, S. (1996), Am J Public Health, 86,172-178.

“Costs of Health Care Administration in the U.S. and Canada.” Woolhandler, S., Campbell, T., & Himmelstein, D.U. (2003), N Engl J Med, 349, 768-775.

“Mythbusters: Canada has a communist-style healthcare system.” Canadian Health Services Research Foundation. (2005).

“Mythbusters: The cost of dying is an increasing strain on the healthcare system.” Canadian Health Services Research Foundation. (2003).

“Mythbusters: User fees would stop waste and ensure better use of the healthcare system.” Canadian Health Services Research Foundation. (2001).

“Privatizing health care is not the answer: lessons from the United States.” Angell, M. (2008), Can Med Assoc J, 179, 916-919.

Talking Point 12: Computerized medical records, chronic disease management, and malpractice reform do not save money. The only way to slash administrative over-head and improve quality is with a single payer system.

“Hospital computing and the costs and quality of care: a national study.” Himmelstein, D.U., Wright, A & Woolhandler, S. (2009), Am J Med, 2009 Nov 16.

“Hope And Hype: Predicting The Impact Of Electronic Medical Records.” Himmelstein, D.U. & Woolhandler, S. (2005), Health Affairs, 24, 1121-1123.

“Disease Management: Panacea, Another False Hope, or Something in Between?” Geyman, J. (2007), Ann Fam Med, 5, 257-260.

“Costs of Health Care Administration in the U.S. and Canada.” Woolhandler, S., Campbell, T., & Himmelstein, D.U. (2003), N Engl J Med, 349, 768-775.

“A Better Quality Alternative: Single-Payer National Health System Reform.” Schiff, G.D., Bindman, A.B., & Brennan, T.A. (1994), J Am Med Assoc, 272, 803-808.

“How Single-Payer Health System Reform Improves Quality.” PNHP Document

“You Can’t Leap a Chasm in Two Jumps: The Institute of Medicine Health Care Quality Report.” Schiff, G.D. & Young, Q.D. (2001), Public Health Rep, 116, 396-403.

“Medical Malpractice. Health Care Quality and Health Care Reform.” Schiff, G. (2003), Forum Report #4. PNHP NY Metro.

Talking Point 13: Alternative proposals for “universal coverage” (e.g. based on the Federal Employees Health Benefits Program, the old “Clinton health plan” or the recent reform in Massachusetts) do not work. State health reforms over the past two decades have failed to reduce the number of uninsured.

“State Health Reform Flatlines.” Woolhandler, S., Day, B., & Himmelstein, D.U. (2008), Int J Health Serv, 38, 585-592.

“FEHBP: A Feeble Model for Universal Health Care.” Rodberg, L. & Landy, J. (2004), On the Issues #2. PNHP NY Metro.

“Health Reform You Shouldn’t Believe In.” Angell, M. (2008), The American Prospect, April 21.

“Getting the Facts Right: Why HillaryCare Failed.” Navarro, V. (2007), PNHP Newsletter.

“The Massachusetts Way?” Rodberg, L. (2008), The New York Times, Sept. 26.

Talking Point 14: Drug companies spend more on marketing (31 percent) and profits (20 percent) than on R & D (13 percent). Lower drug prices would not jeopardize drug innovation, much of which is, in fact, publicly-funded.

“Extraordinary Claims Require Extraordinary Evidence.” Light, D.W. & Warburton, R.N. (2005), J Health Econ, 24, 1030-1033.

“Global Drug Discovery: Europe Is Ahead.” Light, D.W. (2009), Health Affairs, web exclusive, w969-w977.

“Will Lower Drug Prices Jeopardize Drug Research? A Policy Fact Sheet.” Light, D.W. & Lexchin, J. (2004), Am J Bioethics, 4, W3-W6.

“Foreign Free Riders and the High Price of U.S. Medicines.” Light, D.W. & Lexchin, J. (2005), Brit Med J, 331, 958-60.

Talking Point 15: Co-pays and deductibles are not necessary to control costs and reduce necessary care as much as unnecessary care. It is a myth that patient overuse will bankrupt any system without cost-sharing and that the demand for healthcare is “infinite”.

“Cost Sharing in Health Insurance – A Reexamination.” Rasell, M.E. (1995), N Engl J Med, 332, 1164-1168.

“Health needs, health-care requirements, and the myth of infinite demand.” Frankel, S. (1991), Lancet, 337, 1588-1590.

“Does universal comprehensive insurance encourage unnecessary use? Evidence from Manitoba says ‘no.’” Roos, N.P., Forget, E., Walld, R., & MacWilliam, L. (2004), Can Med Assoc J, 170, 209-214.

Talking Point 16: Universal coverage cannot be achieved with U.S.-style investor-owned private insurance companies. Every other industrialized, capitalist country has some form of non-profit national health care. For-profit, private insurance (mostly “gap” coverage) accounts for less than 5 percent of health expenditures in Europe.

“International Health Systems for Single Payer Advocates.” Hellander, I.

“PBS Frontline Interview with T.R. Reid, Fall 2008.” Reid, T.R. (2008).

“Sick Around the World.” Reid, T.R. (2008).

“Private health insurance and access to health care in the European Union.” Thompson, S. & Mossialos, E. (2004), Euro Observer, 6(1).

“Health Care Systems – Four Basic Models.” Reid, T.R.

“Health care reform must start with a plan to simplify.” McCanne, D. (2008), Quote of the Day, Sept. 18.

Talking Point 17: A majority of physicians (59 percent), and an even higher proportion of Americans (two-thirds) support single payer national health insurance or “Medicare for all.” Polling indicates that people are also willing to pay “higher taxes” for guaranteed coverage and that even the term “socialized medicine” has lost its negative connotations.

“Support for National Health Insurance among U.S. Physicians: 5 Years Later.” Carroll, A.E. & Ackerman, R.T. (2008), Ann Intern Med, 148, 566.

“Single-Payer, Health Savings Accounts, or Managed Care? Minnesota Physicians Perspective.” Albers, J.M., Lathrop, B.P., Allison, K.C., Oberg, C.N., & Hart, J.F. (2007), Minn Med, 90, February.

“PNHP Backgrounder: Recent Public Polls on Single Payer.” PNHP. (2007).

“PNHP Backgrounder: Physician Polls on Single Payer Prior to 2008.” PNHP. (2008).

'Medicare buy-in' called a subsidy to private insurers

The following radio interview with Dr. Steffie Woolhandler, co-founder of Physicians for a National Health Program and professor at Harvard Medical School, took place on the morning of Dec. 9 with an affiliate of Los Angeles-based KPFK Pacifica. A number of details about the bill were still unknown at that time.

Click here to listen to the interview.

Is it accurate to say that, even though this version of the Senate bill is still using the term “public option,” it’s really now going to be run by private health insurance companies?

That’s true. What the “public option” is going to be for folks under the age of 55 is just a menu, a menu of private plans that they can buy. It’s similar to the menu that is offered to federal workers, but of course federal workers actually get money to buy the health insurance. They don’t just get the menu, they get the money. So under the age of 55, if you’re uninsured, you will be offered this menu of nonprofit plans.

The issue about the folks over the age of 55 being able to buy into Medicare is actually quite bad as well. One of the better provisions of the reform legislation was that it prohibited charging older people any more than twice (or thrice in the some versions) as much as you charge younger people in the individual market. But by saying anyone over 55 in the individual market can be picked up by Medicare, you’ve really let the insurance industry off the hook.

That is, the highest-cost patients in the individual market will be taken off the insurance companies’ hands and paid for by the taxpayers; and private insurance will remain the only option for people under the age of 55 and for anyone who gets their insurance through their employer. Another way of saying that is: if you now have private health insurance and you don’t like it, you’re forced to keep it.

The buy-in to Medicare is only for those 55 to 64 and it’s only for people who are not offered private health insurance through an employer. So it turns into just a subsidy to private health insurance: the taxpayers will pay for the high-cost patients and the health insurance industry can take the lower-cost patients.

I want to remind people that at its core, this bill takes $450 billion in new taxes from the taxpayers, and hands it over to the private health insurance as subsidies. So, the core of the bill is a financial strengthening of the private health insurance industry. And even one of the small things that was good about the plan, that is, forcing the insurance industry to lower the prices for older enrollees – that’s been taken out of the bill, essentially.

Explain the subsidy, a little bit further; is this what the government would offer, as help for low-income Americans who cannot buy insurance? Because this bill, I’m assuming, also still has the mandate that all Americans have insurance, is that true?

That’s true. I live in Massachusetts, where we already have a very similar plan in place, and people do get subsidies if their income is less than 300 percent of poverty. The problem is that the subsidies are not very large, so you might get several thousand dollars in subsidy, but your insurance plan might be $10,000 or even $15,000, so that the mandate forces many low-income people to continue to take thousands of dollars out of their pocket and hand it to the private health insurance industry. So, in effect, the taxpayers are giving money to private health insurance, the individual family is being forced to hand over thousands more to the private health insurance industry.

What do you make of the words of Senator Max Baucus, who’s been a leading figure in the health care reform movement coming from the state of Montana, and getting huge numbers of campaign contributions from insurance companies? He is claiming that this compromised bill is the only kind of proposal, he said it’s probably the closest proposal so far that could get the support of 60 senators. “It’s got legs,” he says.

The issue here is what private health insurance wants. They did give Max Baucus $1.4 million in campaign contributions, but more significantly than that, Max Baucus has an assistant who’s actually writing the bill. We know she’s writing the bill because when you look at the documents that the Senate Finance Committee is putting out, for instance the so-called Baucus Framework, and you right-click and look at the properties box, you’ll see that the framework was written on the computer of Elizabeth Fowler. Her previous job was as vice president of WellPoint, the nation’s largest insurance company. So the insurance company is right there, on the inside, writing this bill. Not a word goes on that piece of paper that they don’t have an influence on. And when you look at something like the Medicare buy-in, you have to ask, “Well, what did the insurance industry get out of it?” because they have indeed hijacked this process and are writing the bills. Now they’re lobbying with these swing senators to get more and more and more of what the private insurance industry wants out of the bill.

One of the things in the House version of the bill that did, have some, that some progressives did like was the possibility that states individually could potentially start their own single-payer system. What’s the status of that in this bill?

An amendment was put forth in the House but not included in the final bill would have allowed state single-payer bills. Senator Bernie Sanders has been talking about putting an amendment forward in the Senate. We certainly expect to see that and hope that he’ll do that. But the bill that seems likely to emerge from the Senate and from the conference committee will probably not have that single-payer option in it. We’d like to see it because that would encourage people at the state level to continue to work on single payer, it would make their work easier, but we doubt that is actually going to be in the final bill. We’re still hopeful, but we doubt it.

I think we have to look at the totality of the bill at this point, and the totality of the bill is that it’s absolutely no solution. It’s going to make some people better off, some people worse off, but it’s going to leave us with probably 25 million uninsured people when fully implemented in 2020. It’s going to cost the taxpayers $450 billion in taxes that end up going straight to the private insurance industry as subsidies. There are many, many bad things in this bill that reflect the role of the insurance industry.

There is also the amendment that would prohibit any kind of government subsidies for plans that might offer abortion services; again, this is similar to the House version of the bill that was put forward as a way to get the votes of pro-life, anti-abortion senators.

Well, the anti-abortion planks are still in play. That is, within the House version there is a complete prohibition on plans sold through the exchange covering abortion. That’s obviously a major step backwards for reproductive rights. Right now, government money can’t support abortions, but there’s never before been a restriction on private plans. So, the House bill for the first time would put a restriction on abortion into private health insurance plans.

In the Senate, my understanding is that it is still in play. Senator Nelson is saying he refuses to support the bill unless he gets a Stupak [anti-abortion] amendment in there. The proposal on the table is to come up with some elaborate system to try and separate the monies that are public and private so that private plans might still offer abortions, but only out of the private monies, but that issue is still in play in the Senate bill.

It’s amazing that they are still calling the health insurance exchange, th
e private health insurance exchange, a public option. Do you see this step in the entire health care debate as basically being just not really worth carrying on anymore, from your perspective? You’d like to just stop and start over?

Yes. I think we need to start from scratch and throw this bill away. We need to start over, with the Medicare-for-All framework: that everyone in the country would have the same type of insurance that would be paid for by taxes, that the patients would have complete free choice of doctor or hospital.

The beauty of the Medicare-for-All approach is that you get so much on administrative savings that you can pay for the expanded access. You save more than $350 billion annually through administrative simplification and that’s the money you need not only to cover all of the uninsured, but also to plug the gaps in coverage for people who now have private coverage with gaps in it.

That’s the direction we need to be heading – toward that single payer. As long as we are leaving the private health insurance industry in the bill, it’s enormously expensive. One of the aspects of the bill that we haven’t discussed is that it has 10 years of taxes in it, but only 6 years of new coverage. That is, the tax provisions go into effect immediately, but all of the coverage provisions go into effect in 2014. So the only way they even got this bill to balance financially is by putting 10 years of taxes against 6 years of coverage. So the bill is really not affordable. Even if your only issue or concern was about cost and affordability, this bill is not affordable over the long run.

‘Medicare buy-in’ called a subsidy to private insurers

The following radio interview with Dr. Steffie Woolhandler, co-founder of Physicians for a National Health Program and professor at Harvard Medical School, took place on the morning of Dec. 9 with an affiliate of Los Angeles-based KPFK Pacifica. A number of details about the bill were still unknown at that time.

Click here to listen to the interview.

Is it accurate to say that, even though this version of the Senate bill is still using the term “public option,” it’s really now going to be run by private health insurance companies?

That’s true. What the “public option” is going to be for folks under the age of 55 is just a menu, a menu of private plans that they can buy. It’s similar to the menu that is offered to federal workers, but of course federal workers actually get money to buy the health insurance. They don’t just get the menu, they get the money. So under the age of 55, if you’re uninsured, you will be offered this menu of nonprofit plans.

The issue about the folks over the age of 55 being able to buy into Medicare is actually quite bad as well. One of the better provisions of the reform legislation was that it prohibited charging older people any more than twice (or thrice in the some versions) as much as you charge younger people in the individual market. But by saying anyone over 55 in the individual market can be picked up by Medicare, you’ve really let the insurance industry off the hook.

That is, the highest-cost patients in the individual market will be taken off the insurance companies’ hands and paid for by the taxpayers; and private insurance will remain the only option for people under the age of 55 and for anyone who gets their insurance through their employer. Another way of saying that is: if you now have private health insurance and you don’t like it, you’re forced to keep it.

The buy-in to Medicare is only for those 55 to 64 and it’s only for people who are not offered private health insurance through an employer. So it turns into just a subsidy to private health insurance: the taxpayers will pay for the high-cost patients and the health insurance industry can take the lower-cost patients.

I want to remind people that at its core, this bill takes $450 billion in new taxes from the taxpayers, and hands it over to the private health insurance as subsidies. So, the core of the bill is a financial strengthening of the private health insurance industry. And even one of the small things that was good about the plan, that is, forcing the insurance industry to lower the prices for older enrollees – that’s been taken out of the bill, essentially.

Explain the subsidy, a little bit further; is this what the government would offer, as help for low-income Americans who cannot buy insurance? Because this bill, I’m assuming, also still has the mandate that all Americans have insurance, is that true?

That’s true. I live in Massachusetts, where we already have a very similar plan in place, and people do get subsidies if their income is less than 300 percent of poverty. The problem is that the subsidies are not very large, so you might get several thousand dollars in subsidy, but your insurance plan might be $10,000 or even $15,000, so that the mandate forces many low-income people to continue to take thousands of dollars out of their pocket and hand it to the private health insurance industry. So, in effect, the taxpayers are giving money to private health insurance, the individual family is being forced to hand over thousands more to the private health insurance industry.

What do you make of the words of Senator Max Baucus, who’s been a leading figure in the health care reform movement coming from the state of Montana, and getting huge numbers of campaign contributions from insurance companies? He is claiming that this compromised bill is the only kind of proposal, he said it’s probably the closest proposal so far that could get the support of 60 senators. “It’s got legs,” he says.

The issue here is what private health insurance wants. They did give Max Baucus $1.4 million in campaign contributions, but more significantly than that, Max Baucus has an assistant who’s actually writing the bill. We know she’s writing the bill because when you look at the documents that the Senate Finance Committee is putting out, for instance the so-called Baucus Framework, and you right-click and look at the properties box, you’ll see that the framework was written on the computer of Elizabeth Fowler. Her previous job was as vice president of WellPoint, the nation’s largest insurance company. So the insurance company is right there, on the inside, writing this bill. Not a word goes on that piece of paper that they don’t have an influence on. And when you look at something like the Medicare buy-in, you have to ask, “Well, what did the insurance industry get out of it?” because they have indeed hijacked this process and are writing the bills. Now they’re lobbying with these swing senators to get more and more and more of what the private insurance industry wants out of the bill.

One of the things in the House version of the bill that did, have some, that some progressives did like was the possibility that states individually could potentially start their own single-payer system. What’s the status of that in this bill?

An amendment was put forth in the House but not included in the final bill would have allowed state single-payer bills. Senator Bernie Sanders has been talking about putting an amendment forward in the Senate. We certainly expect to see that and hope that he’ll do that. But the bill that seems likely to emerge from the Senate and from the conference committee will probably not have that single-payer option in it. We’d like to see it because that would encourage people at the state level to continue to work on single payer, it would make their work easier, but we doubt that is actually going to be in the final bill. We’re still hopeful, but we doubt it.

I think we have to look at the totality of the bill at this point, and the totality of the bill is that it’s absolutely no solution. It’s going to make some people better off, some people worse off, but it’s going to leave us with probably 25 million uninsured people when fully implemented in 2020. It’s going to cost the taxpayers $450 billion in taxes that end up going straight to the private insurance industry as subsidies. There are many, many bad things in this bill that reflect the role of the insurance industry.

There is also the amendment that would prohibit any kind of government subsidies for plans that might offer abortion services; again, this is similar to the House version of the bill that was put forward as a way to get the votes of pro-life, anti-abortion senators.

Well, the anti-abortion planks are still in play. That is, within the House version there is a complete prohibition on plans sold through the exchange covering abortion. That’s obviously a major step backwards for reproductive rights. Right now, government money can’t support abortions, but there’s never before been a restriction on private plans. So, the House bill for the first time would put a restriction on abortion into private health insurance plans.

In the Senate, my understanding is that it is still in play. Senator Nelson is saying he refuses to support the bill unless he gets a Stupak [anti-abortion] amendment in there. The proposal on the table is to come up with some elaborate system to try and separate the monies that are public and private so that private plans might still offer abortions, but only out of the private monies, but that issue is still in play in the Senate bill.

It’s amazing that they are still calling the health insurance exchange, the private health insurance exchange, a public option. Do you see this step in the entire health care debate as basically being just not really worth carrying on anymore, from your perspective? You’d like to just stop and start over?

Yes. I think we need to start from scratch and throw this bill away. We need to start over, with the Medicare-for-All framework: that everyone in the country would have the same type of insurance that would be paid for by taxes, that the patients would have complete free choice of doctor or hospital.

The beauty of the Medicare-for-All approach is that you get so much on administrative savings that you can pay for the expanded access. You save more than $350 billion annually through administrative simplification and that’s the money you need not only to cover all of the uninsured, but also to plug the gaps in coverage for people who now have private coverage with gaps in it.

That’s the direction we need to be heading – toward that single payer. As long as we are leaving the private health insurance industry in the bill, it’s enormously expensive. One of the aspects of the bill that we haven’t discussed is that it has 10 years of taxes in it, but only 6 years of new coverage. That is, the tax provisions go into effect immediately, but all of the coverage provisions go into effect in 2014. So the only way they even got this bill to balance financially is by putting 10 years of taxes against 6 years of coverage. So the bill is really not affordable. Even if your only issue or concern was about cost and affordability, this bill is not affordable over the long run.

Reason's Matt Welch on French health care

Why I Prefer French Health Care

The U.S. system’s deep flaws make socialism more tempting

By Matt Welch
Reason
January 2010

By now I’m accustomed to being the only person in any given room with my particular set of cockamamie politics. But even within the more familiar confines of the libertarian movement, I am an awkward outlier on the topic of the day (and the topic of this issue of reason): health care.

To put it plainly, when free marketers warn that Democratic health care initiatives will make us more “like France,” a big part of me says, “I wish.” It’s not that I think it’s either feasible or advisable for the United States to adopt a single-payer, government-dominated system. But it’s instructive to confront the comparative advantages of one socialist system abroad to sharpen the arguments for more capitalism at home.

For a dozen years now I’ve led a dual life, spending more than 90 percent of my time and money in the U.S. while receiving 90 percent of my health care in my wife’s native France. On a personal level the comparison is no contest: I’ll take the French experience any day. ObamaCare opponents often warn that a new system will lead to long waiting times, mountains of paperwork, and less choice among doctors. Yet on all three of those counts the French system is significantly better, not worse, than what the U.S. has now.

What’s more, none of these anecdotes scratches the surface of France’s chief advantage, and the main reason socialized medicine remains a perennial temptation in this country: In France, you are covered, period. It doesn’t depend on your job, it doesn’t depend on a health maintenance organization, and it doesn’t depend on whether you filled out the paperwork right. Those who (like me) oppose ObamaCare, need to understand (also like me, unfortunately) what it’s like to be serially rejected by insurance companies even though you’re perfectly healthy. It’s an enraging, anxiety-inducing, indelible experience, one that both softens the intellectual ground for increased government intervention and produces active resentment toward anyone who argues that the U.S. has “the best health care in the world.”

Don’t even get me started on the Kafkaesque ordeal of switching jobs without taking any time off, yet going uncovered by anything except COBRA for nearly two months even though both employers used the same health insurance provider. That incident alone cost me thousands of dollars I wouldn’t have paid if I had controlled my own insurance policy.

I’ve now reached the age where I will better appreciate the premium skill level of American doctors and their high-quality equipment and techniques. And in a very real way my family has voted with its feet when it comes to choosing between the two countries. One of France’s worst problems is the rigidity and expense that comes with an extensive welfare state.

But as you look at the health care solutions discussed in this issue, ask yourself an honest question: Are we better off today, in terms of health policy, than we would have been had we acknowledged more loudly 15 years ago that the status quo is quite awful for a large number of Americans? Would we have been better off focusing less on waiting times in Britain, and more on waiting times in the USA? It’s a question I plan to ask my doctor this Christmas. In French.

(Matt Welch is Reason’s editor in chief.)

http://reason.com/archives/2009/12/07/why-prefer-french-health-care

Comment:

By Don McCanne, MD

Reason magazine is a publication of Reason Foundation, a libertarian organization advancing “free minds and free markets.” In this refreshing moment of candor, Reason’s editor in chief, Matt Welch, does not allow libertarian ideology to cloud the truth about the contrasts between our health care system in the United States and France’s system of social insurance.

He has not abandoned his libertarian ideology in that he seems to reject a single payer system for the United States, while suggesting that France’s “socialist system” can “sharpen the arguments for more capitalism at home.” Yet when he describes the superiority of the French system he is describing attributes of social insurance and not free market capitalism. Including these favorable attributes in the U.S. capitalist system would be impossible without significantly expanding the government role in health care.

He states the he opposes “ObamaCare,” yet for what reason? Although he may be wishing that a capitalistic free market in private health plans would accomplish what France’s social insurance program does, he provides evidence of the opposite. His opposition to the current proposal before Congress seems to be for the same reason that we oppose it. It falls far short of the goals of social insurance. It will not be universal, comprehensive, affordable, equitably funded, adequately risk-adjusted, efficiently administered, nor would it apply the principles of social solidarity that make all other systems more efficient and effective than ours.

Under the proposal, most of our health care system remains the same, with little fundamental change in either employer-sponsored coverage or in our public programs such as Medicare and Medicaid. One advantage for those who “can keep the insurance they have” was to have been removal of the cap on yearly medical costs, but even this promise seems to have been abandoned. Although reform will nominally provide coverage for a portion of the uninsured (falling far short of the goal of universality), it will compound the affordability problem for middle-income Americans though inadequate controls on cost escalation, higher taxes, and higher premiums and out-of-pocket expenses (the opposite of what we were promised).

The nation should listen when a prominent libertarian extolls the virtues of social insurance. Once we accept the principle of social insurance, then we can have a more rational debate over whether we want that to be a single-payer Medicare-type program or a European-style social insurance program using using private plans that are so tightly regulated that they almost function as a single payer system. Though PNHP will continue to advocate for the golden standard of a single payer system, that is the debate that we should be having.

Regardless, we need to dump the current proposal and immediately move on with a reform process that will establish a bona fide social insurance program within the United States. Otherwise Matt Welch will have to keep outsourcing his personal medical care to France.

Reason’s Matt Welch on French health care

Why I Prefer French Health Care

The U.S. system’s deep flaws make socialism more tempting

By Matt Welch
Reason
January 2010

By now I’m accustomed to being the only person in any given room with my particular set of cockamamie politics. But even within the more familiar confines of the libertarian movement, I am an awkward outlier on the topic of the day (and the topic of this issue of reason): health care.

To put it plainly, when free marketers warn that Democratic health care initiatives will make us more “like France,” a big part of me says, “I wish.” It’s not that I think it’s either feasible or advisable for the United States to adopt a single-payer, government-dominated system. But it’s instructive to confront the comparative advantages of one socialist system abroad to sharpen the arguments for more capitalism at home.

For a dozen years now I’ve led a dual life, spending more than 90 percent of my time and money in the U.S. while receiving 90 percent of my health care in my wife’s native France. On a personal level the comparison is no contest: I’ll take the French experience any day. ObamaCare opponents often warn that a new system will lead to long waiting times, mountains of paperwork, and less choice among doctors. Yet on all three of those counts the French system is significantly better, not worse, than what the U.S. has now.

What’s more, none of these anecdotes scratches the surface of France’s chief advantage, and the main reason socialized medicine remains a perennial temptation in this country: In France, you are covered, period. It doesn’t depend on your job, it doesn’t depend on a health maintenance organization, and it doesn’t depend on whether you filled out the paperwork right. Those who (like me) oppose ObamaCare, need to understand (also like me, unfortunately) what it’s like to be serially rejected by insurance companies even though you’re perfectly healthy. It’s an enraging, anxiety-inducing, indelible experience, one that both softens the intellectual ground for increased government intervention and produces active resentment toward anyone who argues that the U.S. has “the best health care in the world.”

Don’t even get me started on the Kafkaesque ordeal of switching jobs without taking any time off, yet going uncovered by anything except COBRA for nearly two months even though both employers used the same health insurance provider. That incident alone cost me thousands of dollars I wouldn’t have paid if I had controlled my own insurance policy.

I’ve now reached the age where I will better appreciate the premium skill level of American doctors and their high-quality equipment and techniques. And in a very real way my family has voted with its feet when it comes to choosing between the two countries. One of France’s worst problems is the rigidity and expense that comes with an extensive welfare state.

But as you look at the health care solutions discussed in this issue, ask yourself an honest question: Are we better off today, in terms of health policy, than we would have been had we acknowledged more loudly 15 years ago that the status quo is quite awful for a large number of Americans? Would we have been better off focusing less on waiting times in Britain, and more on waiting times in the USA? It’s a question I plan to ask my doctor this Christmas. In French.

(Matt Welch is Reason’s editor in chief.)

http://reason.com/archives/2009/12/07/why-prefer-french-health-care

Comment:

By Don McCanne, MD

Reason magazine is a publication of Reason Foundation, a libertarian organization advancing “free minds and free markets.” In this refreshing moment of candor, Reason’s editor in chief, Matt Welch, does not allow libertarian ideology to cloud the truth about the contrasts between our health care system in the United States and France’s system of social insurance.

He has not abandoned his libertarian ideology in that he seems to reject a single payer system for the United States, while suggesting that France’s “socialist system” can “sharpen the arguments for more capitalism at home.” Yet when he describes the superiority of the French system he is describing attributes of social insurance and not free market capitalism. Including these favorable attributes in the U.S. capitalist system would be impossible without significantly expanding the government role in health care.

He states the he opposes “ObamaCare,” yet for what reason? Although he may be wishing that a capitalistic free market in private health plans would accomplish what France’s social insurance program does, he provides evidence of the opposite. His opposition to the current proposal before Congress seems to be for the same reason that we oppose it. It falls far short of the goals of social insurance. It will not be universal, comprehensive, affordable, equitably funded, adequately risk-adjusted, efficiently administered, nor would it apply the principles of social solidarity that make all other systems more efficient and effective than ours.

Under the proposal, most of our health care system remains the same, with little fundamental change in either employer-sponsored coverage or in our public programs such as Medicare and Medicaid. One advantage for those who “can keep the insurance they have” was to have been removal of the cap on yearly medical costs, but even this promise seems to have been abandoned. Although reform will nominally provide coverage for a portion of the uninsured (falling far short of the goal of universality), it will compound the affordability problem for middle-income Americans though inadequate controls on cost escalation, higher taxes, and higher premiums and out-of-pocket expenses (the opposite of what we were promised).

The nation should listen when a prominent libertarian extolls the virtues of social insurance. Once we accept the principle of social insurance, then we can have a more rational debate over whether we want that to be a single-payer Medicare-type program or a European-style social insurance program using using private plans that are so tightly regulated that they almost function as a single payer system. Though PNHP will continue to advocate for the golden standard of a single payer system, that is the debate that we should be having.

Regardless, we need to dump the current proposal and immediately move on with a reform process that will establish a bona fide social insurance program within the United States. Otherwise Matt Welch will have to keep outsourcing his personal medical care to France.

Reason's Matt Welch on French health care

Why I Prefer French Health Care

The U.S. system’s deep flaws make socialism more tempting

By Matt Welch
Reason
January 2010
By now I’m accustomed to being the only person in any given room with my particular set of cockamamie politics. But even within the more familiar confines of the libertarian movement, I am an awkward outlier on the topic of the day (and the topic of this issue of reason): health care.
To put it plainly, when free marketers warn that Democratic health care initiatives will make us more “like France,” a big part of me says, “I wish.” It’s not that I think it’s either feasible or advisable for the United States to adopt a single-payer, government-dominated system. But it’s instructive to confront the comparative advantages of one socialist system abroad to sharpen the arguments for more capitalism at home.
For a dozen years now I’ve led a dual life, spending more than 90 percent of my time and money in the U.S. while receiving 90 percent of my health care in my wife’s native France. On a personal level the comparison is no contest: I’ll take the French experience any day. ObamaCare opponents often warn that a new system will lead to long waiting times, mountains of paperwork, and less choice among doctors. Yet on all three of those counts the French system is significantly better, not worse, than what the U.S. has now.
What’s more, none of these anecdotes scratches the surface of France’s chief advantage, and the main reason socialized medicine remains a perennial temptation in this country: In France, you are covered, period. It doesn’t depend on your job, it doesn’t depend on a health maintenance organization, and it doesn’t depend on whether you filled out the paperwork right. Those who (like me) oppose ObamaCare, need to understand (also like me, unfortunately) what it’s like to be serially rejected by insurance companies even though you’re perfectly healthy. It’s an enraging, anxiety-inducing, indelible experience, one that both softens the intellectual ground for increased government intervention and produces active resentment toward anyone who argues that the U.S. has “the best health care in the world.”
Don’t even get me started on the Kafkaesque ordeal of switching jobs without taking any time off, yet going uncovered by anything except COBRA for nearly two months even though both employers used the same health insurance provider. That incident alone cost me thousands of dollars I wouldn’t have paid if I had controlled my own insurance policy.
I’ve now reached the age where I will better appreciate the premium skill level of American doctors and their high-quality equipment and techniques. And in a very real way my family has voted with its feet when it comes to choosing between the two countries. One of France’s worst problems is the rigidity and expense that comes with an extensive welfare state.
But as you look at the health care solutions discussed in this issue, ask yourself an honest question: Are we better off today, in terms of health policy, than we would have been had we acknowledged more loudly 15 years ago that the status quo is quite awful for a large number of Americans? Would we have been better off focusing less on waiting times in Britain, and more on waiting times in the USA? It’s a question I plan to ask my doctor this Christmas. In French.
(Matt Welch is Reason’s editor in chief.)
http://reason.com/archives/2009/12/07/why-prefer-french-health-care

Reason magazine is a publication of Reason Foundation, a libertarian organization advancing “free minds and free markets.” In this refreshing moment of candor, Reason’s editor in chief, Matt Welch, does not allow libertarian ideology to cloud the truth about the contrasts between our health care system in the United States and France’s system of social insurance.
He has not abandoned his libertarian ideology in that he seems to reject a single payer system for the United States, while suggesting that France’s “socialist system” can “sharpen the arguments for more capitalism at home.” Yet when he describes the superiority of the French system he is describing attributes of social insurance and not free market capitalism. Including these favorable attributes in the U.S. capitalist system would be impossible without significantly expanding the government role in health care.
He states the he opposes “ObamaCare,” yet for what reason? Although he may be wishing that a capitalistic free market in private health plans would accomplish what France’s social insurance program does, he provides evidence of the opposite. His opposition to the current proposal before Congress seems to be for the same reason that we oppose it. It falls far short of the goals of social insurance. It will not be universal, comprehensive, affordable, equitably funded, adequately risk-adjusted, efficiently administered, nor would it apply the principles of social solidarity that make all other systems more efficient and effective than ours.
Under the proposal, most of our health care system remains the same, with little fundamental change in either employer-sponsored coverage or in our public programs such as Medicare and Medicaid. One advantage for those who “can keep the insurance they have” was to have been removal of the cap on yearly medical costs, but even this promise seems to have been abandoned. Although reform will nominally provide coverage for a portion of the uninsured (falling far short of the goal of universality), it will compound the affordability problem for middle-income Americans though inadequate controls on cost escalation, higher taxes, and higher premiums and out-of-pocket expenses (the opposite of what we were promised).
The nation should listen when a prominent libertarian extolls the virtues of social insurance. Once we accept the principle of social insurance, then we can have a more rational debate over whether we want that to be a single-payer Medicare-type program or a European-style social insurance program using using private plans that are so tightly regulated that they almost function as a single payer system. Though PNHP will continue to advocate for the golden standard of a single payer system, that is the debate that we should be having.
Regardless, we need to dump the current proposal and immediately move on with a reform process that will establish a bona fide social insurance program within the United States. Otherwise Matt Welch will have to keep outsourcing his personal medical care to France.

'Bodies' delivered to U.S. senators on Human Rights Day

By Margaret Flowers

WASHINGTON – On International Human Rights Day, Dec. 10, health professionals and patients delivered cardboard cutout “bodies” to selected U.S. senators here to make visible the number of people who die in the senators’ home states because the nation does not have Medicare for all.

As part of a national day of action centered on the theme of health care as a human right, dozens of health professionals and patients gathered at the Hart Senate Building on Thursday morning. The day was sunny but very windy, which made it challenging to hold the large banners which read: “How many must die for insurance company profits?” and “Medicare for all saves lives.” Activists also held signs declaring, “Health care is a human right” and “Single payer now.” They chanted and sang as passing motorists honked their horns in support.

Following the spirited rally, the activists entered the Senate building to visit 26 senators and present them each with a letter requesting their support for Senate Amendment 2837, introduced by Sen. Bernie Sanders, I-Vt. The amendment, co-sponsored by Senators Sherrod Brown, D-Ohio, and Roland Burris, D-Ill., would substitute single-payer financing for the current Senate health legislation and would create a federal health system, administered at the state level, which would be universal, comprehensive and financially sustainable, its supporters say.

The letters to the senators were attached to the backs of large cutouts of bodies, much like the chalk outlines seen at murder scenes. The number of adults who die each year from lack of health insurance in the given senator’s state was printed on the front of the body, with the words that there would be a corresponding number of fewer deaths if the U.S. had a Medicare-for-all health system.

Some of the Senate staffers reacted strongly to the appearance of the bodies, which was the intention of the action’s organizers. The activists said it is imperative that members of Congress and their staff understand the magnitude of suffering and death that would be prevented if they took steps to pass Medicare for all.

Senate Majority Leader Harry Reid’s Deputy Chief of Staff, David McCallum, met with the delegation that brought a body to his office. The group implored McCallum to at the very least give the majority of Americans who support Medicare for all the right to have S.A. 2837 debated on the floor of the Senate.

Serendipitously, the Mobilization for Health Care for All (www.mobilizeforhealthcare.org), the organization that coordinated pro-single-payer actions in 19 cities Thursday, was contacted by the daughter of the late Sen. Philip Hart, for whom the building is named, on the day before the rally. She stated that International Human Rights Day was also her father’s birthday and that he would have supported single payer, as she does.

Organizers say the movement for single payer continues to grow and become more visible daily. They say it is unacceptable that at least 120 people die each day in the United States from lack of insurance, and that the magnitude of suffering and death from lack of access to health care does not occur in any other industrialized nation.

Dr. Margaret Flowers, a Maryland pediatrician, is congressional fellow for Physicians for a National Health Program (www.pnhp.org) and participated in Thursday’s rally in Washington.

‘Bodies’ delivered to U.S. senators on Human Rights Day

By Margaret Flowers

WASHINGTON – On International Human Rights Day, Dec. 10, health professionals and patients delivered cardboard cutout “bodies” to selected U.S. senators here to make visible the number of people who die in the senators’ home states because the nation does not have Medicare for all.

As part of a national day of action centered on the theme of health care as a human right, dozens of health professionals and patients gathered at the Hart Senate Building on Thursday morning. The day was sunny but very windy, which made it challenging to hold the large banners which read: “How many must die for insurance company profits?” and “Medicare for all saves lives.” Activists also held signs declaring, “Health care is a human right” and “Single payer now.” They chanted and sang as passing motorists honked their horns in support.

Following the spirited rally, the activists entered the Senate building to visit 26 senators and present them each with a letter requesting their support for Senate Amendment 2837, introduced by Sen. Bernie Sanders, I-Vt. The amendment, co-sponsored by Senators Sherrod Brown, D-Ohio, and Roland Burris, D-Ill., would substitute single-payer financing for the current Senate health legislation and would create a federal health system, administered at the state level, which would be universal, comprehensive and financially sustainable, its supporters say.

The letters to the senators were attached to the backs of large cutouts of bodies, much like the chalk outlines seen at murder scenes. The number of adults who die each year from lack of health insurance in the given senator’s state was printed on the front of the body, with the words that there would be a corresponding number of fewer deaths if the U.S. had a Medicare-for-all health system.

Some of the Senate staffers reacted strongly to the appearance of the bodies, which was the intention of the action’s organizers. The activists said it is imperative that members of Congress and their staff understand the magnitude of suffering and death that would be prevented if they took steps to pass Medicare for all.

Senate Majority Leader Harry Reid’s Deputy Chief of Staff, David McCallum, met with the delegation that brought a body to his office. The group implored McCallum to at the very least give the majority of Americans who support Medicare for all the right to have S.A. 2837 debated on the floor of the Senate.

Serendipitously, the Mobilization for Health Care for All (www.mobilizeforhealthcare.org), the organization that coordinated pro-single-payer actions in 19 cities Thursday, was contacted by the daughter of the late Sen. Philip Hart, for whom the building is named, on the day before the rally. She stated that International Human Rights Day was also her father’s birthday and that he would have supported single payer, as she does.

Organizers say the movement for single payer continues to grow and become more visible daily. They say it is unacceptable that at least 120 people die each day in the United States from lack of insurance, and that the magnitude of suffering and death from lack of access to health care does not occur in any other industrialized nation.

Dr. Margaret Flowers, a Maryland pediatrician, is congressional fellow for Physicians for a National Health Program (www.pnhp.org) and participated in Thursday’s rally in Washington.

Saving our children from THEIR deficit

Taming the Deficit

Saving Our Children from Themselves

By David Rosnick and Dean Baker
Center for Economic and Policy Research (CEPR)
December 2009

Understanding the Deficit

One of the most popular causes among Washington political insiders is reducing the budget deficit. The conventional story in these circles is that current and projected future deficits will place an unbearable burden on future generations. Their argument is that the need to reduce the deficit is a question of intergenerational equity.

The leading spokespeople for this position, such as David Walker, the President of the Peter G. Peterson Foundation, often refer to the country’s $62.1 trillion “real federal financial hole.”

However, it seems that very few people have a clear understanding of this debt figure. This figure is not in any way a measure of money transferred from younger generations to older generations. In fact, rather than being a measure of how much debt older generations will pass on to today’s young people, to a large extent this ominous debt figure is actually a measure of the debt that today’s young people are projected to run up given the current structure of existing programs, most importantly Medicare. In other words, the huge debt numbers that are being used to scare the country – especially the young – are largely projections of how much debt today’s young will pass onto future generations.

The Cause of the Projected Debt

There are two reasons why later-age cohorts are projected to add more to the debt than the generations that preceded them. First, life expectancy is increasing decade by decade and is projected to continue to do so. Life expectancy after age 65 is currently 18.9 years. It is projected to be 23.2 years in 2085. If the tax and benefit formulas for Social Security and Medicare remain unchanged, then the benefits received in these programs will rise through time, as workers collect benefits for a longer period of time.

However, increasing longevity is a relatively minor factor in the rising deficit projections. The main factor is that per person health care costs are projected to far outpace the rate of per capita GDP growth. In other words, the main reason that today’s young and those yet to be born are projected to impose a far larger burden on the government than their parents and grandparents is that their health care is projected to be far more costly.

If the United States had health care costs that were in line with those of other wealthy countries, then the projections would show enormous surpluses, not deficits. Figure 3 shows long-term budget projections for the United States and then adjusts these projections under the assumption that it has the same per capita health care costs of Germany, Canada, Spain, and the United Kingdom.

As can be seen in all of these cases, the United States is projected to run enormous surpluses. For example, if the United States had the same per capita health care costs as Canada, its budget surplus would be equal to 0.13 percent of GDP by 2050. By 2080, its budget surplus would be 2.52 percent of GDP. In short, the budget problem facing the United States is almost entirely an issue of dealing with an out of control health care system, not the old stealing from the young.

http://www.cepr.net/documents/publications/taming-the-deficit-2009-12.pdf

Comment: 

By Don McCanne, MD

It has been said the the profligacy of our boomer generation, in wanting to keep our Medicare and Social Security benefits, is resulting in an intergenerational transfer that will drown our children and grandchildren in debt racked up by the tsunami of federal budget deficits caused by these two programs.

The potential is very real, but the framing is flat out wrong because it leads to advocacy of policies that could not be more damaging: cut Social Security benefits and make even deeper cuts in Medicare benefits.

Social Security is not a problem. The program requires little more than a few tweaks to make it solvent forever.

Medicare is the problem, but it is not due to our overuse of health care services. Our level of use is comparable to other nations. It is the outrageous rate of health care inflation that is the driving force that will create intolerable deficits in the future. We do not need to eliminate beneficial health care services. We need only to tame health care inflation, just as every other nation has already done by adopting some form of social insurance.

Because we are way behind schedule, with health care inflation already taking a heavy toll, we should not accept the less efficient models of social insurance but instead try to make up with a more efficient version – a single payer Medicare for all.

This report should be downloaded since it is invaluable as a resource to educate others. In fact, right now click on the link and quickly look at Figure 3 (cited above). That alone should motivate you to retain this report and share it with others.

We do have an obligation to our children and grandchildren, though it is not in declining the intergenerational transfer to finance our programs that provide us with security in retirement. Our obligation is to create and transfer to them a health care financing program that will ensure that they always will have the security of health care without the insecurity of mounting debt to pay for it. We need to transfer to our progeny a financing system which will save them from THEIR deficit.

Senate Tweaks Away Your Healthcare

By Donna Smith
CommonDreams, December 11, 2009

As my grandmother used to say, “I was born on a weekend but not last weekend.” The latest insult to Americans hungry for a bit of healthcare justice for all comes from the news that the Senate health bill now allows insurance companies to place annual limits on payments for some catastrophic illnesses, like cancer.

Surprise, surprise, surprise. Another day. Another lie uncovered in the process. Another piece of this reform bill that favors the for-profit health insurance industry.

Associated Press’ Ricardo Alonso-Zaldivar, ” [The] health care loophole would allow coverage limits:” A loophole in the Senate health care bill would let insurers place annual dollar limits on medical care for people struggling with costly illnesses such as cancer, prompting a rebuke from patient advocates. 

“The legislation that originally passed the Senate health committee last summer would have banned such limits, but a tweak to that provision weakened it in the bill now moving toward a Senate vote.

“As currently written, the Senate Democratic health care bill would permit insurance companies to place annual limits on the dollar value of medical care, as long as those limits are not ‘unreasonable.’ The bill does not define what level of limits would be allowable, delegating that task to administration officials.”

Read that passage again folks. The bill was “tweaked.” No official or legal amendment required when the insurance industry needs a tweak they damn well get a tweak. And this is quite a tweak.

Just hours ago, I continued to read reports that claimed our healthcare reformers in Congress were doing away with pre-existing condition clauses and also ending lifetime caps on coverage. Some patients and families were thrilled with this change alone, and most especially those people struggling with serious illnesses.

This summer, a friend of mine in Colorado was asked to introduce President Obama at a forum in Grand Junction. Nathan Wilkes was selected to do so because he could speak clearly and passionately about his family’s troubles keeping enough insurance coverage for his son, Thomas, who has a serious blood disorder. My friend has been and is a supporter of Medicare for all, single-payer type reform, but this opportunity to introduce the President and weigh in about eliminating lifetime benefit caps was a powerful pull. Nathan gave an intelligent and emotional intro for the President, and he was later invited to Washington to watch Obama’s address to Congress on healthcare reform.

Well, the joke’s on you Nathan and on a lot of others who trusted the details of reform being sold by members of Congress and President Obama. Only this is not at all funny. Families like the Wilkes family will go broke trying to keep kids like Thomas alive. And kids like Thomas will die without the care they need. The death panels allowed by this legislation are those set up and protected by the insurance industry–and tweaked into law by Congress and the President.

You simply cannot do this sort of tweaking and not have people notice. Did you think the Wilkes family wouldn’t notice when the annual cap is reached for Thomas and they have to start paying out of pocket or stop treatment?

This process has been fraught with disclosures of the misleading marketing of various details in the reform legislation from all involved. Who can the American public trust on this? Anybody?

As we sit on the verge of 2010, we citizens have some more political work of our own to do. We need to do some tweaking in the streets and at the polls. Because we surely are not going to get healthcare as a basic human right from this Congress and this administration. Neither the Republicans nor the Democrats seem to get it.

When we do the math for ourselves and when we watch you all play a deadly game of push-me, pull-me with our healthcare reform legislation, we know for certain you are only maneuvering for political advantage while we are out here fighting for our lives, our health and for our financial security. You didn’t hear us loudly enough at the polls in 2008, apparently.

Let me get this straight. You will force us to buy private insurance products that will not guarantee approval of treatment or payment for treatment. You will tax our insurance benefits if our employers offer those deemed as “Cadillac coverage” regardless of whether or not we make less than $250,000 a year. You cannot guarantee that employers will keep our current insurance plans and provider networks or that insurance companies will keep benefits and providers the same–therefore we cannot keep what we’ve got if we like it. You’ve crumbled on the notion of any real public option for coverage at all much less a “robust” option – whatever that squishy word ever meant. And now insurance companies will decide when we’ve had enough treatment for serious illness each year.

Wow. Sweet tweaking indeed for the profit-takers–and without so much as a debate or airing on the floor of the Senate. It seems only the things that would benefit real people require an appropriate following of legal process in Congress and full debate–amendments like Senator Bernie Sanders’ single-payer amendment aimed at strengthening real reform haven’t even gotten a hearing. We’re still fighting for that.
Please don’t insult us any more by selling this legislation as healthcare reform or even health insurance reform. This seems more and more like health industry protection and less like anything at all to do with providing what President Obama declared as a basic human right during the campaign. Even he said the only way to get to full coverage is a single-payer plan. And that’s a tweak too far from profit protection, it seems.

Hang on, fellow citizens. This healthcare mess is about to get messier and make you wonder if anyone told us the truth at all. Then we’ll have some serious tweaking of our own to do in 2010 and 2012. We will not forget this.

http://www.commondreams.org/view/2009/12/11-7

Maine AFL-CIO Calls for Labor Summit & Strategy to Win Single Payer

by Matt Schlobohm
Public Policy & Poltical Mobilization Director
Maine AFL-CIO, and Charlie Urquhart, Organizer, Maine Labor Group on Health

On Friday October 23, 2009 the delegates at the Maine AFL-CIO’s 27th Biennial Convention unanimously passed a resolution calling on the AFL-CIO to convene, after the current healthcare reform process in Congress concludes, a democratic strategic planning process to develop a long term strategy to win Single Payer national health insurance.

The resolution was enthusiastically supported by the delegates and is rooted in the belief that to win a Medicare for all single payer system the labor movement needs to pursue a different strategy – one that is rooted in building a broadbased social movement, taking a long term approach to this fight, organizing around basic principles and pursuing relentless rank & file education and mobilization.

Maine AFL-CIO Vice President & IBEW 567 Training Director Don Berry laid out the Federation’s position, “Most union leaders are clear that we need a single payer system to solve the healthcare crisis. Yet as a labor movement our strategy has not been clearly, solidly and unambiguously behind single payer.  We think it is time for us to commit to and stick with a long term strategy to win Medicare for All.  That’s the only thing that’s going to get us out of the healthcare crisis we face at the bargaining table and in society at large and its high time we put our full force behind it.”

Building on the momentum of the National AFL-CIO’s historic and unanimous passage of Resolution 34 that called for the creation of a Medicare for All, single payer social insurance program, the Maine AFL-CIO saw this resolution as an important step to making that resolution real and pursuing some important next steps.

In this spirit the Maine AFL-CIO unanimously passed the following resolution:

RESOLUTION # 5

Single Payer Healthcare Resolution Whereas the National AFL-CIO unanimously passed Resolution 34 strongly endorsing a Medicare for All single payer health care system;

Whereas 39 State AFL-CIO Federations, 134 Central Labor Councils, and 572 different labor organizations have endorsed HR 676;

Whereas as a State Federation we strongly believe that a Medicare for all national health insurance system with single payer financing is the solution that is required to solve the healthcare crisis union members face at the bargaining table and that we face collectively as a society;

Whereas regardless of how the current healthcare reform effort concludes in Congress it will not come close to solving the current healthcare crisis;

Whereas historically, significant structural changes in this country have occurred when progressive forces have built powerful social movements that organize around a long term strategy that involves relentless rank & file education, organizing around basic fundamental principles, having rank & file leaders lead the movement and committing to a long term approach to the issue;

Whereas we strongly believe that to win a single payer national health insurance system the labor movement needs to pursue that kind of strategy and work to build a broad based working class social movement and;

Whereas we believe that had we collectively pursued such a strategy after the last healthcare policy failure in Congress in the mid 1990s – by staking out a strong single payer position, educating our membership as deeply as possible, pushing for political support of single payer legislation and sticking with that approach for the last fifteen years – we would be in a much stronger position today to win meaningful healthcare reform;

Therefore, we call on the National AFL-CIO to convene, after the current healthcare reform process in Congress concludes, a democratic strategic planning process to develop a long term strategy to win Single Payer national health insurance. We think this process should:

1. Start with a Single Payer labor movement summit

2. Involve, among others, Central Labor Councils, State Federations and rank & file single payer union activists in the planning process

3. Do an assessment of how we’ve historically built powerful social movements in this country and put our best thinking forward about what would need to be done today to build a social movement powerful enough to win single payer

4. Include a commitment of resources from the AFL-CIO of no less than the resources that have been devoted to the current health care reform effort

5. Include a commitment from the AFL-CIO to support state’s efforts to pass single payer legislation

Submitted by: the Western Maine Labor Council to the Maine AFL-CIO’s 27th
Biennial Convention
Approved unanimously by Maine AFL-CIO Convention delegates: Friday October 23, 2009

Distributed by:
All Unions Committee For Single Payer Health Care–HR 676
c/o Nurses Professional Organization (NPO)
1169 Eastern Parkway, Suite 2218
Louisville, KY 40217
(502) 636 1551
Email: nursenpo@aol.com
http://unionsforsinglepayerHR676.org
12/10/09