PNHP

Boston University Medical Student Iyah Romm's Testimony in Support of Single Payer

Boston University Medical Student Iyah Romm's Testimony in Support of Single Payer

Massachusetts Joint Comittee on Public Health
October 20, 2009
Boston, MA

Thank you, Madame Chair and Members of the Committee for the opportunity to testify this morning. My name is Iyah Romm, and I am a medical student at Boston University School of Medicine. I also serve as a national leader of the American Medical Student Association (AMSA), where I am the New England Regional Director and Co-Chair of the Health Care for All Steering Committee.

In my capacity as a medical student and AMSA leader, I am here today to offer the perspective of a large cohort of physicians-in-training regarding the broken health care system in which we are training, and which we will inherit. With respect to this system, AMSA believes the following:

1. Health care is a fundamental human right and is the single greatest moral imperative for our generation. We, even in the Commonwealth, are woefully failing to ensure quality, affordable, health care to all of our residents.

2. Medicine and the entire health care sector must serve the public good over private industry profits.

3. The best solution to our health care crisis is a single-payer system of publicly funded, publicly accountable, privately delivered, quality, affordable health care for all.

With 62,000 members, AMSA is the oldest and largest independent association of physicians-intraining in the US and has a rich history of advocacy on issues affecting our current and future patients. In fact, AMSA was borne from a seminal moment in the history of our health care system – the establishment of America’s own single payer system, Medicare. As an organization of future physicians, AMSA is committed to advancing a legislative agenda that reflects this history and basic principles.

While Chapter 58 reform has resulted in modest improvements in health insurance coverage, health care costs are spiraling out of control – even in Massachusetts.1 Despite a health insurance market dominated by not-for-profit insurers, premiums are expected to increase by 7-12 percent next year. In 2008, Massachusetts had the highest family coverage premiums in the country – $13,788 on average. These costs are being deflected onto the residents of the Commonwealth and are overwhelming state, municipal, family, and individual budgets and livelihoods. Public services are being slashed resulting in difficult choices and erosions of coverage.2 The long-term sustainability of “universal coverage” in Massachusetts is in peril. Clearly we cannot allow this trend of misprojection to continue at the expense of our patients and our friends, our neighbors, our sisters, and our fathers.

The individual mandate is a unique element of Chapter 58; many other components have been implemented previously in other states on differing scales. As we have seen in those other states, including but not limited to Maine, Minnesota, and Oregon, coverage has increased following reform. But these expansions in coverage have fallen short of the elusive goal of universality and true access for all3 – each time sabotaged by lack of financial sustainability. The culprit? Continued reliance upon commercial insurance markets as the gateway to care and the false hope of competition as a means of “bending the cost curve.”

By definition, incremental reforms explicitly limit access if not decrease the quality of coverage through many ‘crowd-out’ mechanisms to prevent the collapse of the private insurance sector – a necessary sequela of universal health care. Three years after implementation of Chapter 58, we have yet to see anticipated significant gains in coverage or affordability. In 1987, 7% of Massachusetts residents were uninsured – today, the sum is 3%, at best. Moreover, many Bay State residents struggle with skyrocketing premiums seemingly unhindered by the enhanced “competition” fostered by Chapter 58 and the Connector. And without comprehensive reform, the number of uninsured – and number of individuals qualifying for hardship exemption – will continue to rise unchecked. If I were to lose my university-provided insurance, I would be forced to spend exorbitant sums for minimal coverage.

Incremental reforms have focused on the crisis of uninsurance rather than the ultimate goal of ensuring access to quality, affordable health care. Expansions in health insurance coverage do not guarantee concurrent expansions in access. Through high deductibles and other cost-sharing mechanisms, commercial insurers continue to erect financial barriers to care. Indeed, despite purported universal coverage, one in six Massachusetts residents was unable to pay his or her medical bills last year. The result? Many Commonwealth residents are still forced to forego medically necessary care. Such practices by private insurance companies render expansions in coverage meaningless – and ultimately more costly. These are the patients that my peers and I do not see on our primary care rotations; rather, they still present unnecessarily in the Emergency Department with preventable conditions.

Recent funding cuts have torn gaping holes in our ‘safety net,’ with those clinics and hospitals committed to the underserved suffering under massive budget shortfalls – including Boston Medical Center where I study. In the hospital, I see how these shortfalls have resulted in staff reductions that ultimately threaten the quality and availability of care. And we have begun down the slippery slope of tiering coverage with, for example, the recent benefit restrictions imposed on legal immigrants.

Single payer is the only responsible health care reform option. The vast majority of our seniors are satisfied with Medicare; in fact, many patients anxiously await Medicare eligibility because of the program’s guarantee of both coverage and access. Labor unions and advocacy organizations across the Commonwealth support a single payer system, as do the majority of health care providers.4 These groups — these constituencies — recognize that single payer is the best system in which to guarantee quality, affordable, health care for all. Across the country, politicians, policy-makers, and citizens are looking to Massachusetts as a beacon of hope on health care reform. The private insurance industry has had eight decades to lead change, to shift from a world predicated upon a race to the bottom to culture of innovation and care. But their time has passed. Your Committee has the opportunity to truly provide that light. I hope you will offer the leadership necessary to reform our system and to address one of our greatest moral failures of the last fifty years. Only a single payer system can provide the change we need – simplifying payment, eliminating unnecessary bureaucracy, and investing the subsequent savings into a solitary goal, providing care to all. The math is simple, the morality pure, and the passion indefatigable. As a future physician, this is the type of system in which I aspire to practice medicine.

Thank you very much for the opportunity to share this perspective.

1. Steinbrook, R. Health Care Reform in Massachusetts — Expanding Coverage, Escalating Costs. N Engl J Med 2008 358: 2757-2760
2. Sack K. Massachussetts Faces Costs of Big Health Care Plan. NYT, 2009.
3. Long S, Masi P. An update on health reform in Massachusetts, fall 2008. Health Aff (Millwood). 2009;28(4):w578–87
4. McCormick D et al. Single-Payer National Health Insurance: Physicians’ Views Arch Intern Med. 2004;164(3):300-304.

Boston University Medical Student Iyah Romm’s Testimony in Support of Single Payer

Massachusetts Joint Comittee on Public Health
October 20, 2009
Boston, MA

Thank you, Madame Chair and Members of the Committee for the opportunity to testify this morning. My name is Iyah Romm, and I am a medical student at Boston University School of Medicine. I also serve as a national leader of the American Medical Student Association (AMSA), where I am the New England Regional Director and Co-Chair of the Health Care for All Steering Committee.

In my capacity as a medical student and AMSA leader, I am here today to offer the perspective of a large cohort of physicians-in-training regarding the broken health care system in which we are training, and which we will inherit. With respect to this system, AMSA believes the following:

1. Health care is a fundamental human right and is the single greatest moral imperative for our generation. We, even in the Commonwealth, are woefully failing to ensure quality, affordable, health care to all of our residents.

2. Medicine and the entire health care sector must serve the public good over private industry profits.

3. The best solution to our health care crisis is a single-payer system of publicly funded, publicly accountable, privately delivered, quality, affordable health care for all.

With 62,000 members, AMSA is the oldest and largest independent association of physicians-intraining in the US and has a rich history of advocacy on issues affecting our current and future patients. In fact, AMSA was borne from a seminal moment in the history of our health care system – the establishment of America’s own single payer system, Medicare. As an organization of future physicians, AMSA is committed to advancing a legislative agenda that reflects this history and basic principles.

While Chapter 58 reform has resulted in modest improvements in health insurance coverage, health care costs are spiraling out of control – even in Massachusetts.1 Despite a health insurance market dominated by not-for-profit insurers, premiums are expected to increase by 7-12 percent next year. In 2008, Massachusetts had the highest family coverage premiums in the country – $13,788 on average. These costs are being deflected onto the residents of the Commonwealth and are overwhelming state, municipal, family, and individual budgets and livelihoods. Public services are being slashed resulting in difficult choices and erosions of coverage.2 The long-term sustainability of “universal coverage” in Massachusetts is in peril. Clearly we cannot allow this trend of misprojection to continue at the expense of our patients and our friends, our neighbors, our sisters, and our fathers.

The individual mandate is a unique element of Chapter 58; many other components have been implemented previously in other states on differing scales. As we have seen in those other states, including but not limited to Maine, Minnesota, and Oregon, coverage has increased following reform. But these expansions in coverage have fallen short of the elusive goal of universality and true access for all3 – each time sabotaged by lack of financial sustainability. The culprit? Continued reliance upon commercial insurance markets as the gateway to care and the false hope of competition as a means of “bending the cost curve.”

By definition, incremental reforms explicitly limit access if not decrease the quality of coverage through many ‘crowd-out’ mechanisms to prevent the collapse of the private insurance sector – a necessary sequela of universal health care. Three years after implementation of Chapter 58, we have yet to see anticipated significant gains in coverage or affordability. In 1987, 7% of Massachusetts residents were uninsured – today, the sum is 3%, at best. Moreover, many Bay State residents struggle with skyrocketing premiums seemingly unhindered by the enhanced “competition” fostered by Chapter 58 and the Connector. And without comprehensive reform, the number of uninsured – and number of individuals qualifying for hardship exemption – will continue to rise unchecked. If I were to lose my university-provided insurance, I would be forced to spend exorbitant sums for minimal coverage.

Incremental reforms have focused on the crisis of uninsurance rather than the ultimate goal of ensuring access to quality, affordable health care. Expansions in health insurance coverage do not guarantee concurrent expansions in access. Through high deductibles and other cost-sharing mechanisms, commercial insurers continue to erect financial barriers to care. Indeed, despite purported universal coverage, one in six Massachusetts residents was unable to pay his or her medical bills last year. The result? Many Commonwealth residents are still forced to forego medically necessary care. Such practices by private insurance companies render expansions in coverage meaningless – and ultimately more costly. These are the patients that my peers and I do not see on our primary care rotations; rather, they still present unnecessarily in the Emergency Department with preventable conditions.

Recent funding cuts have torn gaping holes in our ‘safety net,’ with those clinics and hospitals committed to the underserved suffering under massive budget shortfalls – including Boston Medical Center where I study. In the hospital, I see how these shortfalls have resulted in staff reductions that ultimately threaten the quality and availability of care. And we have begun down the slippery slope of tiering coverage with, for example, the recent benefit restrictions imposed on legal immigrants.

Single payer is the only responsible health care reform option. The vast majority of our seniors are satisfied with Medicare; in fact, many patients anxiously await Medicare eligibility because of the program’s guarantee of both coverage and access. Labor unions and advocacy organizations across the Commonwealth support a single payer system, as do the majority of health care providers.4 These groups — these constituencies — recognize that single payer is the best system in which to guarantee quality, affordable, health care for all. Across the country, politicians, policy-makers, and citizens are looking to Massachusetts as a beacon of hope on health care reform. The private insurance industry has had eight decades to lead change, to shift from a world predicated upon a race to the bottom to culture of innovation and care. But their time has passed. Your Committee has the opportunity to truly provide that light. I hope you will offer the leadership necessary to reform our system and to address one of our greatest moral failures of the last fifty years. Only a single payer system can provide the change we need – simplifying payment, eliminating unnecessary bureaucracy, and investing the subsequent savings into a solitary goal, providing care to all. The math is simple, the morality pure, and the passion indefatigable. As a future physician, this is the type of system in which I aspire to practice medicine.

Thank you very much for the opportunity to share this perspective.

1. Steinbrook, R. Health Care Reform in Massachusetts — Expanding Coverage, Escalating Costs. N Engl J Med 2008 358: 2757-2760
2. Sack K. Massachussetts Faces Costs of Big Health Care Plan. NYT, 2009.
3. Long S, Masi P. An update on health reform in Massachusetts, fall 2008. Health Aff (Millwood). 2009;28(4):w578–87
4. McCormick D et al. Single-Payer National Health Insurance: Physicians’ Views Arch Intern Med. 2004;164(3):300-304.

CBO report on premiums

An Analysis of Health Insurance Premiums Under the Patient Protection and Affordable Care Act

Congressional Budget Office
November 30, 2009

The analysis looks separately at the effects on premiums for coverage purchased individually, coverage purchased by small employers, and coverage provided by large employers.

Nongroup Policies

Average premiums per policy in the nongroup market in 2016 would be roughly $5,800 for single policies and $15,200 for family policies under the proposal, compared with roughly $5,500 for single policies and $13,100 for family policies under current law.

The majority of nongroup enrollees (about 57 percent) would receive subsidies via the new insurance exchanges, and those subsidies, on average, would cover nearly two-thirds of the total premium, CBO and JCT estimate.

Employment-Based Coverage

By CBO and JCT’s estimate, the average premium per policy in the small group market would be in the vicinity of $7,800 for single policies and $19,200 for family policies under the proposal, compared with about $7,800 and $19,300 under current law. In the large group market, average premiums would be roughly $7,300 for single policies and $20,100 for family policies under the proposal, compared with about $7,400 and $20,300 under current law.

Those figures do not include the effects of the small business tax credit on the cost of purchasing insurance. A relatively small share (about 12 percent) of people with coverage in the small group market would benefit from that credit in 2016. For those people, the cost of insurance under the proposal would be about 8 percent to 11 percent lower, on average, compared with that cost under current law.

http://www.cbo.gov/ftpdocs/107xx/doc10781/11-30-Premiums.pdf

Comment:

By Don McCanne, MD

For most individuals and families, the Senate health care reform bill will have very little impact on the premiums to be paid for health plans. There are three important exceptions:

* Premiums in the individual market will increase significantly because the plans will be required to provide an actuarial value of 60 percent, higher than the average value in the current individual market.

* About 57 percent of individuals eligible for coverage in the exchange will receive subsidies which will more than offset the premium increases. Note that most individuals are not eligible for coverage in the exchange and would not receive these subsidies.

* Although there will be little change in premiums for small group plans, about 12 percent of people in the small group market will benefit from a small business tax credit designed to encourage small business owners to offer coverage to their employees.

The really bad news in this report is that, on average, premiums for group plans will continue to increase at the same intolerable rates that they would have if we did nothing. This CBO analysis demonstrates that, in 2016, the family premium alone for employer-sponsored coverage, not including deductibles and other out-of-pocket costs, would be over $20,000 for a large group plan, whether or not the proposed legislation is enacted. That is quite a hit for a hard-working family with a $60,000 income.

The only hope for premium relief is for innovative insurance products that would reduce costs for those who don’t need health care, but would increase even more the costs for those who do. This demonstrates why focusing on premium relief has been a misguided endeavor. We have been diverted from the the much more important goal of relieving the financial burden of those who actually need health care.

We can achieve that goal by improving Medicare, funding it equitably, and using its monopsonistic powers to provide us with greater value in our health care purchasing. Had we done that when the Clintons were proposing their flawed model of reform, our national health expenditures would be about 20 percent less than they currently are.

It’s tragic that we would be starting from an inflated baseline, but we can still achieve that level of efficiency in the future if we dumped the highly flawed proposal before Congress and adopted the much more humane system of an improved Medicare for all.

Obama's Privatized Health Care Propaganda Tour.

Public's Favorite Option, Single Payer, Wasn't on Baucus or Kennedy's

Allison Kilkenny
The Huffington Post, June 11, 2009 

The public finally got a look at Senator Kennedy’s behemoth 615-page health care bill, a document so gargantuan that Huffington Post put out an SOS to readers to help the editors read it. During the lead-up to the health care war, Kennedy promised Americans that the conversation about their health industry would be a national one, unlike the debacle the first time when the Clintons tried to take on private health care. No more secrecy, Teddy promised. Except, this time the negotiations are — once again — happening behind closed doors, and the public’s favorite option, single-payer, isn’t represented at the table.

Kennedy has depicted this secret operation as essential to negotiations, but the popular single-payer option has been almost entirely shut out of the debate (59% of Americans believe the government should provide national health insurance). Meanwhile, according to The New York Times, lobbyists from “AARP, Aetna, the A.F.L.-C.I.O., the American Cancer Society, the American Medical Association, America’s Health Insurance Plans, the Business Roundtable, Easter Seals, the National Federation of Independent Business, the Pharmaceutical Research and Manufacturers of America, and the United States Chamber of Commerce,” are all present at the Kennedy meetings.

You’d think single-payer advocate House Judiciary Chair John Conyers has the plague these days from the way his associates on the hill are dodging him. Conyers has been criticizing his fellow politicians for sabotaging the single-payer option.

“There is some notion that universal single-payer healthcare is off the table. Well, that raises a very important question. If you take the most popular healthcare reform measure and take it off the table, heaven knows what it is, I guess, you think you’re left with. This is the most popular form, and it would be very unlike the party in the majority now to determine that the most popular system would not even be examined. I am asking for a hearing in every committee, every committee, and if they will let us into the Senate, as well.”

Conyers, who — once again represents what the majority of Americans actually want — has been forced to chase the back of the health care bus like a crazed dog ever since March when he was not invited to President Obama’s Health Care Summit. Ultimately, Obama invited him when Conyers threatened to take his case to the president himself.

Why does one of the only politicians truly representing a populist desire need to grovel, beg, and holler to be included in the Kennedy-Obama closed-door meetings?

One reason may be that men like Max Baucus are permitted to aid in health care reform. Baucus is a human version of a NASCAR race car except all his corporate logos advertise pharmaceutical companies. Great Falls Tribute reports that Baucus “received more campaign contributions from the pharmaceutical and health insurance industries than any other sitting Democrat in the House or Senate, receiving $183,750 from health insurance companies and $229,020 from drug companies during that period.” It’s self-explanatory why a man who makes a living sucking from the teat of private health care wouldn’t be the most enthusiastic advocate of single-payer representatives being included in negotiations.

Others, like President Obama argue that the single-payer option isn’t (his favorite word) “pragmatic.”

“If I were starting a system from scratch, then I think that the idea of moving towards a single-payer system could very well make sense…We don’t want a huge disruption as we go into health care reform where suddenly we’re trying to completely reinvent one-sixth of the economy.”

But now is precisely the moment when the system needs to be reinvented and purged of pharmaceutical and health insurance lobbyists. America’s health care system is already a global embarrassment. The World Health Organization (WHO) reports the U.S. health care system rates 37th in the world in terms of quality and fairness. WHO Director-General Dr. Gro Harlem Brundtland says: “The main message from this report is that the health and well- being of people around the world depend critically on the performance of the health systems that serve them. Yet there is wide variation in performance, even among countries with similar levels of income and health expenditure. It is essential for decision- makers to understand the underlying reasons so that system performance, and hence the health of populations, can be improved.”

Dr. Julio Frenk, Executive Director for Evidence and Information for Policy at WHO says: “It is especially beneficial to make sure that as large a percentage as possible of the poorest people in each country can get insurance…Insurance protects people against the catastrophic effects of poor health. What we are seeing is that in many countries, the poor pay a higher percentage of their income on health care than the rich.”

The message seems lost on the US government. Secret meetings with healthcare lobbyists, a 600+ page, dense bill offered without a summary cover page, killing the popular single-payer option? Kennedy’s bill appears to be extremely undemocratic.

President Obama has promised to bring his message to the people soon. Starting in the Midwest, he’ll try to convince the American people that his public-private hybrid health care is best for the nation. The single-payer option seems to already be a thing of the past. Instead of listening to what the majority of Americans want, Obama and associates are trying to convince the American people that a partially privatized system is best for them. This is the opposite of democracy. It’s a privatized health care propaganda tour.

Cross-posted from Allison Kilkenny’s blog, this article ran under the title “Density and Secrecy Will Defeat Democracy in Kennedy’s Health Care Bill” on Huffington Post

http://www.huffingtonpost.com/allison-kilkenny/density-and-secrecy-will_b_214292.html

Obama’s Privatized Health Care Propaganda Tour.

Public’s Favorite Option, Single Payer, Wasn’t on Baucus or Kennedy’s

Allison Kilkenny
The Huffington Post, June 11, 2009 

The public finally got a look at Senator Kennedy’s behemoth 615-page health care bill, a document so gargantuan that Huffington Post put out an SOS to readers to help the editors read it. During the lead-up to the health care war, Kennedy promised Americans that the conversation about their health industry would be a national one, unlike the debacle the first time when the Clintons tried to take on private health care. No more secrecy, Teddy promised. Except, this time the negotiations are — once again — happening behind closed doors, and the public’s favorite option, single-payer, isn’t represented at the table.

Kennedy has depicted this secret operation as essential to negotiations, but the popular single-payer option has been almost entirely shut out of the debate (59% of Americans believe the government should provide national health insurance). Meanwhile, according to The New York Times, lobbyists from “AARP, Aetna, the A.F.L.-C.I.O., the American Cancer Society, the American Medical Association, America’s Health Insurance Plans, the Business Roundtable, Easter Seals, the National Federation of Independent Business, the Pharmaceutical Research and Manufacturers of America, and the United States Chamber of Commerce,” are all present at the Kennedy meetings.

You’d think single-payer advocate House Judiciary Chair John Conyers has the plague these days from the way his associates on the hill are dodging him. Conyers has been criticizing his fellow politicians for sabotaging the single-payer option.

“There is some notion that universal single-payer healthcare is off the table. Well, that raises a very important question. If you take the most popular healthcare reform measure and take it off the table, heaven knows what it is, I guess, you think you’re left with. This is the most popular form, and it would be very unlike the party in the majority now to determine that the most popular system would not even be examined. I am asking for a hearing in every committee, every committee, and if they will let us into the Senate, as well.”

Conyers, who — once again represents what the majority of Americans actually want — has been forced to chase the back of the health care bus like a crazed dog ever since March when he was not invited to President Obama’s Health Care Summit. Ultimately, Obama invited him when Conyers threatened to take his case to the president himself.

Why does one of the only politicians truly representing a populist desire need to grovel, beg, and holler to be included in the Kennedy-Obama closed-door meetings?

One reason may be that men like Max Baucus are permitted to aid in health care reform. Baucus is a human version of a NASCAR race car except all his corporate logos advertise pharmaceutical companies. Great Falls Tribute reports that Baucus “received more campaign contributions from the pharmaceutical and health insurance industries than any other sitting Democrat in the House or Senate, receiving $183,750 from health insurance companies and $229,020 from drug companies during that period.” It’s self-explanatory why a man who makes a living sucking from the teat of private health care wouldn’t be the most enthusiastic advocate of single-payer representatives being included in negotiations.

Others, like President Obama argue that the single-payer option isn’t (his favorite word) “pragmatic.”

“If I were starting a system from scratch, then I think that the idea of moving towards a single-payer system could very well make sense…We don’t want a huge disruption as we go into health care reform where suddenly we’re trying to completely reinvent one-sixth of the economy.”

But now is precisely the moment when the system needs to be reinvented and purged of pharmaceutical and health insurance lobbyists. America’s health care system is already a global embarrassment. The World Health Organization (WHO) reports the U.S. health care system rates 37th in the world in terms of quality and fairness. WHO Director-General Dr. Gro Harlem Brundtland says: “The main message from this report is that the health and well- being of people around the world depend critically on the performance of the health systems that serve them. Yet there is wide variation in performance, even among countries with similar levels of income and health expenditure. It is essential for decision- makers to understand the underlying reasons so that system performance, and hence the health of populations, can be improved.”

Dr. Julio Frenk, Executive Director for Evidence and Information for Policy at WHO says: “It is especially beneficial to make sure that as large a percentage as possible of the poorest people in each country can get insurance…Insurance protects people against the catastrophic effects of poor health. What we are seeing is that in many countries, the poor pay a higher percentage of their income on health care than the rich.”

The message seems lost on the US government. Secret meetings with healthcare lobbyists, a 600+ page, dense bill offered without a summary cover page, killing the popular single-payer option? Kennedy’s bill appears to be extremely undemocratic.

President Obama has promised to bring his message to the people soon. Starting in the Midwest, he’ll try to convince the American people that his public-private hybrid health care is best for the nation. The single-payer option seems to already be a thing of the past. Instead of listening to what the majority of Americans want, Obama and associates are trying to convince the American people that a partially privatized system is best for them. This is the opposite of democracy. It’s a privatized health care propaganda tour.

Cross-posted from Allison Kilkenny’s blog, this article ran under the title “Density and Secrecy Will Defeat Democracy in Kennedy’s Health Care Bill” on Huffington Post

http://www.huffingtonpost.com/allison-kilkenny/density-and-secrecy-will_b_214292.html

CBO report on premiums

An Analysis of Health Insurance Premiums Under the Patient Protection and Affordable Care Act

Congressional Budget Office
November 30, 2009
The analysis looks separately at the effects on premiums for coverage purchased individually, coverage purchased by small employers, and coverage provided by large employers.
Nongroup Policies
Average premiums per policy in the nongroup market in 2016 would be roughly $5,800 for single policies and $15,200 for family policies under the proposal, compared with roughly $5,500 for single policies and $13,100 for family policies under current law.
The majority of nongroup enrollees (about 57 percent) would receive subsidies via the new insurance exchanges, and those subsidies, on average, would cover nearly two-thirds of the total premium, CBO and JCT estimate.
Employment-Based Coverage
By CBO and JCT’s estimate, the average premium per policy in the small group market would be in the vicinity of $7,800 for single policies and $19,200 for family policies under the proposal, compared with about $7,800 and $19,300 under current law. In the large group market, average premiums would be roughly $7,300 for single policies and $20,100 for family policies under the proposal, compared with about $7,400 and $20,300 under current law.
Those figures do not include the effects of the small business tax credit on the cost of purchasing insurance. A relatively small share (about 12 percent) of people with coverage in the small group market would benefit from that credit in 2016. For those people, the cost of insurance under the proposal would be about 8 percent to 11 percent lower, on average, compared with that cost under current law.
http://www.cbo.gov/ftpdocs/107xx/doc10781/11-30-Premiums.pdf

For most individuals and families, the Senate health care reform bill will have very little impact on the premiums to be paid for health plans. There are three important exceptions:
* Premiums in the individual market will increase significantly because the plans will be required to provide an actuarial value of 60 percent, higher than the average value in the current individual market.
* About 57 percent of individuals eligible for coverage in the exchange will receive subsidies which will more than offset the premium increases. Note that most individuals are not eligible for coverage in the exchange and would not receive these subsidies.
* Although there will be little change in premiums for small group plans, about 12 percent of people in the small group market will benefit from a small business tax credit designed to encourage small business owners to offer coverage to their employees.
The really bad news in this report is that, on average, premiums for group plans will continue to increase at the same intolerable rates that they would have if we did nothing. This CBO analysis demonstrates that, in 2016, the family premium alone for employer-sponsored coverage, not including deductibles and other out-of-pocket costs, would be over $20,000 for a large group plan, whether or not the proposed legislation is enacted. That is quite a hit for a hard-working family with a $60,000 income.
The only hope for premium relief is for innovative insurance products that would reduce costs for those who don’t need health care, but would increase even more the costs for those who do. This demonstrates why focusing on premium relief has been a misguided endeavor. We have been diverted from the the much more important goal of relieving the financial burden of those who actually need health care.
We can achieve that goal by improving Medicare, funding it equitably, and using its monopsonistic powers to provide us with greater value in our health care purchasing. Had we done that when the Clintons were proposing their flawed model of reform, our national health expenditures would be about 20 percent less than they currently are.
It’s tragic that we would be starting from an inflated baseline, but we can still achieve that level of efficiency in the future if we dumped the highly flawed proposal before Congress and adopted the much more humane system of an improved Medicare for all.

Aetna to dump 600,000 members

Aetna prepares for loss of 600,000 members as it raises 2010 prices

By Emily Berry
American Medical News
November 30, 2009

Back when it was the largest private health plan in the country, Aetna downsized its membership by millions but boosted profits during an overhaul of its business several years ago.

Now it looks to be making a similar — but smaller — move with a planned price increase for many of its customers in 2010.

The company figures it will lose between 600,000 and 650,000 members next year because of the price hikes.

In a conference call with investment analysts to discuss the company’s third-quarter earnings, Chair and CEO Ron Williams told analysts, “The pricing we put in place for 2009 turned out to not really be what we needed to achieve the results and margins that we had historically been delivering.”

Aetna President Mark Bertolini laid out how the company planned to raise prices to improve the company’s profit margin. He said the firm had “implemented a combination of underwriting enhancements, pricing actions and plan design changes, intended to ensure that each customer is priced to an appropriate margin.”

Laying out specific expected membership losses is “pretty candid,” said David Gibbs, a retired health insurance industry consultant from San Luis Obispo, Calif. He worked for and consulted with health insurers, including Aetna, for 25 years.

He said Aetna’s decision comes from a system that encourages insurers to drive away sicker members — a strategy not unique to one insurer. “They’re running a business, and their obligation is a very singular one: to increase shareholder profits.”

Gibbs said simply raising prices probably would not get Aetna what it wants. That actually tends to result in sick people who are more “desperate” for coverage to keep it, and healthier groups to drop it. Instead, Aetna might change benefit designs, scaling back prescription drug coverage, for example, which sicker populations tend to value but healthier ones don’t notice as much.

http://www.ama-assn.org/amednews/2009/11/30/bisb1130.htm

Comment:

By Don McCanne, MD

This act by Aetna indicates the level of sincerity the insurance industry has in its alleged new effort to cooperate in ensuring that everyone has the health care coverage that they need. Aetna is redesigning and repricing its products in order to dump over 600,000 of its less profitable members. They need to be sure that “each customer is priced to an appropriate margin.” And, above all, they owe it to their shareholders “to drive away sicker members.”

But that’s one of the ways that markets work – improve profits by cutting losses. We keep hearing that markets improve quality while reducing costs, yet in a bit of irony, for those healthier populations that remain with the Aetna, the insurer is reducing quality through product redesign, and increasing costs through higher premiums.

Once Aetna dumps these members, what private insurer is going to jump in to capture this higher cost population? None you say? And under reform? The higher cost individuals buy into the weak public option driving premiums up through adverse selection to even more unaffordable levels?

Try to imagine Medicare dumping over 600,000 patients because they need more medical care. That is unthinkable and would be reprehensible in a public social insurance program such as Medicare. Yet for the private insurance industry, it’s business as usual. And President Obama and Congress want to keep these marketeers in charge? Talk about reprehensible!

Filibustering the Public

Editorial
The Nation, Nov. 24, 2009

This is not what democracy looks like. When Americans vote, by overwhelming majorities, to place control of the executive and legislative branches in the hands of a party that has promised fundamental change, they are supposed to get that change. They are not supposed to watch as a handful of self-interested and special-interested senators prevent progress by exploiting the arcane rules of the less representative of our two legislative chambers–rules requiring that not a majority but a supermajority be attained in order even to discuss necessary reforms, and that a similar supermajority be in place to thwart a filibuster.

Yet this is where America, a nation often inclined to tell other nations how to practice democracy, finds itself as the debate about healthcare reform reaches its critical stage. We have a president who is prepared to sign legislation to expand access to healthcare while establishing at least some controls against profiteering by insurers. We have a House of Representatives in which a majority has voted for imperfect but real reform. We have a Senate in which a majority is ready to vote for what could be even better reform. Unfortunately, that majority is sidelined as a few wavering senators game the system.

Unless Harry Reid and his colleagues implement majority rule–by abolishing rules that allow two-fifths of the chamber’s members (as few as forty-one senators) to prevent passage of that legislation–the character and quality of any “reform” will be dictated by a tiny minority from some of the nation’s least populous states.

The Nation has argued for years that the filibuster is antidemocratic. We long ago rejected the notion that rules preventing the majority of senators from implementing the will of the people must be maintained as a bow to tradition. The filibuster is not constitutionally mandated. It was established by rules that have been repeatedly altered over the years. Besides, as Thomas Geoghegan recently noted (see “The Case for Busting the Filibuster,” August 31/September 7), the proper reply to the history buffs is, “Yes, well, slavery and segregation are also part of our history, and that’s what the filibuster was used to defend. I’m all in favor of history and tradition, but I see no reason to go on cherishing either the filibuster or the Confederate flag.”

The healthcare debate highlights everything that’s wrong with the filibuster. Polling shows that more than 75 percent of Americans favor a public option, yet it could be eliminated–not to gain majority support in the Senate but to gain supermajority support. That’s absurd, and citizens know it. That’s why tens of thousands have signed petitions circulated by the Progressive Change Campaign Committee, Florida Congressman Alan Grayson and Firedoglake demanding alteration of the filibuster rule.

Reid should listen to the outcry. This is about more than healthcare. At stake is the promise of democratic governance and the credibility of Congress. A great lie of politics is that all legislators are “bought” by special-interest donors. In fact, most senators are not bought by insurance-industry contributions. Think of Bernie Sanders and Tom Harkin, who have stood so forthrightly for robust reform, and Jay Rockefeller, who battled another senior Democrat, Max Baucus, on behalf of the public option.

But as long as antidemocratic rules remain, the deliberations will be guided not by Sanders, Harkin or Rockefeller but by the likes of Ben Nelson, who from 2003 to 2008 banked more than $600,000 in insurance-industry donations, and Blanche Lincoln, another collector of industry cash, who is so worried about potential 2010 election challenges that she cannot think straight. Nelson and Lincoln are not holding out for a better deal for their constituents; they are watching out for special interests and perceived political self-interest. And they are not even doing a good job of that, especially Lincoln, who has resisted backing a public option even though polls show a clear majority of her constituents favor this approach. It’s even worse with supposedly moderate Republicans like Olympia Snowe and Susan Collins, who want to be seen as reformers but won’t back real reform.

Compromise with these senators compromises democracy. It warps the will of the people. And it creates bad policy–don’t forget that Reid’s decision earlier this year to cut funding for job creation in the stimulus bill in order to get three GOP votes limited the government’s ability to address rising unemployment.

Reid should take a stand for majority rule. He has decided against the budget reconciliation process, which would allow a simple majority to pass legislation with a robust public option. That’s understandable, as this procedure is arduous. But that decision must not become an excuse for making the compromises demanded by a corrupt or self-absorbed minority. No matter where the healthcare debate takes us, Reid and Senate Democrats should commit to getting rid of rules that stifle debate and prevent action, and they should eliminate the filibuster and implement majority rule. That, after all, is what democracy is supposed to look like.

This article appeared in the December 14, 2009 edition of The Nation.

Dr. John Shearer

By Lori A. Carter
Press-Democrat, Santa Rosa, Calif., Nov. 27, 2009

John Shearer, a Petaluma physician for more than 40 years and outspoken advocate for health care, died Nov. 18 only a few weeks after being diagnosed with pancreatic cancer. He was 77.

Services are pending.

Shearer began his career making house calls to patients, providing obstetric care and delivering hundreds of babies to Petaluma mothers.

Over the past two decades, he became concerned with the number of residents who were either denied medical coverage or couldn’t afford it, said his wife of 32 years, Donna Brasset Shearer of Petaluma.

“He actually had been working on health care reform for almost 20 years,” she said. “He was really a pioneer. Before and after he retired, he never stopped working for health care reform. He was always speaking at conferences and working on panels.

“In his practice, he knew many people who couldn’t afford health care and he saw them suffer. He saw quite a few tragedies because of people’s lack of coverage. It became personal for him.”

Shearer retired earlier than he could have after becoming disillusioned by the insurance industry’s control over medical care, she said.

Shearer was born in Kokomo, Ind., and later moved to Detroit with his family, where he met his first wife, Mary Diedrich, in 1955. Shearer earned his medical degree in family practice in 1962 from Wayne State University, where he graduated among the top in his class in medical school.

Two years later, he moved to Petaluma and joined the El Rose Medical Group with three other physicians. He served as president of the medical staffs of Hillcrest Hospital in 1974 and at Petaluma Valley Hospital in 1986-87. He was the chair of the Ethics Committee at Petaluma Valley for several years until 2005.

He served on a variety of local health care boards, including the California Physician’s Alliance, a chapter of Physicians for a National Health Program, an organization that advocates for a single-payer, national health insurance.

He also worked locally for children’s health care. He helped create the Children’s Healthcare Access Coalition, which led to a program that provides health insurance for every child in Sonoma County.

He also volunteered his medical services at the Jewish Community Free Clinic in Rohnert Park, serving as its medical director for two years.

“Beyond being thoroughly kind and warm-hearted, he was also the least judgmental, least critical person I’ve ever known,” his wife said. “My life with him was a song.”

As the cancer worsened, Shearer became philosophical about the end of life.

“He said he was the luckiest person, he was surrounded by people he loved and who loved him,” she said. “He had a sense of accomplishment about his life. He was happy that he did it the way he wanted to.”

As recently as a month ago, he was walking 18 to 20 miles a week, she said. He died in the hospital, surrounded by his wife and family.

In addition to his wife, he is survived by his daughter, Annette Moussa of Petaluma; son David Shearer of Gig Harbor, Wash.; sisters Marianna Shearer of Woodland and Linda Rook of Arizona; and three grandchildren.

In lieu of flowers, the family prefers written reminiscences that can be sent to dosdocs2@hotmail.com or a donation to California Physicians Alliance, 2344 Sixth St., Berkeley, CA, 94710.

http://www.pressdemocrat.com/article/20091127/ARTICLES/911279933?Title=Dr-John-Shearer

Single-payer supposition: Medicine should save lives

Letters to the editor
The Oregonian
November 24, 2009

The article “Study: More uninsured die in ER” (Nov. 17) and the accompanying sidebar story on health care reform costs deserve a comment. 

The article states that trauma patients without insurance are 80 percent more likely to die than those with insurance. This follows research that shows, after adjusting for age, sex and race/ethnicity, uninsured adults are at least four times as likely as the insured to report delaying or foregoing needed health services, that cancer patients without insurance are twice as likely to die over a 5-year span than their insured counterparts and that those without insurance have an overall death rate higher than those who are insured leading to 45,000 deaths a year.

Clearly leaving 15 percent or 50 million people uninsured in our country leads to suffering and death and should be unacceptable in our rich country.

The current federal health reform legislation’s answer is to insure most Americans by mandating citizens buy private insurance. Unfortunately the private insurance industry and its related bureaucracy and administration waste $400 billion a year and leave many millions more underinsured and laden with medical bills.

Furthermore, since there are no effective cost controls in the legislation, we will be unable to subsidize private insurance when premiums rise at 10 percent a year as they have historically.

Eventually, premiums will rise too high and the number of uninsured will rise again or insurance companies will charge lower premiums but skimp on coverage and pass more of our health care costs on to the individual and family. 

The problem of the uninsured and their shamefully worse health outcomes as well as ongoing medical debt and bankruptcy will continue.

The only way to insure everyone while containing costs at the same time is to eliminate private insurance and create a single pool of all Americans — single-payer national health insurance. By enrolling everyone in the same risk pool financed with progressive premium payments to the government, which then pays doctors and hospital bills for everyone, we can offer comprehensive care without co-pays, deductibles and cost shifting to 100 percent of Americans.

As Harvard health care economist and architect of Taiwan’s popular single-payer health care system William Hsiao says, “You can have universal coverage and good quality health care while still managing to control costs. But you have to have a single-payer system to do it.”

DR. PETER MAHR
Southeast Portland

http://blog.oregonlive.com/myoregon/2009/11/single-payer_supposition_medic.html

Aetna to dump 600,000 members

Aetna prepares for loss of 600,000 members as it raises 2010 prices

By Emily Berry
American Medical News
November 30, 2009
Back when it was the largest private health plan in the country, Aetna downsized its membership by millions but boosted profits during an overhaul of its business several years ago.
Now it looks to be making a similar — but smaller — move with a planned price increase for many of its customers in 2010.
The company figures it will lose between 600,000 and 650,000 members next year because of the price hikes.
In a conference call with investment analysts to discuss the company’s third-quarter earnings, Chair and CEO Ron Williams told analysts, “The pricing we put in place for 2009 turned out to not really be what we needed to achieve the results and margins that we had historically been delivering.”
Aetna President Mark Bertolini laid out how the company planned to raise prices to improve the company’s profit margin. He said the firm had “implemented a combination of underwriting enhancements, pricing actions and plan design changes, intended to ensure that each customer is priced to an appropriate margin.”
Laying out specific expected membership losses is “pretty candid,” said David Gibbs, a retired health insurance industry consultant from San Luis Obispo, Calif. He worked for and consulted with health insurers, including Aetna, for 25 years.
He said Aetna’s decision comes from a system that encourages insurers to drive away sicker members — a strategy not unique to one insurer. “They’re running a business, and their obligation is a very singular one: to increase shareholder profits.”
Gibbs said simply raising prices probably would not get Aetna what it wants. That actually tends to result in sick people who are more “desperate” for coverage to keep it, and healthier groups to drop it. Instead, Aetna might change benefit designs, scaling back prescription drug coverage, for example, which sicker populations tend to value but healthier ones don’t notice as much.
http://www.ama-assn.org/amednews/2009/11/30/bisb1130.htm

This act by Aetna indicates the level of sincerity the insurance industry has in its alleged new effort to cooperate in ensuring that everyone has the health care coverage that they need. Aetna is redesigning and repricing its products in order to dump over 600,000 of its less profitable members. They need to be sure that “each customer is priced to an appropriate margin.” And, above all, they owe it to their shareholders “to drive away sicker members.”
But that’s one of the ways that markets work – improve profits by cutting losses. We keep hearing that markets improve quality while reducing costs, yet in a bit of irony, for those healthier populations that remain with the Aetna, the insurer is reducing quality through product redesign, and increasing costs through higher premiums.
Once Aetna dumps these members, what private insurer is going to jump in to capture this higher cost population? None you say? And under reform? The higher cost individuals buy into the weak public option driving premiums up through adverse selection to even more unaffordable levels?
Try to imagine Medicare dumping over 600,000 patients because they need more medical care. That is unthinkable and would be reprehensible in a public social insurance program such as Medicare. Yet for the private insurance industry, it’s business as usual. And President Obama and Congress want to keep these marketeers in charge? Talk about reprehensible!

Labor Bargains for Too Little on Health Care, Gets Even Less

Jane Slaughter
Labor Notes, Nov. 23, 2009

Its been a frustrating year for supporters of single-payer health care reform–Medicare for all. They protested as their proposal, which they call the most comprehensive, humane, and economical solution to the health care mess, was sidelined from the get-go. Their jaws dropped as the Houses health care bill, which subsidizes the insurance industry by forcing almost everyone to buy insurance, with government help, was dubbed socialistand fascist.

And their fight is not over, as the Senate grinds out a plan that may reject a public option, repeat the Houses curtailment of access to abortion, or even tax those who have insurance now.

Single-payer activists are voicing a mix of frustration and pride at having grown and fortified their movement while they worry about possible side-effects down the road.

Jim Savage, a Steelworkers local president at a Sunoco refinery in Philadelphia, said, Youre talking to a depressed guy right now. We thought we elected the right people last year. We knocked on doors, made the phone calls, donated moneyand we ended up with a shitty bill.

Will this years outcome feed cynicism in general, Savage asks, and give health care reform a bad name?

Now that its clear the final bill wont even provide much of a public option,single-payer activists are assessing the role labor played in the debate.

LEAD FROM THE MIDDLE?

The forces against single payer were vastthe Obama administration, most of Congress, right-wing media, not to mention the insurance companies. But how could labor have pushed for a better bill this year while positioning the single-payer cause for the next stage of the fight?

The basic problem? I dont think you go into these fights with your compromise position as your opening position,said Tom Leedham, a Teamsters local president who sits with Savage on the steering committee of the Labor Campaign for Single Payer (LCSP). Leedham said it was a huge setback for single payer to be ruled out of the discussion, leaving Congressional supporters nowhere to compromise from.

Mark Dudzic, who staffs the LCSP, got specific. If labor had mobilized independently around single payer from the beginning and held peoples feet to the fire, it could have restructured the whole discussion. Instead of bailing out the insurance industry we could have ended up with something incremental to move us closer to single payer, like moving Medicare eligibility down to age 55,Dudzic said.

Instead theyve ensconced private insurance at the heart of the system.

FEET TO FIRE

In countless actions throughout the year, single-payer activists inside and outside the labor movement took the fight to the decision-makers.

In Portland, Oregon, Jobs with Justice delivered an oversized $395,000 check to Senator Ron Wyden, what the senator took in in campaign contributions from the medical-industrial complex,explained JwJ director Margaret Butler. Single-payer advocates are looking to set up a free clinic for the uninsuredas close to Wydens office as possible.

In Detroit the JwJ chapter invited Canadian unionists to a forum to explain how single payer works in practice. (The Canadians were appalled at the stories from this side of the border.) In Los Angeles, union members were among those arrested for civil disobedience at Cigna, the health insurance giant, in late October.

And everywhere, union supporters of single payer trained speakers, went to community meetings of all kinds, distributed fact sheets, ran radio ads, met Congressional delegations, and disrupted hearings that excluded single-payer views. Says Leedham, Its the easiest organizing Ive ever done. People totally get it.

Leedhams most effective handout showed when, given current trends, the cost of family health insurance will equal average household income. The two lines on the graph cross in 2025.

WHY DIDNT LABOR LEAD?

But labor didnt lead the single-payer movement. Almost all union headquarters devoted their political capital with members, exhorting them to call their Congress members in favor of a public option or against taxing benefits. Why didnt the official labor movement lead on single payereven as a bargaining chip?

No surprise here: Unions are tied into the Democratic Partyin particular the public worker unions of Teachers (AFT) and AFSCME, the state and local employees.

AFSCME and AFT have enormous influence within the AFL-CIO, and AFSCME and AFT are dependent on Democratic local politicians for much of what they do in collective bargaining and what theyre able to do in new organizing,says one union staffer. So they are held accountable by the Democrats to carry out Democratic policies.And Democrats from the White House to the statehouses made clear that single payer was untouchable.

Add to this the usual acquiescence to realismId love to see single payer but were not going to get it this yearand the desire to be seen as a playerunion lobbyists love being in the room for the briefings.

Some labor leaders may have hoped early on that the public option could be solid enough to form a step toward single payer. Indeed, proponents were buoyed by early estimates that half the working-age population, and their families, would enroll.

AFL-CIO President Rich Trumka said labor wouldnt support a bill without an employer mandate to provide insurance, no taxation of benefits, and a public option. (The Service EmployeesAndy Stern and TeamstersJames Hoffa, on the other hand, said the public option was not a deal-breaker.)

But the wrangling wore on and the House version of a public option was whittled down to 6 million eligible participantsjust 2 percent of the non-Medicare population and far from an effective counterweight to insurance companies.

Unions in turn became wrapped up in the defensive fight around taxing benefits and a symbolic fight around preserving some form of public option,Dudzic says.

Even then, unions had to confront the Obama administration, which wasnt committed to the public option and seemed unconscious of the unpopularity of taxing benefitswhich would hit far more people than just union members.

With no cost controls in place, Leedham warns that the tax floated by the Senate Finance Committee, on family plans costing more than $21,000, will hit most union plans by 2013 or soon after.

Savage is worried about the tax. The Steelworkers spent months in 2008 convincing members to vote for Obama over McCain on that very issue. If the bill ends up taxing health care benefits, I think weve completely lost any credibility with the rank and file,he said.

TAKE IT OFF THE TABLE

Dudzic points out that an implicit goal for labor was to take health care off the bargaining table, because it eats up so much of the available dollars.

That didnt happen, although (assuming these provisions survive negotiations with the Senate), some small progress was made.

The expansion of Medicaid will help low-income workers, including low-income union members. The employer mandate and penalties for employers who dont provide insurance will help equalize costs in partially unionized industries, making union employerscosts not as far out of line.

And a $10 million fund for pre-Medicare retirees was set up, described by the Auto WorkersAlan Reuther as temporarybecause of its small size. It will pick up part of the cost of catastrophic insurance and thus encourage employers not to drop coverage for retirees under 65.

FORWARD OR BACKWARD?

As activists anxiously await the House-Senate compromise, opinions are divided on whether an inadequate bill sets back the cause of health care reform or should be supported for the improvements it does include.

Some say the weak public option will be a flop that makes any public health care look bad. Others will support just about any bill in order to avoid the appearance of a defeat, fearing that to weaken Obama would jeopardize all labors goals, particularly the Employee Free Choice Act.

Savage and others fear the bill will feed the cynicism that already exists about political involvement, recalling union membersanger after President Clinton busted a gut to pass NAFTA in 1993.

Despite piercing disappointment, there is no question that the movement for Medicare for Allhas strengthened in the last year.

We kept the issue in the game throughout the entire discussion,notes Dudzic, because there was a real movement pushing it, not just insiders but people pushing from outside.

What are next steps for the movement?

Many groups will turn to winning single payer in their states, whether or not national lawmakers enact a waiver that would make that easier. (Obamas chief of staff Rahm Emanuel was hyperactive in making sure the Kucinich amendment, which would have allowed such waivers, was killed.)

Geri Jenkins, co-president of the California Nurses Association, says, Single payer may be something we have to push forward on a state level and prove it works before we roll it out nationally.

A major barrier we need to confront is ideological,says Sandy Eaton, a member of the Massachusetts Nurses Association.

We need to say that health care is a right, not a commodity. People are so used to worrying about getting the best benefit you can negotiate over the table rather than thinking, I have a right to it.

Savage says quit relying on elections and put your feet on the street.

The LCSPs Dudzic is optimistic that the experiences of this year will win over more activists to the single-payer cause when public-option advocates realize the public option wont establish health care for all.

LCSP will hold a conference to plan the next years work in Washington March 5-7.

http://labornotes.org/2009/12/labor-bargains-too-little-health-care-and-gets-even-less