PNHP

Ignagni calls for lawmakers (not insurers) to control costs

Ignagni calls for lawmakers (not insurers) to control costs

White House says health-care bills contain cost-cutting remedies

By Shailagh Murray
The Washington Post
November 26, 2009

Critics of the Democratic bills point to cost control as a chief deficiency. Karen Ignagni, president of America’s Health Insurance Plans, said the Senate bill includes only “pilot programs and timid steps” to reform the health-care delivery system, “given the scope of the cost challenge the nation faces.”

Unless lawmakers institute changes across the entire system, Ignagni said in a statement Wednesday, “Health costs will continue to weigh down the economy and place a crushing burden on employers and families.”

http://www.washingtonpost.com/wp-dyn/content/article/2009/11/25/AR2009112503474.html

Comment:

By Don McCanne, MD

AHIP president Karen Ignagni says that unless lawmakers institute changes across the entire system, health care costs will continue to weigh down the economy, placing a crushing burden on employers and families. There could not be a more explicit admission that the private insurance industry is not and never has been capable of controlling our very high health care costs. Yet their administrative excesses along with the administrative burden they place on the delivery system are major sources of waste in our health care system.

We need everyone covered, and we need costs controlled in a system designed to provide us greater value. Neither will occur under the proposal before Congress. Although the private insurance industry can’t do it, an improved Medicare program would be designed specifically to accomplish those goals, and at a much lower administrative cost.

Karen Ignagni says that the lawmakers must institute the necessary changes across the entire system (because the insurers can’t). Let’s join her in demanding that Congress take the actions necessary, and then thank her for her efforts, as we dismiss her superfluous industry from any further obligations to manage our health care dollars.

Ignagni calls for lawmakers (not insurers) to control costs

White House says health-care bills contain cost-cutting remedies

By Shailagh Murray
The Washington Post
November 26, 2009
Critics of the Democratic bills point to cost control as a chief deficiency. Karen Ignagni, president of America’s Health Insurance Plans, said the Senate bill includes only “pilot programs and timid steps” to reform the health-care delivery system, “given the scope of the cost challenge the nation faces.”
Unless lawmakers institute changes across the entire system, Ignagni said in a statement Wednesday, “Health costs will continue to weigh down the economy and place a crushing burden on employers and families.”
http://www.washingtonpost.com/wp-dyn/content/article/2009/11/25/AR2009112503474.html

AHIP president Karen Ignagni says that unless lawmakers institute changes across the entire system, health care costs will continue to weigh down the economy, placing a crushing burden on employers and families. There could not be a more explicit admission that the private insurance industry is not and never has been capable of controlling our very high health care costs. Yet their administrative excesses along with the administrative burden they place on the delivery system are major sources of waste in our health care system.
We need everyone covered, and we need costs controlled in a system designed to provide us greater value. Neither will occur under the proposal before Congress. Although the private insurance industry can’t do it, an improved Medicare program would be designed specifically to accomplish those goals, and at a much lower administrative cost.
Karen Ignagni says that the lawmakers must institute the necessary changes across the entire system (because the insurers can’t). Let’s join her in demanding that Congress take the actions necessary, and then thank her for her efforts, as we dismiss her superfluous industry from any further obligations to manage our health care dollars.

Single-payer health advocate tells Congress: 'Start from scratch'

Statement of Dr. Margaret Flowers on the House and Senate health bills

‘The pending legislation is a turkey,’ physician says, adding lawmakers need to ‘start from scratch with a Medicare-for-All approach’

FOR IMMEDIATE RELEASE       
Nov. 25, 2009    

Contact:
Margaret Flowers, M.D., mdpnhp@gmail.com
Mark Almberg, PNHP, (312) 782-6006, mark@pnhp.org

WASHINGTON – “The current health insurance reform legislation passing through Congress amounts to a massive bailout of the profit-making health industries, which will enrich them and increase their ability to lobby and otherwise influence legislators in the future,” said Dr. Margaret Flowers, a pediatrician and Congressional Fellow for the 17,000-member Physicians for a National Health Program, today.

“At the same time, patients will receive little in the way of long-lasting protection or ability to afford needed health care,” she said. “The legislation is designed to fail. In the meantime, it will waste billions of dollars and delay the process of creating effective health reform.

“We at Physicians for a National Health Program call on Congress to start from scratch. Improving and expanding Medicare to all people would save over $400 billion annually on insurance overhead and bureaucracy, enough to cover all 47 million uninsured Americans. It is the simplest and quickest way to achieve our goal of universal and financially sustainable health care.

“The pending legislation is a turkey,” she said. “It closely resembles health reforms that have already been tried and have failed at the state level.”

Flowers cited 10 additional reasons why the draft legislation “is not the reform America needs on this Thanksgiving eve”:

1. During the time that it will take for the health insurance legislation to begin (2013 in the House version and 2014 in the Senate version), tens if not hundreds of thousands of Americans will die.

2. Once the insurance reform takes effect, people will still be left without health insurance. Whether it is the 17 million left out of the House version or the 24 million left out of the Senate version, we find this unacceptable. We know that the actual number of uninsured people is likely to be higher than these estimates and we know that people without insurance have a 40 percent higher risk of death than those who have insurance.

3. Medical bankruptcies will continue to occur as families will face out-of-pocket costs on covered services of up to $10,000 in addition to the cost of premiums and the cost of uncovered services. The average medical debt that causes insured families to become bankrupt is $18,000.

4. People who are uninsured will suffer the further indignity of being forced to pay a fine which may be as high as 2.5 percent of their income (House version).

5. The number of people who are underinsured will increase with this legislation. People will be required to purchase health insurance or face a penalty. There is no guarantee that premiums will be affordable even for those who qualify for federal subsidies. Health insurers have already predicted that the cost of premiums will rise because they are being required to stop the practices of excluding pre-existing conditions and rescissions. The public insurance is estimated to be more expensive than private insurance plans. A similar reform in Massachusetts has resulted in a rise of patients who forgo needed care because they cannot afford the co-pays and deductibles once they have paid for their premiums.

6. People will continue to be consigned to only receiving the quality of care that they can afford. Instead of a standardized benefit plan that covers all necessary care, people will have to choose from a tiered set of plans. The least expensive plans will cover only 60 percent of necessary care and patients will be required to pay the balance.

7. The legislation will not control health care costs and will in fact increase the waste in health care spending. The regulation of insurance companies, which has failed to date and is predicted to fail again by industry whistleblowers, will be expensive to enforce. And the “exchanges” will have to be created from scratch. The exchange will add another level of bureaucracy which in Massachusetts has added a 4 percent charge to each insurance premium. Unfortunately, this legislation does nothing to reclaim the hundreds of billions of dollars that are currently wasted on administration, paperwork and marketing for the hundreds of health plans in existence.

8. The legislation transfers hundreds of billions of public dollars to private insurance companies. People will be mandated to purchase health insurance whether they can afford it or not, so the insurance companies benefit by having millions of new enrollees. In addition, between $447 billion and $605 billion in public dollars (depending on the Senate or House version) will be given to the private insurers in the forms of subsidies to help people purchase their defective product.

9. The legislation protects the outrageous profits of the pharmaceutical corporations. The majority of Americans will not see any improvement in the costs of medications and the pharmaceutical corporations have already raised prices on brand name prescriptions by 9 percent this year. Biotech firms receive a windfall 12-year patent on new pharmaceuticals.

10. The legislation continues to allow discrimination based on age and immigration status. Older enrollees can be charged up to twice as much as younger enrollees. And enrollees will be required to prove citizenship in order to receive subsidies. Non-citizens will be required to bear the full cost of purchasing insurance.

“We urge support for Senator Bernie Sanders’ single-payer, Medicare-for-All bill, S. 703, as a replacement for the current Senate bill,” stated Flowers. “We urge people who support real health care reform to join with us in this movement.”

****

Dr. Margaret Flowers is a Maryland pediatrician with experience as a hospitalist at a rural hospital and in private practice. She is currently the Congressional Fellow of Physicians for a National Health Program. In addition to her activity with PNHP, she is a board member of Healthcare-Now! Flowers obtained her medical degree from the University of Maryland School of Medicine and did her residency at Johns Hopkins Hospital in Baltimore.

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

Single Payer Advocates Address Deep Flaws in Democratic Health Bill

By Kevin Gosztol
Op-ed News, November 25, 2009

On the day before Thanksgiving, members of single payer advocacy organizations gathered for a press conference to voice strong concerns with a Democratic health bill that they feel fails to address the biggest problems with health care in America.

Dr. Carol Paris and Dr. Margaret Flowers of Physicians for a National Health Program(PNHP), Kevin Zeese of Prosperity Agenda, and Russell Mokhiber of Single Payer Action were all present for the press conference in the National Press Club in Washington, D.C. at 10 am ET.

All four were members of the Baucus Eight that were arrested for confronting senators anddisrupting a Senate hearingafter Sen. Max Baucus and other senators took single payer off the table.

Dr. Paris said the Democratic bill makes the mistake of “keeping the biggest problem, which is the waste of the private insurance industry” a part of the health reform solution being proposed by Congress.

According to Russell Mokhiber, “It’s unfair to call this health reform. This is an insurance industry and pharmaceutical industry bailout.”

Dr. Flowers said, “It’s designed to fail. If our goal for this country is to provide healthcare for every person in a way that is financially sustainable and have it be both universal and cost-efficient, this is not the way to do it.”

Like many advocates for single payer, Dr. Flowers is bothered by how much the insurance industry has influenced the health insurance enrichment bill and how the legislation will “further enrich and empower the health insurance industry by mandating that people purchase their products by usinghundreds of billions of federal dollars to subsidize the purchase of private insurance.”

Single payer advocates do not want to make the perfect the enemy of the good but because the Democratic bill currently mandates that people purchase a defective product—private insurance—compromise, for many advocates, is unjustifiable.

“By forcing people at the point of increased taxes and threat of incarceration to buy a product that’s defective, first, it’s an amazing first in our history, but second, it really undermines the good in this bill because it empowers the cause of health care problems,” said Zeese.

Zeese added “to mandate [that] people buy health insurance under threat” of fines that are up to 2.5% of their income or to threaten criminal punishment is unconscionable especially since none of the basic problems of health insurance would be fixed with this bill.

The single-payer movement believes millions will still be uninsured, the underinsured will still face medical bankruptcy, and massive waste, fraud, and abuse that occurs as a result of the private health insurance industry will continue.

So, some members of the single payer movement are calling on progressive Democrats in Congress to start from scratch and expand Medicare to cover all Americans as an end result goal.

“The system’s not going to work with these kinds of for-profit health insurance companies in the game,” said Mokhiber. “Single Payer Action istrying to peel off a number of members in the House and Senate to vote with them and use [defeating the bill] as a teaching moment.”

Mokhiber is largely critical of progressive Democrats who claimed to support single-payer yet refused to defend or fight for it. In contrast, he says, Blue Dog Democrats have been willing to draw lines in the sand and make people pay attention. And, that’s what progressives need to do instead.

Those participating in the conference that wish to see this bill defeated so that Congress can start from scratch, do not feel that Americans will have to wait another decade for another opportunity for reform to come back around.

Zeese argued that’s wrong because the healthcare crisis has become a government crisis and it has become a primary cause of deficit and debt at the state and federal level.

And, Mokhiber said having single payer activists kill this is “the best way” to do reform and activists should defeat the legislation and make it clear they are doing it so single payer can continue to be possible.

Advocates like Mokhiber and Zeese differentiate themselves from Republicans who simply wish to kill the bill and ensure that not even piecemeal steps toward reform health care are taken.

They make it clear that if Democrats went back to the drawing board they would be there, as they have been since the beginning, advocating for an “everybody in, nobody out” single payer not-for-profit health care system.

Having been a psychiatrist for twenty years, Dr. Paris communicated the need to get this right now and not later.

“There’s this anxiety and stress that’s created by our inability, by the inability of average citizens to access healthcare,” said Dr. Paris. “It’s not bad enough that you’ve got an anxiety disorder or depression or schizophrenia. But then add to it the stress of not knowing how you’re going to pay for your medication, not knowing how you’re going to afford therapy to see a psychiatrist is just adding insult to injury.”

Dr. Flowers is convinced that “we can do much better than this.”

“We have the resources to provide healthcare to every person in this country and to improve our health outcome to be en par the top industrial nation,” said Dr. Flowers. “And there’s no reason why we shouldn’t be going in that direction.”

http://www.opednews.com/articles/Single-Payer-Advocates-Add-by-Kevin-Gosztola-091125-983.html

Insurance Industry Antitrust Fight Headed To Conference Committee

Ryan Grim
Huffington Post, 11-24-09

The insurance industry successfully fought off a Senate threat to revoke its antitrust exemption as part of health care reform, but the issue lives to fight one more battle in the conference committee negotiations that will take place between the two chambers.

The issue surfaced in mid-October, shortly after the industry lobby, America’s Health Insurance Plans (AHIP), pushed hard against the Democratic health care reform effort, claiming it would significantly raise premiums.

Senate Majority Leader Harry Reid (D-Nev.) responded by saying the industry should lose its cherished antitrust exemption — implemented some 60 years ago by the McCarran-Ferguson Act — and be forced to compete under the same rules as any other enterprise.

“Insurance companies have become so large they dominate entire regions of the country,” he said. “They have become so powerful they block start-up businesses from entering the market, and they put smaller companies out of business. They have become so dominant that they dictate business practices. They are so influential that they exert tremendous influence over public policy.”

House Speaker Nancy Pelosi (D-Calif.) seconded Reid the next day, twisting the knife and adding that “it is well known to the public that the health insurance companies are the problem.” The following day Judiciary Committee Chairman John Conyers announced a hearing and a committee vote on revoking the exemption. It passed and was included in the House health care bill that passed two weeks ago.

The insurers recognized the politics at work and strongly voiced their opposition to the provision. “Health insurance is one of the most regulated industries in America at both the federal and state level. McCarran-Ferguson has nothing to do with competition in the health insurance market. The focus on this issue is a political ploy designed to distract attention away from the real issue of rising health care costs,” AHIP spokesman Robert Zirkelbach told HuffPost.

A week before House passage, HuffPost reported that Reid decided not to include the repeal of the exemption but to go for it as a floor amendment instead. The move was seen as a sop to Nebraska Democrat Ben Nelson, an industry backer who had yet to offer his support for Reid’s motion to proceed and who is a strong public supporter of keeping the antitrust exemption in place.

Asked by HuffPost if he had asked Reid to drop the measure in exchange for his vote, Nelson demurred. “That would come as a surprise to Harry Reid,” he said of multiple reports that he had pushed for it to be left out.

But there’s more than one way to push in the Senate and, regardless of whether Nelson raised the issue with Reid, even the Capitol cafeteria workers were aware of Nelson’s strong position.

Nelson argues that repealing the exemption wouldn’t hurt the big insurers because they’re already so big they don’t need to collude with each other. Repealing it, he argues, would only hurt the little guys.

But there are very few little guys left: one or two big insurers are dominant in almost every region of the country.

Nelson, now that he has voted to move the bill forward, is still threatening to filibuster a final bill if he finds it objectionable. Nelson and others want the public health insurance option stripped from the Senate bill, but if it goes to conference too friendly to the industry, the antitrust repeal is likely to be in the bill that comes back. For the industry, it’s pick your poison.

Jonathan Gruber on affordability

For Public, Affordability A Key Issue In Health Bill

By Julie Rovner
NPR
November 24, 2009

Lawmakers debating health care on Capitol Hill have spent months worrying about the potential cost. But mostly it’s been the total cost of the bill, not how much individual families who could soon be required to buy insurance for the first time might have to pay.

That could be a costly miscalculation, says health economist Jonathan Gruber of the Massachusetts Institute of Technology. “Let’s put it this way: It is 10 times as important as the public option and has received one one-hundredth of the coverage,” he says.

Gruber says economists have different ways of defining exactly what is and is not affordable for people. One way is by looking at disposable income, or whether people have money left over after paying for other necessities. “We think no one should have to go without food or shelter to have health insurance,” he says.

Another test is whether people would buy something voluntarily. “And if they would then clearly it’s affordable,” Gruber says.

But there’s also a third test — and it’s that affordability is in the eye of the beholder. And for a lot of beholders in the real world, health insurance costs are quickly becoming unaffordable.

(Under the proposed legislation) no family would have to spend more than 10 percent of its income on health insurance premiums; poor families wouldn’t have to spend more than 2 percent on premiums.

But premiums are only the start of what people spend on health insurance. There are also deductibles, copayments and other out-of-pocket costs. And Gruber says that when it comes to that sort of spending, the House bill is far more generous than the Senate bill.

For example, someone making two times the poverty level, or about $22,000 a year, in the House bill would get “something like a $500 deductible plan,” he says. “On the other hand in that same range in the Senate … now we’re talking a $2,500 deductible plan.”

Gruber says he’s a “big believer” in the concept that people should pay more for their health care so they’ll know what it really costs and have an incentive to save money. “I’m a believer in consumer skin in the game,” he says. “But a $2,500 deductible is a lot to ask for someone making $22,000 a year.”

And it brings Gruber to the ultimate test of affordability, which he says is a political test — “which is, do people revolt if you say, ‘I’m going to mandate you to pay this much’?”

http://www.npr.org/templates/story/story.php?storyId=120723411

And…

A Milestone in the Health Care Journey

By Ronald Brownstein
The Atlantic
November 21, 2009

When I reached Jonathan Gruber on Thursday, he was working his way, page by laborious page, through the mammoth health care bill Senate Majority Leader Harry Reid had unveiled just a few hours earlier. Gruber is a leading health economist at the Massachusetts Institute of Technology who is consulted by politicians in both parties. He was one of almost two dozen top economists who sent President Obama a letter earlier this month insisting that reform won’t succeed unless it “bends the curve” in the long-term growth of health care costs. And, on that front, Gruber likes what he sees in the Reid proposal. Actually he likes it a lot.

“I’m sort of a known skeptic on this stuff,” Gruber told me. “My summary is it’s really hard to figure out how to bend the cost curve, but I can’t think of a thing to try that they didn’t try. They really make the best effort anyone has ever made. Everything is in here….I can’t think of anything I’d do that they are not doing in the bill. You couldn’t have done better than they are doing.”

http://politics.theatlantic.com/2009/11/a_milestone_in_the_health_care_journey.php

Comment

By Don McCanne, MD

Regular readers of these messages are no doubt saturated with the concerns expressed about affordability of health care for individuals and families. For those who have or will have health care needs, even with subsidies, the premiums, deductibles, other cost sharing, out-of-network costs, and the costs of services that are not a benefit of the plans will be unaffordable for all but the relatively wealthy.

Today’s message is significant because MIT economist Jonathan Gruber, one of the most influential proponents of the current legislation, also understands that the issue of affordability has not received the attention it deserves. As he points out, a $2,500 deductible is a lot to ask of an individual making $22,000 a year. He wants them to have “skin in the game,” but even he understands that you can’t ask for their entire hide.

So how would he suggest that we reduce out-of-pocket costs so that health care is affordable? It appears that he would use the measures in the Senate bill to bend the cost curve so excessive costs allegedly aren’t passed on to patients. It seems to matter little to him that the CBO was unable to project a bend in the curve when it did its analysis.

Of course, Gruber is also an advocate of “let’s pass this bill now and then we can fix it later on” – a tacit acknowledgment that affordability will remain a crucial issue.

Gruber says that he can’t think of anything more to do that isn’t in the Senate bill. But you readers know better. We need to dump this plan and  immediately go to work on one that will make health care affordable for everyone – an equitably-financed, single payer, improved Medicare for all. Do really we need to wait for Gruber’s ultimate test for affordability – a revolt?

The National Health Program Reader – Index

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Section I:  PNHP Proposals, Slideshow & Fact Sheets on Single Payer National Health Insurance

 

Key Features of Single payer

Summary of Proposal/Background Fact Sheet

Frequently Asked Questions

Working Group Proposal (JAMA, 2003)

Quality Proposal/Fact sheet on how single payer improves Quality

Long-term Care Proposal

Fact Sheet: How Much Would Single Payer Cost

Fact Sheet: International Health Systems

Fact Sheet: International Comparisons of Health Systems Performance

 

 

Section II:  PNHP Research:  The Evidence-Based Case for Single Payer NHI

 

(Full article(s) and media release reprinted for each point)

 

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

 

Woolhandler, S., Campbell, T., & Himmelstein, D.U. (2003). “Costs of Health Care Administration in the U.S. and Canada.” 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.
                

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

 

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

 

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

 

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.

Woolhandler, S. & Himmelstein, D.U. (2002). “Paying for National Health Insurance – And Not Getting It.” 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.

 

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

 

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

 

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

 

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

Carrasquillo, O., Himmelstein, D.U., Woolhandler, S., & Bor, D.H. (1999). “A Reappraisal of Private Employers’ Role in Providing Health Insurance.” 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.

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

 

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

 

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

 

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

 

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

 

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

 

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

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

 

Tyrance, P.H., Himmelstein, D.U., & Woolhandler, S. (1996). “US Emergency Department Costs: No Emergency.” 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.

Wilper, A., et. al. (2008). “A National Study of Chronic Disease Prevalence and Access to Care in Uninsured U.S. Adults.” 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.

Woolhandler, S., Campbell, T., & Himmelstein, D.U. (2003). “Costs of Health Care Administration in the U.S. and Canada.” N Engl J Med, 349, 768-775. (Refer to full study in Talking Point 1)

 

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

 

“Summary of Fiscal Studies: How Much would Single Payer Cost?” (Refer to Section I)

 

U.S. General Accounting Office. (1991). “Canadian Health Insurance: Lessons for the Unites States.” 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.

 

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

 

Kuttner, R. (2008). “Market-Based Failure – A Second Opinion on U.S. Health Care

Costs.” 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.

 

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

 

Lasser, K., Himmelstein, D.U., & Woolhandler, S. (2006). “Access to Care, Health Status, and Health Disparities in the United States and Canada: Results of a Cross-National Population-Based Survey.” Am J Public Health, 96, 1300-1307. (Refer to full study in Talking Point 4)

 

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

 

Woolhandler, S., Campbell, T., & Himmelstein, D.U. (2003). “Costs of Health Care Administration in the U.S. and Canada.” N Engl J Med, 349, 768-775. (Refer to full study in Talking Point 1)

 

“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).

 

Angell, M. (2008). “Privatizing health care is not the answer: lessons from the United States.” 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.

 

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

 

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

 

Woolhandler, S., Campbell, T., & Himmelstein, D.U. (2003). “Costs of Health Care Administration in the U.S. and Canada.” N Engl J Med, 349, 768-775. (Refer to full study in Talking Point 1)

 

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

 

“How Single-Payer Health System Reform Improves Quality.” PNHP Document (Refer to Section I)

 

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

 

Schiff, G. (2003). “Medical Malpractice. Health Care Quality and Health Care Reform,” 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.

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

 

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

 

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

 

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

 

Rodberg, L. (2008). “The Massachusetts Way?” 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.

 

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

 

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

 

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

 

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

 

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

 

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

 

Roos, N.P., Forget, E., Walld, R., & MacWilliam, L. “Does universal comprehensive insurance encourage unnecessary use? Evidence from Manitoba says ‘no,’” 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.

 

Hellander, I. “International Health Systems for Single Payer Advocates.” (Refer to Section I)

 

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

 

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

 

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

 

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

 

McCanne, D. (2008). “Health care reform must start with a plan to simplify.” 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.

 

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

 

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

 

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

 

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

 

 

Section III:  Becoming an Activist

 

Finding your niche in activism

What PNHP Members Can Do

How to organize a PNHP chapter (it’s easier than you think)

Media Tips

PNHP Chapter Activities (2005-2009)

Right-wing Think Tanks for Beginners

A Brief History of Universal Health Care Efforts in U.S.

The Killer and the Kid

Health Care's Historic Flop

By HELEN REDMOND
Counterpunch, November 23, 2009

I get weekly emails from Levana Layendecker of Health Care for America Now (HCAN) and Mitch Stewart from Organizing for America. In increasingly shrill prose, the two try to convince me to support whatever legislation emerges from Congress. They warn, “IF THE INSURANCE COMPANIES WIN, YOU LOSE.” I agree completely. That is why I won’t support any legislation Congress passes because the insurance companies have already won and we have lost.  

We need only look at the check lists of two of the most powerful people in health care reform to see who is benefiting most from the proposed legislation in Congress.

Karen “Killer” Ignagni, President and CEO of America’s Health Insurance Plans (AHIP) won the following:

  • Still in business making billions of profits for Wall Street investors and CEO’s of insurance companies
  • No cost controls that would decrease profits
  • Mandate giving us at least 30 million new customers and fined if they don’t buy coverage
  • Still able to deny doctor recommended care
  • Still able to increase premiums
  • Kill or weaken public option
  • Investment in 3000 lobbyists and 1.4 million a day paid off 

Then there is Billy “The Kid” Tauzin, President and CEO of the Pharmaceutical Research and Manufacturers of America  (PhRMA.) He was able to check off everything on his list:

  • Get a meeting with President Obama behind closed doors and make a deal to protect PhRMA profits
  • No drug reimportation from Canada or Mexico
  • Extend protections for lucrative biologic drugs
  • No negotiating drug prices for Medicare Part D
  • U.S. drug market continues to be the most profitable

There was even a big, last minute win for the misogynist Catholic Bishops. For thirty years these disgusting, sexist servants of God have fought to restrict access to abortion. Thanks to the betrayal of Nancy Pelosi and Jan Schakowski, the “ardent” defenders of women’s reproductive rights, the no-choice Stupak Amendment passed. The Democrats position on abortion is “safe, legal and rare” and the Stupak Amendment will make abortion rarer still.    

The xenophobes and racists won, too. Millions of undocumented human beings from every corner of the globe who work and pay taxes in the United States are ineligible for Medicaid and subsidies. The message: don’t get sick, but if you do, die quickly and if you don’t, we’ll deport you.

The insurance industry concocted a strategy well in advance of Obama taking office. The crisis they caused could no longer be ignored: 50 million uninsured, millions of medical bankruptcies, employers screaming about rate increases and dropping coverage in record numbers and thousands of health care horror stories in the media. According to Wendell Potter, the former Vice President of Public Relations at Cigna, now a whistleblower, “They [the insurers] knew they had a very big public relations problem, and they knew this day was coming. They knew they had to be perceived as coming to the table with solutions. It was a departure from their previous point of view. But they knew they would be slaughtered if it weren’t.”    

And there they were, just as Potter predicted – the Killer and the Kid, not only at the table, but at all the secret, behind closed-door meetings with the late Ted Kennedy and Max Baucus. Ignagni proclaimed, “We want to play. We want to contribute. We want to help pass health reform legislation this year.” And what a player she is. In an article titled, “Insurers poised to reap benefits from healthcare overhaul” Mark Merritt, a lobbyist, keenly observed, “While so many in this town have been playing checkers, Karen has been playing chess.” Checkmate for AHIP.

Senator Baucus has taken more money from the health and insurance industry than any other member of Congress. Elizabeth Fowler, Baucus’s chief health advisor, is a former VP of public policy for the insurance giant Wellpoint. She “helped” write the Senate bill.

AHIP uses lobbyists and campaign contributions to shape legislation, not to kill or oppose it as HCAN and Organizing for America constantly claim. That’s what the 3000 lobbyists are doing every day in Congress – inserting industry friendly, arcane language and loopholes into unfathomable (except to industry lawyers and actuaries) 2000 page bills which the Democrats support. To be sure, insurers don’t like the public option but it’s so not robust, so eviscerated, so devoid of honesty keeping mechanisms it poses no competition or threat to profits as most political commentators now admit. Similarly, Ignagni wants tougher financial penalties for those who don’t purchase health insurance but it’s not a deal breaker, nor is accepting all patients regardless of health status. The industry has already announced premium increases and the added revenue will underwrite health care for those with “pre-existing” conditions. 

It’s obvious. THE INSURANCE INDUSTRY IS WINNING AND WE ARE LOSING. There is an inconvenient contradiction that both HCAN and Organizing for America attempt to obscure: President Obama and Congressional leaders are working hand in glove with the very corporate criminals both organizations excoriate. AHIP and PhRMA have unfettered access to politicians and a massive influence on health care legislation. Why? Because the Democratic Party, despite its populist image, is a party of big business, of capitalism, not a party of the people. Notwithstanding the occasional howl about “insurance industry abuses” (to hoodwink us into thinking they are curbing those abuses) current legislation entrenches the industry even further into the core of the health care system and is on the brink of handing them unprecedented billions in taxpayer money and a mandate. This is dangerous not only to our health, but to democracy. Once the spigot to billions in public money is open, the industry will oppose attempts to shut it off. The money will flow back into American politics as campaign donations and kickbacks to happy-to-help, pro-industry politicians of which there are no shortage on either side of the aisle.  

THE INSURANCE INDUSTRY IS WINNING AND WE ARE LOSING and anyone who follows the money knows it. Except Levana and Mitch.  

The organizations the two represent are the major purveyors of outright lies, lies of omission and half-truths about health care legislation by asserting the following: health insurance will get better, stable and more secure; health insurance will get cheaper; employers will have to offer good, affordable insurance and not shift additional costs onto you; if you lose your job you will always be able to afford insurance, and expenses will be capped. They assert Medicaid and Medicare benefits won’t be cut.

Here’s an inconvenient, honest-to-god truth: the legislation does nothing to solve the health care crisis. It’s estimated up to twenty million people will still be uninsured. There are no effective cost containment mechanisms in either bill because that would reduce profits. There are no controls on the price of premiums and the House bill permits charging twice as much for older people as for younger ones. More profits. Insurers can continue to deny physician recommended medical care and patient claims. Medical-loss ratio in favor of insurers, million dollar salaries for CEO’s and Wall Street investors untouched. The caps on out-of-pocket expenses are $5000 for individuals and $10,000 for families. These amounts result in medical bankruptcy now. Employers must pay 72.5 percent of premiums for individuals and 65 percent for families. That gives companies who currently pay a higher percentage an incentive to shift costs onto employees then dump them
into the insurance exchange because it will be cheaper. The plans in the exchange will be high deductible, stripped down, tiered plans much like the ones available through the Commonwealth Connecter in Massachusetts. There will be an expansion of Medicaid but the history of the program reveals that just as it expands, it contracts. Eligibility criteria and reimbursement rates for Medicaid change with the fiscal fortunes of the states and federal government. It is truly stunning that health care reform will be paid for with billions in “savings” from the health care program for the elderly; Medicare. Why not use “savings” from the bloated 700 billion dollar military budget? The talk about fraud and waste in the Medicare program is a cover to cut benefits and seniors are right to be angry and mistrustful.

Levana and Mitch are playing chess, too. Their deceit is insidious and not without precedence. HCAN and Organizing for America are following in the footsteps of organizations that are created every time health care reform is attempted. They promote incremental changes to the system and the legislation urgently (health reform can’t wait!) and passionately promoted is not designed to solve the crisis, but rather to guarantee the continued existence and profit-making power of the insurance industry. Moreover, their job is to tamp down expectations for fundamental change, like single-payer, and convince the public the legislation, although not perfect, is the best we can get. It’s still “change we can believe in.”

Any bill that passes will be hailed as historic. It will be historic: historic in the sense that it’s yet another sellout in a long history of sellouts of the American people – bankrupt and broken, still desperate and dying for reform that makes health care a human right and where profit has no place.

Helen Redmond, LCSW, is a medical social worker in Chicago. She can be reached at redmondmadrid@yahoo.com. She blogs at http://helenredmond.wordpress.com

Jonathan Gruber on affordability

For Public, Affordability A Key Issue In Health Bill

By Julie Rovner
NPR
November 24, 2009
Lawmakers debating health care on Capitol Hill have spent months worrying about the potential cost. But mostly it’s been the total cost of the bill, not how much individual families who could soon be required to buy insurance for the first time might have to pay.
That could be a costly miscalculation, says health economist Jonathan Gruber of the Massachusetts Institute of Technology. “Let’s put it this way: It is 10 times as important as the public option and has received one one-hundredth of the coverage,” he says.
Gruber says economists have different ways of defining exactly what is and is not affordable for people. One way is by looking at disposable income, or whether people have money left over after paying for other necessities. “We think no one should have to go without food or shelter to have health insurance,” he says.
Another test is whether people would buy something voluntarily. “And if they would then clearly it’s affordable,” Gruber says.
But there’s also a third test — and it’s that affordability is in the eye of the beholder. And for a lot of beholders in the real world, health insurance costs are quickly becoming unaffordable.
(Under the proposed legislation) no family would have to spend more than 10 percent of its income on health insurance premiums; poor families wouldn’t have to spend more than 2 percent on premiums.
But premiums are only the start of what people spend on health insurance. There are also deductibles, copayments and other out-of-pocket costs. And Gruber says that when it comes to that sort of spending, the House bill is far more generous than the Senate bill.
For example, someone making two times the poverty level, or about $22,000 a year, in the House bill would get “something like a $500 deductible plan,” he says. “On the other hand in that same range in the Senate … now we’re talking a $2,500 deductible plan.”
Gruber says he’s a “big believer” in the concept that people should pay more for their health care so they’ll know what it really costs and have an incentive to save money. “I’m a believer in consumer skin in the game,” he says. “But a $2,500 deductible is a lot to ask for someone making $22,000 a year.”
And it brings Gruber to the ultimate test of affordability, which he says is a political test — “which is, do people revolt if you say, ‘I’m going to mandate you to pay this much’?”
http://www.npr.org/templates/story/story.php?storyId=120723411

And…

A Milestone in the Health Care Journey
By Ronald Brownstein
The Atlantic
November 21, 2009
When I reached Jonathan Gruber on Thursday, he was working his way, page by laborious page, through the mammoth health care bill Senate Majority Leader Harry Reid had unveiled just a few hours earlier. Gruber is a leading health economist at the Massachusetts Institute of Technology who is consulted by politicians in both parties. He was one of almost two dozen top economists who sent President Obama a letter earlier this month insisting that reform won’t succeed unless it “bends the curve” in the long-term growth of health care costs. And, on that front, Gruber likes what he sees in the Reid proposal. Actually he likes it a lot.
“I’m sort of a known skeptic on this stuff,” Gruber told me. “My summary is it’s really hard to figure out how to bend the cost curve, but I can’t think of a thing to try that they didn’t try. They really make the best effort anyone has ever made. Everything is in here….I can’t think of anything I’d do that they are not doing in the bill. You couldn’t have done better than they are doing.”
http://politics.theatlantic.com/2009/11/a_milestone_in_the_health_care_journey.php

Regular readers of these messages are no doubt saturated with the concerns expressed about affordability of health care for individuals and families. For those who have or will have health care needs, even with subsidies, the premiums, deductibles, other cost sharing, out-of-network costs, and the costs of services that are not a benefit of the plans will be unaffordable for all but the relatively wealthy.
Today’s message is significant because MIT economist Jonathan Gruber, one of the most influential proponents of the current legislation, also understands that the issue of affordability has not received the attention it deserves. As he points out, a $2,500 deductible is a lot to ask of an individual making $22,000 a year. He wants them to have “skin in the game,” but even he understands that you can’t ask for their entire hide.
So how would he suggest that we reduce out-of-pocket costs so that health care is affordable? It appears that he would use the measures in the Senate bill to bend the cost curve so excessive costs allegedly aren’t passed on to patients. It seems to matter little to him that the CBO was unable to project a bend in the curve when it did its analysis.
Of course, Gruber is also an advocate of “let’s pass this bill now and then we can fix it later on” – a tacit acknowledgment that affordability will remain a crucial issue.
Gruber says that he can’t think of anything more to do that isn’t in the Senate bill. But you readers know better. We need to dump this plan and immediately go to work on one that will make health care affordable for everyone – an equitably-financed, single payer, improved Medicare for all. Do really we need to wait for Gruber’s ultimate test for affordability – a revolt?

Morbid Symptoms: Current Healthcare Struggles

An interview with Colin Leys

By Greg Albo
http://monthlyreview.org/

Colin Leys lives in London.  He is an emeritus professor of political studies and co-editor of the annual publication, the ‘Socialist Register’.  He is currently active in the fight against the privatization of Britain’s National Health Service.

GA:  Colin, the latest Socialist Register, Morbid Symptoms: Health Under Capitalism, co-edited with Leo Panitch (Monthly Review Press), is gaining great accolades from health activists and practitioners, and from sections of the Left that have not traditionally been focussed on health. How did you and Leo come to focus on this issue as important for a Register audience?  And how does it fit within your personal evolution as a Left intellectual in terms of your long-standing concerns with states and development in the ‘third world’, especially Africa, on the one hand and states and parties in the advanced capitalist world, especially Britain, on the other?

CL: Given the crucial importance of health in people’s lives it struck us that there was a major lack of critical left thinking about it – about how neoliberalism was undermining the health gains of the postwar years, about what was happening to health care as a field of employment, and above all how health care was becoming a massive new field of capital accumulation, with dire implications for population health – and for democracy – everywhere. The best contribution the Register could make, we felt, was to help develop a historical materialist analysis of health under capitalism. Over the last 30 years a handful of progressive health experts, such as Vicente Navarro in the US, and Lesley Doyall and Julian Tudor Hart in the UK, have laid the groundwork for this, but the left in general  has not taken it on board as much as we should have. And the extent to which the mainstream health policy literature fails to confront the neoliberal agenda is frankly shocking. Dependence on government funding for research plays an obvious role there. With some honourable exceptions everything is presented as if the political-economic determinants of ill health are a (regrettable) given. We wanted to break decisively with this pattern, foregrounding the centrality of the capitalist health industry in policy-making, and showing how ruling-class interests are served by it.

And yes, my own previous work in Africa and on development did give me a special interest in the theme. The routine normality of painful illness and early death in the global ‘south’ is so shameful, when we know that it is largely preventable; we also know that no amount of ‘aid’ is going to prevent it under the existing power relations of global capitalism. The determinants of poverty and ill-health, and of the lack of health care for all in the ‘south’, are the same ones that are now driving the restoration of inequality and the dismantling of social protection in the ‘north’. My work on British political economy under Thatcher and Blair took health policy as a test case of the way global market forces were driving domestic policy. What this revealed was a process that has ended in an amazing phenomenon – the British Labour Party, which 60 years ago set an example of universal and comprehensive health care that was followed all over the world – including in Canada – is now busy dismantling the integrated National Health Service and recreating a healthcare market – relying heavily on US advisers and US health multinationals to make it happen.

GA: What are some of the key themes of the new Register?

CL: There are really two core issues. One is the need to focus on the militant campaign that is now being waged by capital – the health insurance industry, the pharmaceutical and biotechnology industry, and big healthcare provider companies – to break up state-funded and provided healthcare systems in every country that has them, and turn them into fields of accumulation. In middle- and high-income countries we are talking of potential markets worth from 7 to 12% of national income or even more. The power of the corporations moving in on public health services is huge, and growing. In Canada and the UK and other advanced capitalist countries they are major actors in the restructuring of states on neoliberal lines that has been pushed through to a greater or lesser extent in all countries over the past 30 years. They are increasingly installed at the heart of government policy-making. Health ministries and departments have been downsized and policy development has been handed over to private sector personnel as consultants, or appointed to government posts, while ministers and career civil servants leave to take lucrative jobs in the private health sector. The boundary between public and private interests is increasingly blurred, especially in relation to health. This is not nearly as well understood as it needs to be.

The second core issue is the fact that health care, important as it is, is not the most important thing: the crucial determinants of health, wherever you live – India, Canada, South Africa, the US, it makes no difference – are good food, good shelter, safety at work and protection against infections, so whether you and your family are healthy or not is above all a matter of equality. The poorest countries have the worst health, and so do the poorest people in all countries, including rich ones. Unless public policy is geared towards equality, even in rich countries most people’s health will remain a lot worse than it should be. But the more neoliberal a government is, the less policy is concerned with equality. In the US and the UK, where inequality has been dramatically increased, it is condemning growing numbers of people to pain, disability and early death. The same is true internationally. As Meri Koivusalo shows in her essay in the volume, effective control over international health policy has been steadily transferred from the World Health Organisation to commercially-oriented and unaccountable organisations such as  the Gates Foundation and the Global Fund to fight AIDS, tuberculosis and malaria, Even the WHO depends on ‘voluntary’ contributions from a range of sources for over four-fifths of its budget, as opposed to its core funding through UN member states. The bulk of health aid is thus increasingly controlled by agencies with links to corporate interests, especially those of big pharma. The WHO’s 1978 commitment to promoting ‘health for all’ via comprehensive primary care has given way to aid targeted at specific diseases largely chosen by these other agencies. The aim of improving people’s health is compromised by the aim of making money.

GA: How have health care and all its associated activities and sectors become integrated into neoliberal capitalism and its global dynamics?  Are there any particular contradictions that this volume of the Register reveals?

CL: There is an objective contradiction between capital’s need for a workforce capable of providing reliable labour-power, and therefore being healthy enough to do so, and the compulsion on individual capitals – on companies – to constantly seek to pay less for it, well below what is needed to keep workers healthy. But this contradiction is less in evidence at present because of the huge pool of labour that is now available in China and India and other countries of the ‘south’; so far global capital has not found itself obliged to help keep this labour force healthy, and it has not.

But there is also an immediate contradiction between health care’s role in making capitalism acceptable to workers – its legitimation function – , and healthcare capital’s drive for profits. An important essay in the volume by Shaoguang Wang shows that
in order to maintain political stability the Chinese government has felt obliged, for the sake of social stability, to give up its market approach to health care and at least aim to restore universal access to health care. Whether western electorates who have come to take universal access to health care for granted will accept seeing it converted back into a commodity, very unequally available, is a question that the left needs to focus on as a matter of urgency. Will people be ready to accept the idea that it is no longer the responsibility of governments to keep everyone well?

GA: It is striking that the volume is coming out in the midst of the U.S. healthcare struggle.  Even as a Bill passes the House it seems it will be blocked and transformed in the Senate. What is your assessment of this struggle and what insights does the new volume bring to it?

CL: Yes, the struggle over healthcare reform in the US it shows just how deeply access to health care goes to the heart of politics today. But it’s also very significant that Obama and many Democrats in Congress felt unable to win what they had previously supported – a ‘single-payer’ (i.e. tax-funded) system, doing away with the grossly inefficient and rapacious health insurance industry. On top of that they then even proved unable to secure their alternative, extremely weak, market-friendly option – a public insurance plan that would compete with the private ones. Only a taxpayer-subsidised adjustment to the existing private sector oligopoly will – perhaps – be allowed to pass. What the story shows above all is just how far the private healthcare industry controls senators and congressmen by funding their campaigns. The health industry also devotes enormous resources to influencing public opinion against any form of ‘state medicine’. In spite of that, in this instance public opinion supported a single payer system – but Congressmen have again proved more answerable to capital than to voters. The book had to go to press before this story had run very far, and we are still waiting to see the outcome; it’s a measure of the quality of Marie Gottschalk’s analysis of the US situation that her essay stressed the severe limitations of the ‘public plan’ and assessed what was likely to happen very accurately. The lack of an anti-capitalist movement in the US that could mobilise a powerful response has again denied the American working class what it voted for. It should and could prove to be a catalyst for change in this regard, as the consequences become clear.

GA: Colin, another big issue right now is the H1N1 pandemic. This is being portrayed in the most narrow of terms as a public health issue to be managed by cleanliness, on the one hand, and mass vaccines, on the other, with other dimensions going unmentioned.  One wonders whether we might see similar dynamic to that of a few years ago with respect to AIDS, which began as a technical issue seen as a minority problem butt led to great struggles about social inequalities, sexuality and big pharma. Is it any more rational to treat swine flu as simply technical issue separate  from the inequalities, institutions and dynamics of capitalism, or should we be looking at the linkages between the two?

CL:  If it does develop as a serious killer disease like AIDS we will surely quickly become aware of those linkages. It spreads easily and affects everyone more or less equally and so can’t be attributed to ‘lifestyle choices’ the way sexually transmitted diseases or lung cancer often are. But given that those most liable to become seriously ill and even die from it are those whose health is already compromised, and that these are typically poorer people than the average, the class dimension of it will be there to see if it becomes more lethal. The issue of who gets the vaccine first has already revealed class privileges in Canada and elsewhere. A related question is whether the price charged by the big pharmaceutical companies such as GlaxoSmithKline who are supplying the vaccine to governments is right: how far should collective protection against a collective threat yield windfall profits for capital?

GA: The IMF has now called for a decade of austerity in the public sector and in wages and benefits for workers. This comes on top of a long period of struggles against healthcare privatization and the working conditions of healthcare workers. You have been engaged in a lot of these struggles with the NHS in Britain and, of course, and no doubt kept up with some of the struggles in Canada given your frequent visits and continuing close contacts here.  What do you expect might be coming in the way of confrontations?

CL: This is a very important issue. In OECD countries other than the USA (where health is still treated as a commodity) people have been resisting – with varying degrees of success, depending on circumstances – the privatisation of the publicly-funded and managed healthcare systems that were established after WWII. In Canada, for example, the reality of the American healthcare market is there to be seen just across the border. Many Canadians have relatives there and know all about it. They didn’t need to see Michael Moore’s film ‘Sicko’. Many Canadians are also relatively recent immigrants who are keenly aware of the ‘freedom from fear’ of illness or accidents that the universal healthcare system in their adopted country gives them. On top of this the labour unions have put resources into the fight to defend Canadian health care: the Canada Health Coalition has a high media profile and widespread support. The result is as near unanimity as you can ever get on anything in a free and democratic country – a recent poll found 89.9% of Canadians support or somewhat support universal health care.

In spite of this massive public endorsement, the Canadian healthcare system has also been subjected to the application of neo-Taylorism in hospitals, to contracting out of the ‘ancillary’ work of  hospital cleaning, laundry and cooking, and to the offloading of health care to the unpaid labour of families, and especially women. This comes across clearly in the essay by Pat and Hugh Armstrong on struggles for control in the Canadian healthcare workplace. The call for more public sector cutbacks and assaults on the rights of public sector workers will undoubtedly worsen these trends, but as the Armstrongs also show, there is a growing potential for alliances among ancillary workers, nurses and even doctors to confront further attacks.

In England, where the assault on the public system has gone much further, campaigners against it are handicapped by the fact that it has been pushed through not by the Conservatives (who of course are happy to see it happen), but by a Labour government – and the trade unions are affiliated to the Labour Party. Even UNISON, the main health service workers’ union, is unwilling to attack Labour’s marketisation of the National Health Service publicly, even though its members are overwhelmingly opposed to it. As a result, while the NHS remains the most popular institution in the country there is limited understanding of how far and fast it is being broken up and privatised. Now that all the main political parties have signed up to the idea that everyone must just put their hands up and pay for the bankers’ greed by accepting a decade of cuts in public services, it will be interesting to see what happens when the cuts start to make a major impact on health services. There is an urgent need – and a major opportunity – for the left to make the connections clear. The impact of austerity on health services could and should force the unions to finally detach themselves from their subservience to the neo-Thatcherite Labour elite, and encourage new political forces to coalesce around the need to reassert the right to health care as a basic political right, a c
omponent of equal citizenship.

GA: Do you see the book as a handbook for healthcare activists?

CL: We certainly hope it will be, and the essay by Sanjay Basu on what activists can learn from HIV/AIDS mobilizations to build a comprehensive public health movement is very important in this respect. But the book is aimed at a wider readership as well. One of the problems to be overcome is that what is happening to health and health care is so poorly reported and analysed in the media. The owners of most newspapers, magazines, TV channels and radio stations are part of the neoliberal order. This means that health features in just two ways: amazing stories about medical ‘breakthroughs’ in individual treatments, usually in surgery; and failures and scandals – and never the successes – of publicly-funded and managed healthcare systems. On the other hand editors working for public-service broadcasting or more critical newspapers tend to see health policy as too complex for most viewers and readers. Even medical students get shockingly little exposure to issues of health policy. Most medical training pays scant attention to the social and economic context of disease and its treatment, or to what forces are determining health policy, or how far current health policies fall short of reflecting what medical science tells us. You don’t need to be a socialist to see that this is wrong. You just need to have a concern for scientific evidence and the welfare of the society you live in. Morbid Symptoms should be read by medical students and doctors and nurses and everyone in the caring professions – in fact by everyone who thinks health matters.

GA: The Socialist Register has always tried to have a vision of practical utopias for socialist struggles. This is something we have encountered as a problem in Canada in relation to health care – the need to go beyond just blocking any further erosion of public health.  What contribution does the new Register add to practical utopias today and a programme for the Left in terms of health?

CL:  The principles that a socialist health programme should rest on come across clearly enough from the volume. In general, a socialist health policy would aim at making economic policy serve the goal of making everyone as healthy as possible, rather than making a few people as rich as possible. As Hans-Ulrich Deppe, an eminent German professor of medicine, says in his essay on the nature of health care, health is a universal need that should be a universal right, and this means that every aspect of health policy must be grounded in the principle of social solidarity. What this means in practice will vary widely, depending on the health system that already exists, public attitudes to health and medicine, country-specific variations in need, etc. And it can only be worked out in practice; blueprints made in advance are not going to help much. But a more democratic health policy, which must be the starting-point, will always imply some striking changes. For instance Julian Tudor Hart’s powerful closing essay in the volume points out that in advanced capitalist countries an amazing third of all adults experience a mental health problem of one kind or another, but only a tiny fraction of the misery that this represents is even acknowledged, let alone treated – even in health systems that are supposedly equally accessible by all. A socialist health policy must obviously confront this, implying some major shifts of attitudes and resources, and a radical change in the social conditions that cause so much of the problem. It would aim to bring medical priorities into line with the findings of medical science – a very different thing from the priority now assigned to high-tech medical care for conditions that represent a tiny fraction of the burden of disease among the population at large (not to mention the populations of the global ‘south’).

Thinking through what a socialist health policy would look like in any given society in fact opens up several extremely exciting vistas. It also opens up the possibility of new alliances in the struggle for socialism generally. For example, once it is recognised that good health depends more on social and economic equality than on health care – crucially important though health care is – healthcare activists thinking about the kind of politics needed to secure good health for all find they have natural allies in a whole range of movements struggling for equality – for labour, for women, for the unemployed, for undocumented people, and for minorities of many kinds. In the same way, envisaging the kind of state, and the kinds of democratic accountability, that could ensure that maximising people’s health became and remained a core commitment of society, is a powerful way of focusing on the kind of state needed for achieving other solidaristic goals.

Health is a deeply emotive matter, and the left has every reason to make it a core issue of its own. And not just in defending publicly-provided, universal-access health care, but in a more radical sense too, as Leo and I suggest in the Preface to the book: the contradiction between capitalism and health should become a pivotal dimension of a revitalised socialist strategy.

In addition to co-editing the Socialist Register Colin Leys is the author of various books including Underdevelopment in Kenya, Politics in Britain: From Labourism to Thatcherism,  The Rise and Fall of Development Theory, and Market-Driven Politics: Neoliberal democracy and the public interest.