By Kyle Chene
Belmont (Mass.) Citizen-Herald
Wed Oct 21, 2009

Boston, Mass. – Although state leaders have bristled at the pointed, dismissive and sometimes downright false claims made about the Massachusetts health care system by outsiders, they have said little about the dissent from within.

A quarter of the Legislature has signed onto a proposal to scrap the state’s landmark health care system, which still relies on private insurance companies to cover millions of residents, in favor of a single-payer system, publicly run and available to all residents.

Backers of the single-payer plan (H 2127) argued Tuesday that the state’s current system has failed to control costs, prevented even insured residents from obtaining needed care and left as much as 5 percent of the population without coverage.

The legislative supporters include Rep. Ellen Story (D-Amherst), a member of House Speaker Robert DeLeo’s leadership team and a stable of reliably liberal legislators. Officials from the League of Women Voters, the National Association of Social Workers, the Massachusetts Nurses Association and other social advocacy organizations were also on hand to register support. While such proposals have sparked fierce opposition nationally, no opponents spoke at the hearing.

The proposal by Rep. Matt Patrick (D-Falmouth) would establish a “Massachusetts Health Care Trust” reimbursing providers for health care costs, investing in health care facilities, streamlining health care bureaucracy and incentivizing quality of care. The trust would be funded by a “dedicated tax” on employers, workers and citizens, intended to replace funds currently spent on insurance premiums. The trust would also consolidate all municipal and federal health care dollars.

The trust would be overseen by a board that includes the secretary of health and human services, the secretary of administration and finance, the commission of public health, three gubernatorial appointees, three appointees of the attorney general and eight members elected by state residents.

All Massachusetts residents would be eligible to receive health care through the trust, as well as non-residents who work more than 20 hours a week in Massachusetts, pay Massachusetts income and payroll taxes and pay premiums established by the trust. Benefits would include prescription drugs, emergency care, doctor visits, hearing, vision and dental care, home health, maternity coverage and various other medical procedures.

The debate comes at a time that the governor and top lawmakers are eyeing a fundamental overhaul in the way the state pays for care. A special commission of legislators, administration officials, doctors, hospitals, insurers and health care experts recommended over the summer that Massachusetts implement a system of “global payments” aimed at curbing health care costs by coordinating individual patients’ care among various providers.

Gov. Deval Patrick has said he expects legislation enshrining such a system to be ready by the end of the month, and stakeholders from across the health care system voiced conditional support for ending the state’s current “fee-for-service” model.

Noting that the commission report “sounded the alarm” about soaring health care costs, Rep. Patrick questioned the recommendations because the members did not consider a single payer system.

“I dare you to read the report and tell me how it will work,” he said.

Sen. Patricia Jehlen (D-Somerville), a sponsor of the proposal, said passing it this year would be “politically unrealistic,” although she said health care costs would crowd out other government programs if left unchecked.

Despite the criticism of the state’s current system, aimed at offering universal access to health insurance, there is a wide array of support. Backers of the existing structure, while acknowledging that health care costs have continued to climb, note that the state has covered about 430,000 residents since the inception of health care reform in 2006. Individuals are required to purchase health insurance, and low-income residents without access to health care through their employers may obtain partially or fully-subsidized care through the state’s Connector Authority, an exchange that pairs consumers with private plans.

Opponents of single-payer care worry that it places government bureaucrats in charge of important health care decisions, would add layers of bureaucracy to the existing system, would reduce the quality of care and would disrupt relationships between doctors and patients, arguments that single-payer backers reject.

For much of the hearing, single-payer backers spoke to a sparse panel of legislators, as House members flitted between a Democratic caucus and the basement hearing room. In addition, Senate Chair Susan Fargo (D-Lincoln) and Vice Chair Mark Montigny (D-New Bedford) were absent, leaving Sen. Jennifer Flanagan (D-Leominster) with the gavel for much of the hearing. House Chair Jeffrey Sanchez (D-Boston) and Reps. Jason Lewis (D-Winchester), Cleon Turner (D-Barnstable) and Michael Brady (D-Brockton) attended parts of the hearing.

Single-payer advocate Benjamin Day, executive director of MassCare, said his favored system often fails to gain political traction because of intense lobbying efforts by the insurance industry.

“I think it’s tough because single-payer contains effective cost control,” he said. “Every bill that contains cost control is a political slugfest.”

He and other proponents of a single-payer system argued that every ambitious health care reform plan enacted by states has ultimately failed because of unsustainable costs.

Dr. Steffie Woolhandler, a Harvard University professor and advocate with Physicians for a National Health Program, questioned a 97.4 percent health insurance rate in Massachusetts, a figure highly touted by the Patrick administration.

“That’s a single organization, the Urban Institute, that gives that number,” she said. “The problem of underinsurance, being unable to afford care despite having insurance, has actually gotten worse in the state … We’ve tried a reform in this state that’s left 5 percent of the people uninsured, costing the commonwealth $1.3 billion this year.”

Rep. Timothy Madden, a freshman Democrat from Nantucket, said his family has “been through the mill” with insurance companies.

“I think the system is broken,” he said. “We should set the tenor in the leadership and the message to Washington.”

http://www.wickedlocal.com/belmont/news/x927260116/Single-payer-proponents-say-state-health-care-system-broken

By Roni Caryn Rabin
New York Times
Prescriptions Blog
October 23, 2009

Americans without health insurance are less likely to know if they have diabetes or high cholesterol than those with coverage, and they’re less likely to keep their high blood pressure under control than the insured, a new study reports.

The researchers used national health survey data to look at three chronic but manageable health conditions — diabetes, hypertension and high cholesterol — that can lead to serious long-term complications when not kept in check. The long-term problems, including heart attacks, strokes and kidney disease, are expensive conditions that are often treated at public expense, contributing to overall health care costs.

Some 46 percent of uninsured people with diabetes had never been diagnosed with the disease, compared with only 23.2 percent of insured diabetics, the researchers found. Over half of the uninsured people with high cholesterol, or 52 percent, did not know about their condition, compared with 29.9 percent of the insured.

Whether insured or not, about three-quarters of those with high blood pressure had been given a diagnosis, which may reflect a broad public health effort to raise awareness about this common condition and the ease with which it can be checked at a health fair or drugstore. But without insurance, people were less likely to keep their blood pressure under control: 58 percent of uninsured hypertensives had uncontrolled blood pressure, compared with 51.2 percent of the insured.

Likewise, 77.5 percent of uninsured patients with elevated cholesterol were not keeping it under control, compared with 60.4 percent of the insured.

While the goal of the study was to learn how common it is for uninsured people to have a perfectly manageable condition that goes undiagnosed and therefore untreated, the researchers stumbled on a disturbing finding: even people with insurance weren’t doing very well keeping these conditions under control.

“It was striking,” said Andrew P. Wilper, lead author of the paper, which appeared in the journal Health Affairs. “The control of some of these chronic illnesses, even for the insured, is not that great. Among the uninsured, it is even worse.”

The insured and uninsured did not differ much in their control of diabetes, for example. Some 44.2 percent of insured diabetics had uncontrolled diabetes, compared with 46.6 percent of uninsured diabetics.

The study analyzed data about from the National Health and Nutrition Examination Survey of 1999-2006, which included interviews of 41,510 people. Other information was gleaned from questionnaires, physical exams and lab data, and individuals who were under 18 or older than 64 were excluded. About one in five people in the sample did not have health insurance.

by Leonard Rodberg
Tikkun Magazine
November/December 2009

President Obama’s health reform plan is in trouble. Public support for it is only lukewarm; both Left and Right oppose it. Pundits and editorial writers complain that Obama has turned the issue over to Congress, or that he hasn’t explained the plan well enough. He and his staff have been working closely with many members of Congress from the very beginning, and he has described his plan repeatedly and in many forums — and no one questions that he is a superb communicator. And yet disquiet and confusion persist. What has gone wrong?

The President’s Fateful Choice

Sixty percent of all Americans get their health insurance from private insurers, mostly through their employers, with some buying it directly from insurance companies. About half as many — 87 million according to the latest report from the Census Bureau — are covered by Medicare (the federal program for the elderly and the disabled), Medicaid (the joint federal-state program for the poor), the VA, and other public programs.

However, when you look at who pays the bills, you find a very different picture: nearly half of all medical bills are paid by government, largely through Medicare and Medicaid, but also through support for community health centers, the VA, and so on. Private insurance accounts for barely a third of all health care spending. The reason is clear: government covers those who are most in need of medical care, the elderly and the poor, while private insurance covers the healthy part of the population, those who are working.

When Obama decided to tackle health care reform, he could have chosen to build it upon either the public or the private systems. He said he wanted to build on what works, and he could have proposed expanding the public programs we now have to cover everyone (or everyone who wanted that kind of coverage). These programs work, and they work well. Instead, he chose to base his program on for-profit private insurance, the part of our health financing system that is most expensive and deficient. He chose the private path, and, as Robert Frost said, that has made all the difference. No plan that rests on multiple weakly regulated for-profit insurance companies can possibly achieve the goals he has set out and still claims his plan will achieve.

The Obama Mandate Model

Obama has declared many times that his chief goal is to contain the escalating cost of health care. However, the president and the congressional committees that have followed his lead have chosen principally to focus on getting insurance for the uninsured. That seemed simpler to address so, as a result, they have adopted the “mandate model” as exemplified most recently by the plan passed in Massachusetts in 2006.

Everyone will be required to have insurance, and at least the larger employers may be required to offer insurance or contribute to a public fund that will subsidize the purchase of insurance by their low-income employees and others. (An important exception: low-income individuals with incomes below 133 percent of the federal poverty level will be able to sign up for Medicaid.)

In an op-ed published in the New York Times on August 16, the president claimed that “if you don’t have health insurance, you will have a choice of high-quality, affordable coverage for yourself and your family.” However, as put forward in slightly differing versions by five congressional committees, nothing in his plan guarantees that the insurance offered by these private companies will be either “high-quality” or “affordable.”

Currently, the average premium paid by employers for a family policy is $13,375; by 2013, when this plan would go into effect, insurance is sure to be even more costly. Insurance plans will have to meet new requirements, including no exclusions for pre-existing medical conditions, no co-pays for preventive care, annual limits on cost-sharing (co-pays and deductibles) of $5,000 for individuals and $10,000 for families, and no limits on lifetime coverage. All of these requirements, while desirable, will make insurance policies even more expensive. What many are beginning to realize, and to find objectionable, is that the plan does not regulate premiums, deductibles, or co-pays, so we will be required to buy insurance from companies that can charge us whatever they choose.

Employment-based insurance will be otherwise unchanged. Employers will still be able to change the coverage and the plan they offer their employees. Insurers can still change their provider networks, dropping or adding physicians and hospitals. Employees are still locked into their jobs if they want to keep their current plan. But now, employees must accept their employer’s plan; the individual mandate requires it.

But won’t the vaunted “public option” address some of these problems? The original “robust” plan would have provided real competition to the private insurers. It would have had open enrollment — anyone could have joined. Like Medicare, it would have been backed by the federal government, and, according to the best estimates, nearly 120 million people would have joined it. Such a large public program could have had an enormous impact in reducing costs and leading to an efficient restructuring of health care delivery.

However, what even the most progressive committees in Congress are proposing is something very different. Enrollment in this public plan will be restricted to the uninsured and the smallest employers. The plan must be self-sustaining, following the same rules as private insurers and receiving no federal subsidy. And, as the president himself has said, the best estimate is that barely 5 percent of the American people will join it. The 800-pound gorilla has been turned into a mouse!

Costs Will Keep Climbing

In his New York Times op-ed, Obama went on to claim that “reform will finally bring skyrocketing health care costs under control.” But nothing in the plan directly cuts costs. In fact, this plan will increase the overall cost of the health care system by hundreds of billions of dollars as millions of Americans who now have no insurance purchase policies from the insurance companies. The director of the Congressional Budget Office has said, “We do not see the sort of fundamental changes that would be necessary to reduce federal health spending by a significant amount.” Instead, the plan relies on reducing waste and inefficiency in Medicare and Medicaid, on competition among insurance companies, and on a series of innovations — computerization, chronic disease management, and new ways of providing and paying for medical services such as the “medical home” — that are certain to cost added billions for the next few years and may, or may not, eventually produce some savings.

Then how will the plan be paid for? In his September 9 speech to Congress, Obama said “most of this plan can be paid for by finding savings within the existing health care system.” Taxes on “Cadillac” health insurance, reductions in planned Medicare and Medicaid reimbursements to hospitals and other providers; cuts in subsidies to Medicare Advantage plans (the private plans that provide insurance to Medicare recipients); and reduced waste and fraud in Medicare and Medicaid are counted on to yield the necessary funds.

Congress is envisioning devoting nearly $1 trillion to this program over ten years. Unfortunately, even this substantial sum is not nearly enough to enable everyone to buy insurance under this plan. According to the Congressional Budget Office, between 17 million and 25 million people will need “hardship waivers” and will remain uninsured. So the designers of this plan have failed to achieve even their most basic goal.

The Public Alternative

The alternative that Obama might have chosen is the public route to real health care reform, using Rep. John Conyers’ Expanded and Improved Medicare for All Act, HR 676. This plan is straightforward. It would expand the existing Medicare program so that everyone would be covered via automatic enrollment, just as seniors are automatically covered now when they turn 65. It would provide comprehensive benefits, much improved over the existing Medicare program, which has deductibles and co-pays that keep many seniors from getting the care they need. It would allow free choice of doctor and hospital, which would remain independent, as they are now. A public agency would process and pay the bills, and the system would be financed through a progressive tax.

Numerous studies conducted over the past several decades have shown that — in sharp contrast to a plan that relies on private, for-profit insurance companies — such a simplified, publicly funded system would cost no more than we are now spending. Estimates based on a number of studies performed over the last decade suggest that covering the uninsured and improving the coverage of the underinsured, including eliminating co-pays and deductibles, would cost about $250 billion each year. On the other hand, the reduction in the cost of insurance administration (Medicare averages 3 percent overhead, while insurance companies average 20 percent) — along with savings in hospital and doctor billing costs, savings from bulk purchasing, and savings from the better coordination of care that a single funding source could achieve — will yield even more than that in savings. The excess could be used to retrain those who are now processing insurance bills, so they could begin doing useful work.

A Medicare for All program could be paid for in many ways. The simplest would be through a payroll tax in which, for instance, employees would pay between 4 percent and 5 percent of their paycheck while employers would pay between 8 percent and 10 percent. For both employers and employees, this would be a significant saving compared to what they’re paying now.

Further, a Medicare for All program, unlike the congressional plans now on the table, offers real tools for containing costs in the future. These include the use of annual budgets, especially for hospitals; the planning of capital investment; and an emphasis on primary care, coordination of care, and more cost-efficient ways of paying for physician services.

Conclusion

Private health insurance is a defective product that needs an expensive fix. By building his program on private insurance, President Obama has tied himself to a system that is too expensive and is unlikely to achieve the goals he has set. It will not lead to universal coverage and cannot contain costs going into the future.

On the other hand, an expanded Medicare for All system can provide comprehensive services while costing no more than we now spend, and it provides real mechanisms for containing costs. Should a private mandate plan be passed, the problems of the health care system will not go away. Real health care reform will continue to be essential. As costs continue to climb faster than incomes, health care will absorb a larger and larger fraction of our national livelihood. At some point, we will have to move to a unified public mechanism for funding health care that will be truly sustainable.

Leonard Rodberg is professor and chair of urban studies at Queens College, City University of New York, and research director of the NY Metro Chapter of Physicians for a National Health Program.

http://www.tikkun.org/article.php/nov_dec_09_rodberg

By Don R. McCanne
International Journal of Health Services
Issue: Volume 39, Number 4 / 2009
Pages: 699 – 704

Abstract: Among OECD nations, the United States is an outlier in having the highest per capita health care costs in a system that unnecessarily exposes many individuals to financial hardship, physical suffering, and even death. President Obama and Congress are currently involved in a process to reform the flawed health care system. The OECD has contributed to that process by releasing a paper, “Health Care Reform in the United States,” which describes some of the problems that must be addressed, but then provides proposed solutions that omit consideration of a more equitable and efficient universal public insurance program. The same omission is taking place in Washington, DC. By reinforcing proposals that support the private insurance industry, the source of much of [he waste and inequities in health care, the authors of the OECD paper have failed in their responsibility to inform on policies rather than politics.

****

It would be an understatement to say that, when it comes to the effectiveness and efficiency of the health care financing system, of all member nations of the Organization for Economic Cooperation and Development (OECD), the United States is a highly exceptional outlier. With a per capita spending at twice the average of the OECD nations, the United States is receiving the worst value for its health care investment (1).

Not only is population health lower in the United States than OECD averages, but the nation’s fragmented, dysfunctional health care financing system has allocated spending in a manner that fails to prevent financial hardship for those individuals with health care needs. No other nations would tolerate the numbers of people without health insurance coverage, now at about 46 million, nor would they tolerate the explosion in underinsurance products that fail to provide adequate financial protection for those who are insured. In spite of spending more than 16 percent of gross domestic product (GDP) on health care, or $2.5 trillion, excessive financial burdens and even personal bankruptcy have become commonplace for those who must access the health care system (2).

Although the growing problem has been recognized for decades by legislators and the policy community in the United States, they have been overwhelmed with inertia, partly due to anti-government, pro-market ideology, and partly due to the tremendous influence of special interests that fare well under the current financing system. Particularly influential has been the private insurance industry, especially through its lobby organization, America’s Health Insurance Plans.

Advocates of health care justice have long supported reform that would remove financial barriers to access for everyone who has health care needs, but egalitarianism is so weak in the United States that it has failed as a driving stimulus for reform. The failure to act has gradually magnified a problem that all sectors recognize as being intolerable. The payers of health care are crashing into the solid barrier of unaffordable costs. Employers have had increasing difficulties in paying for their employee health benefit programs, and they have responded by reducing the coverage or even dropping it altogether. The federal, state, and local governments have struggled with budget constraints and have responded by reducing payments to the health care delivery system, shifting costs to other payers. Especially threatened are the safety-net institutions.

Most severely affected by health care affordability are the individuals with health care needs. Health care is now so expensive that the premiums for insurance products that cover necessary services are no longer affordable for average-income individuals and families. To make the premiums more affordable, the private insurers have introduced innovations in their products that shift more of the costs to those accessing health care. Thus health care is now frequently unaffordable even for those who have private insurance. The Milliman Medical Index for 2009 shows that a family of four with employer-sponsored coverage (a healthy sector and lower-cost risk pool) now has average annual health care costs of $16,771, clearly a burden when the typical household income is about $60,000 (3).

It is a sad commentary that egalitarian concern for our brothers and sisters was not enough to mobilize the president and Congress, but we do have some consolation that pecuniary interests may now actually move the process. Most observers of the U.S. health care scene believe that we are in another window of opportunity to achieve the reform that has eluded us for so many decades. Although other nations should learn from the United States what not to do, the United States has an opportunity to learn from other nations what has worked well.

The OECD has been a particularly valuable resource for highly credible studies of the health care systems of its member nations and for the international comparisons provided. As an example, the OECD-WHO-Eurostat Health Accounts database has been particularly helpful for economists in the United States (4). It is probably more than a coincidence that the OECD has just released a new paper, “Health Care Reform in the United States,” by David Carey, Bradley Herring, and Patrick Lenain (5). David Carey and Patrick Lenain work in the OECD Economics Department, and Bradley Herring is a professor at the Johns Hopkins University. The paper includes the usual disclaimer that the views are those of the authors and do not necessarily reflect the position of OECD. The only role of OECD was to provide two of the three authors and to publish and distribute the document at the time that an intensive effort for reform is taking place in the United States.

Fulfilling its role of providing an objective assessment of health care problems within the United States, the paper is helpful when it describes the very high health expenditures along with a population health status that is falling behind other nations. More specific to the need for financing reform, the paper explains the growing proportions of both the uninsured and the underinsured. Individuals over age 65 and individuals with long-term disabilities are covered by the public Medicare program. Many, but not all, lower-income individuals are covered by the public welfare programs, Medicaid and CHIP (Children’s Health Insurance Program). Everyone else either relies on private insurance or has no coverage at all, primarily because they cannot afford it.

With heavy reliance on pro-market ideology, especially since the Reagan years, the nation has been waiting for the private insurers to solve the problems. The private insurers did exactly what any reasonable business would do. They made the premiums for their insurance products competitive by reducing spending on health care through marketing practices that targeted the healthy, especially the healthy workforce and their young, healthy families, and through innovative product design that shifted more of the responsibility of paying for care to those with health care needs. Yet, except for instituting contracted rates with health care providers, they did nothing to slow the rapidly escalating costs of health care. Clearly, comprehensive reform is no longer an option, but a necessity.

Although the OECD paper helps us understand the deficiencies in the U.S. financing system, the recommendations are problematic. To maintain academic purity, the discussion should have included the benefits and deficiencies of a public insurance model such as single payer, a model built on private plans, and a hybrid model of public and private plans. The authors remain silent on a public insurance model. They primarily discuss changes in private insurance coverage to address insurance market failures. They recommend greater risk pooling, providing income-related subsidies for the purchase of private plans, and paying for the subsidies by eliminating the tax exclusion for employer-sponsored plans. In spite of having cited the growing problem of underinsurance, they recommend avoiding moral hazard by increasing cost sharing, which can only further accelerate the problem of underinsurance. They also recommend a few tweaks in the Medicare program that would have a very small impact on future trends. The recommendations would greatly increase health care spending while falling short of the goals of equity, universality, and cost containment.

A previous OECD report stated that “whatever the role played in a health system, private health insurance has added to total health expenditure” (6). A WHO report stated that “evidence shows that private sources of health care funding are often regressive and present financial barriers to access. They contribute little to efforts to contain costs and may actually encourage cost inflation” (7). Several micro-simulations of proposed models of health care reform in the United States have shown that a single-payer national health program would be the most effective model in providing all necessary health care services for absolutely everyone, while being the least expensive model of beneficial, comprehensive reform.

The 30 member nations of the OECD are “countries dedicated to democracy and the market economy” (8). This may explain why the two authors who are OECD employees produced a paper that limits its recommendations to private insurance markets, without discussing the possibilities of a public insurance program. However, as an academic, Professor Bradley Herring should not be constrained by a mission to limit consideration of policy options to those in a market economy.

It is not as if Professor Herring does not clearly understand the single-payer model. In a very recent Kaiser Commission/Alliance for Health Reform forum, he discussed four models of reform for the United States (9). He described single payer as “very elegant and simple.” “You pay taxes into the system and in return you get the medical care that you need.” He stated that single payer is probably the only model that is going to get everyone covered, and that there would be large reductions in administrative costs. In response to a question about the ability of the various options to control costs, he said: “I would think that the single payer approach yields the most promise towards reducing health care costs.” His academic ethics would have been better served had he included these comments in the OECD paper on reform in the United States.

A single-payer national health program is precisely what the United States now needs. It would establish a single universal risk pool, funded equitably through progressive taxes, and it would remove financial barriers to care so that absolutely everyone could receive the care that they need, when they need it. The $2.5 trillion that we are already spending is more than enough to ensure adequate capacity in the health care delivery system.

Senator Max Baucus (D-MT) is leading the closed-door process wherein the reform legislation is being crafted. He has said that all options are on the table, except single payer. In this last election cycle he received over a million dollars from the insurance and pharmaceutical industries (10).

President Barack Obama recently held a health care summit at the White House. Representatives of every sector and interest were invited except single-payer advocates, who were specifically excluded. Less than 24 hours before the summit, the president of Physicians for a National Health Program, a single-payer advocacy organization, was invited to attend, in exchange for agreeing to cancel the planned white coat demonstration in front of the White House, which would have been composed of physicians, nurses, and medical students. Although President Obama has previously expressed his support for single-payer reform, he has decided that political pragmatism requires him to support inclusion of the private insurance industry within the framework of reform.

As innumerable polls now demonstrate, a majority of Americans support national health insurance. It is what we want, what we need, and what we are already paying for. Yet the politicians, working with the moneyed special interests, continue to conspire to deprive us of health care justice. The political opponents to a public insurance program have been effective in excluding single payer from more than a token representation in the legislative process. The people of the United States do not benefit when representatives of the OECD join in that conspiracy merely to advance the ideology of the market economy. Continued financial hardship, suffering, and death are far too great a price to pay.

REFERENCES

1. OECD. OECD Health Data 2008: Statistics and Indicators for 30 Countries. www.oecd.org/health/healthdata
2. Himmelstein, D. U., et al. Illness and injury as contributors to bankruptcy. Health Aff, w5.63, February 2, 2005, doi 10.1377/hlthaffw5.63.
3. Milliman. 2009 Milliman Medical Index. May 2009. www.milliman.com
4. OECD. A System of Health Accounts. www.oecd.org/health/sha
5. Carey, D., Herring, B., and Lenain, P. Health Care Reform in the United States. Economics Department Working Paper No. 665. ECO/WKP(2009)6. OECD Economics Department, 2009. www.oecdwash.org/PDFILES/ECO_WP_Health_Reform_US.pdf
6. OECD. Privale Health Insurance in OECD Countries. OECD Policy Brief. September 2004. www.oecd.orgldataoecd/42/6/33820355.pdf.
7. World Health Organization. What Are the Equity, Efficiency, Cost Containment and Choice Implications of Private Health-Care Funding in Western Europe? July 2004. www.euro.who.int/document/e83334.pdf
8. OECD. Mission Statement. www.oecd.org/pages/Q,3417,en_36734052_36734103_1_1_1_1_1,00.html
9. HealthCast. Covering the Uninsured: Options for Reform. kaisernetwork.org, March 2, 2009. www.kaisernetwork.org/health_cast/hcast_index.cfm?display=detail&hc=3120
10. Center for Responsive Politics. Sen Max Baucus (D-MT). OpenSecrets.org. www.opensecrets.org/politicians/summary.php?cid=N00004643

Direct correspondence to: don@mccanne.org

International Journal of Health Services, Volume 39, Number 4, Pages 699-704, 2009 (c) 2009, Baywood Publishing Co., Inc.

By Kyle Chene
Belmont (Mass.) Citizen-Herald
Wed Oct 21, 2009

Boston, Mass. – Although state leaders have bristled at the pointed, dismissive and sometimes downright false claims made about the Massachusetts health care system by outsiders, they have said little about the dissent from within.

A quarter of the Legislature has signed onto a proposal to scrap the state’s landmark health care system, which still relies on private insurance companies to cover millions of residents, in favor of a single-payer system, publicly run and available to all residents.

Backers of the single-payer plan (H 2127) argued Tuesday that the state’s current system has failed to control costs, prevented even insured residents from obtaining needed care and left as much as 5 percent of the population without coverage.

The legislative supporters include Rep. Ellen Story (D-Amherst), a member of House Speaker Robert DeLeo’s leadership team and a stable of reliably liberal legislators. Officials from the League of Women Voters, the National Association of Social Workers, the Massachusetts Nurses Association and other social advocacy organizations were also on hand to register support. While such proposals have sparked fierce opposition nationally, no opponents spoke at the hearing.

The proposal by Rep. Matt Patrick (D-Falmouth) would establish a “Massachusetts Health Care Trust” reimbursing providers for health care costs, investing in health care facilities, streamlining health care bureaucracy and incentivizing quality of care. The trust would be funded by a “dedicated tax” on employers, workers and citizens, intended to replace funds currently spent on insurance premiums. The trust would also consolidate all municipal and federal health care dollars.

The trust would be overseen by a board that includes the secretary of health and human services, the secretary of administration and finance, the commission of public health, three gubernatorial appointees, three appointees of the attorney general and eight members elected by state residents.

All Massachusetts residents would be eligible to receive health care through the trust, as well as non-residents who work more than 20 hours a week in Massachusetts, pay Massachusetts income and payroll taxes and pay premiums established by the trust. Benefits would include prescription drugs, emergency care, doctor visits, hearing, vision and dental care, home health, maternity coverage and various other medical procedures.

The debate comes at a time that the governor and top lawmakers are eyeing a fundamental overhaul in the way the state pays for care. A special commission of legislators, administration officials, doctors, hospitals, insurers and health care experts recommended over the summer that Massachusetts implement a system of “global payments” aimed at curbing health care costs by coordinating individual patients’ care among various providers.

Gov. Deval Patrick has said he expects legislation enshrining such a system to be ready by the end of the month, and stakeholders from across the health care system voiced conditional support for ending the state’s current “fee-for-service” model.

Noting that the commission report “sounded the alarm” about soaring health care costs, Rep. Patrick questioned the recommendations because the members did not consider a single payer system.

“I dare you to read the report and tell me how it will work,” he said.

Sen. Patricia Jehlen (D-Somerville), a sponsor of the proposal, said passing it this year would be “politically unrealistic,” although she said health care costs would crowd out other government programs if left unchecked.

Despite the criticism of the state’s current system, aimed at offering universal access to health insurance, there is a wide array of support. Backers of the existing structure, while acknowledging that health care costs have continued to climb, note that the state has covered about 430,000 residents since the inception of health care reform in 2006. Individuals are required to purchase health insurance, and low-income residents without access to health care through their employers may obtain partially or fully-subsidized care through the state’s Connector Authority, an exchange that pairs consumers with private plans.

Opponents of single-payer care worry that it places government bureaucrats in charge of important health care decisions, would add layers of bureaucracy to the existing system, would reduce the quality of care and would disrupt relationships between doctors and patients, arguments that single-payer backers reject.

For much of the hearing, single-payer backers spoke to a sparse panel of legislators, as House members flitted between a Democratic caucus and the basement hearing room. In addition, Senate Chair Susan Fargo (D-Lincoln) and Vice Chair Mark Montigny (D-New Bedford) were absent, leaving Sen. Jennifer Flanagan (D-Leominster) with the gavel for much of the hearing. House Chair Jeffrey Sanchez (D-Boston) and Reps. Jason Lewis (D-Winchester), Cleon Turner (D-Barnstable) and Michael Brady (D-Brockton) attended parts of the hearing.

Single-payer advocate Benjamin Day, executive director of MassCare, said his favored system often fails to gain political traction because of intense lobbying efforts by the insurance industry.

“I think it’s tough because single-payer contains effective cost control,” he said. “Every bill that contains cost control is a political slugfest.”

He and other proponents of a single-payer system argued that every ambitious health care reform plan enacted by states has ultimately failed because of unsustainable costs.

Dr. Steffie Woolhandler, a Harvard University professor and advocate with Physicians for a National Health Program, questioned a 97.4 percent health insurance rate in Massachusetts, a figure highly touted by the Patrick administration.

“That’s a single organization, the Urban Institute, that gives that number,” she said. “The problem of underinsurance, being unable to afford care despite having insurance, has actually gotten worse in the state … We’ve tried a reform in this state that’s left 5 percent of the people uninsured, costing the commonwealth $1.3 billion this year.”

Rep. Timothy Madden, a freshman Democrat from Nantucket, said his family has “been through the mill” with insurance companies.

“I think the system is broken,” he said. “We should set the tenor in the leadership and the message to Washington.”

http://www.wickedlocal.com/belmont/news/x927260116/Single-payer-proponents-say-state-health-care-system-broken