By Steffie Woolhandler
New York Times
Room for Debate Blog
August 10, 2009

“The Health Insurers Have Already Won” reads the cover story in Business Week’s Aug. 6 issue. That’s the short answer to why the public option option is off the table as well as to why the new bill will use an individual mandate to force the uninsured to buy private insurance. Or, more fundamentally, why Congress didn’t pursue the single-payer, Medicare-for-all approach used in other developed nations.

The public option was never single payer. Certainly, the option would have cut into private insurers’ profits (that’s why they killed it). But their profits — about $10 billion — are a fraction of what they waste on marketing (to attract the healthy); de-marketing (to avoid the sick); billing their ever-shifting roster of enrollees; fighting with providers over bills; and lobbying politicians. Doctors and hospitals spend billions more on paperwork, none of which the public option would save.

In contrast, single payer would eliminate private insurance, saving nearly $400 billion annually on insurance and provider paperwork, enough to cover the uninsured and plug the gaps in coverage for those with insurance.

In 2007, 62 percent of U.S. bankruptcies occurred in the wake of medical illness, and 77 percent of those in medical bankruptcy had health insurance (usually private insurance) when they first got sick.

Private health insurance is a defective consumer product, and Congress has no business forcing uninsured Americans to buy it.

In order to get the bill out of committee, Speaker Nancy Pelosi promised single-payer supporters, led by Representative Anthony Weiner of New York a floor vote in the fall. This is a tremendous victory for single-payer supporters like my group, the 16,000-member Physicians for a National Health Program. Members of Congress, many of whom say they personally support single payer, must now go on record on the eve of the 2010 electoral cycle. Constituents take note!

Steffie Woolhandler is a professor of medicine at Harvard Medical School, a primary-care doctor and co-founder of Physicians for a National Health Program.

http://roomfordebate.blogs.nytimes.com/2009/08/10/what-happened-to-a-public-health-plan/#steffie

The corporate ties between insurers and media companies

How often are employees allowed to work on projects that might put some of the people they work for out of business? That’s the conflict of interest that journalists reporting on the healthcare reform debate are often put in by the boards of media corporations they work for, which frequently include representatives of the insurance industry.

While a recent New York Times/CBS poll (6/20/09) has found yet again that the majority of Americans believe the government would both provide better coverage and keep costs lower than private insurance companies, a single-payer plan as an option for healthcare reform continues to be underrepresented in the media (Extra!, 6/09). A single-payer plan would allow the delivery of healthcare to remain private, but the government would pay for it out of a single federal health insurance fund. Like Medicare or Canada’s healthcare program, it would cut out the middleman by bypassing private health insurance companies. But such companies are well-represented on the boards of directors of media conglomerates — a factor that may help explain the blackout of such a popular possibility for reform.

When a director from one company sits on the board of directors of another company, that’s known as an interlocking directorate. For example, directors of the New York Times Co. also sit on the boards of several other large companies, including Chevron, Verizon and Ticketmaster. These directors are expected to act in the best interest of each company they direct; when one of the corporations in question is a media company, this can pose a conflict. Would someone who sits on a media company’s board object to coverage that damages another company that board member directs? Extra! has pointed out this conflict in the past (e.g., 9-10/01), noting that “even if these board members do not attempt to influence coverage of their businesses, their presence likely suffices to make media executives think twice about covering certain stories.”

A recent FAIR study of nine major media corporations and their major outlets, Disney (ABC), General Electric (NBC), CBS, Time Warner (CNN, Time), News Corporation (Fox), New York Times Co., Washington Post Co. (Newsweek), Tribune Co. (Chicago Tribune, L.A. Times) and Gannett (USA Today) found connections to six different insurance companies. Five out of the nine media corporations studied shared a director with an insurance company; two insurance companies — Chubb and Berkshire Hathaway — were represented by more than one media corporation director.

The study also found crossover between these media corporations and several large pharmaceutical companies, such as Eli Lilly, Merck and Novartis, whose profits would also likely be negatively impacted by a single-payer system. Out of the nine media corporations studied, six had directors who also represented the interests of at least one pharmaceutical company. In fact, save for CBS, every media corporation had board connections to either an insurance or pharmaceutical company.

For example, the board of directors of the Chubb Corporation, whose accident and health division has offered health insurance for over 30 years, shares directors with two major media companies: Gannett and General Electric. A search of the Nexis database from January 1 through June 30, 2009, found just six articles mentioning single-payer in USA Today, Gannett’s major outlet. Out of those, only one (6/12/09) is from an advocate — a reprinted block quote from Sen. Bernie Sanders (Ind.-Vt.) originally published in the Huffington Post (6/8/09). On NBC News, GE’s major outlet, single-payer was mentioned on only two occasions in the past six months. Of those two occasions, one was on Meet the Press (6/28/09), in which both Republican strategist Mike Murphy and former Governor Mitt Romney asserted that a public option would lead to a single-payer plan. The other NBC News mention of single-payer was favorable, but very brief — PBS’s Tavis Smiley named Obama’s move away from the plan as one of his concerns after Obama’s first 100 days (4/25/09).

At the Washington Post Co., two directors are on the board of insurance conglomerate Berkshire-Hathaway, whose subsidiary General Re sells health reinsurance. In fact, Washington Post director Warren Buffet not only chairs Berkshire-Hathaway’s board, he is the company’s CEO. (Berkshire-Hathaway is also one of the 10 biggest U.S. advertisers, along with pharmaceutical company Abbott Laboratories Ad Age, 6/22/09.) Another Washington Post director, Thomas Gaynor, is the vice president of insurance company Markel Corporation. In the past six months, the Washington Post has published hundreds of articles on the subject of healthcare reform, fewer than 25 of which mention single-payer. Fewer than 30 percent of the sources who spoke about single-payer in these articles were advocates of the plan.

In all, though healthcare reform has been mentioned thousands of times in the output of these media corporations’ major outlets, single-payer was mentioned in only 164 articles or news segments from January 1 through June 30, 2009; over 70 percent of these mentions did not include the voice of a single-payer advocate. Over 45 percent of the pieces that did include a single-payer advocate were episodes of the Ed Show, an MSNBC program whose host, Ed Shultz, frequently advocates for single-payer healthcare. Without the Ed Show, just 19 percent of articles or news segments that mentioned single-payer would have included an actual advocate of the plan.

While it should go without saying that correlation is not causation — and MSNBC’s example proves that interlocking directorates are hardly the only factor in media coverage — this study indicates that, at the very least, corporate media and the insurance and pharmaceutical industries’ interests are fundamentally aligned.

By John Geyman and Deborah Burger
Star-Ledger
July 30, 2009

Medicare, which turns 44 this week, has taught us many valuable lessons, perhaps none more valuable than this: the more we let private, for-profit insurance companies muscle into our publicly financed health care programs, the worse the outcome for patients, doctors and nurses.

We know this from firsthand experience. We know this from the statistics. Our lawmakers in Washington would do well to take heed as they consider the options for reform.

As a single-payer public financing system covering some 43 million Americans 65 years of age and older, as well as about 2 million disabled people, today’s Medicare is the only solid rock in a sea of deteriorating health insurance coverage. Many millions of middle-age Americans, sick or not, look forward anxiously to their 65th birthday for the relief that Medicare brings when it kicks in.

For those advocating a “uniquely American” reform, you couldn’t find a system more American, signed into law by President Lyndon Johnson in Independence, Mo., under the gleeful eyes of its first two enrollees, Harry, the former president, and Bess Truman.

Our made-in-America Medicare system is a model of success, especially compared with the rapidly unraveling mess created by the private insurance system.

By comparison, Medicare’s strengths are clear. A comprehensive set of predicable benefits; universal access for those who qualify by age or disability, regardless of pre-existing conditions; free choice of physician, other providers, and hospitals anywhere in the country; simplified administration costing only about 3 percent in overhead (compared to overhead five to nine times higher for private insurers); and a binding social contract that people can count on.

Medicare’s record is one that private insurers can only envy — as numerous studies attest, including recent ones from the Commonwealth Fund, printed in the prestigious journal Health Affairs, and from the Department of Health and Human Services.

The Commonwealth Fund/Health Affairs study compared the experiences of elderly Medicare beneficiaries with those of people under age 65 with employer-based, private health insurance from 2001 to 2007.

Even though Medicare beneficiaries were older and sicker, their experiences were better across the board, with better access, higher-rated quality of care, fewer problems with medical bills, and higher satisfaction with coverage at lower cost.

The HHS-commissioned survey in June also cited substantially higher satisfaction among Medicare patients than among those with private insurance — 56 percent of enrollees in traditional Medicare give Medicare a rating of 9 or 10 on a 0-10 scale, compared to only 40 percent of Americans in private plans.

Medicare also has its problems, of course, some of which were wired into the program at its beginning as a result of political compromises with its opponents, such as the insurance industry. For example, Blue Cross, as the lead private intermediary under contract to Medicare to deal with providers, was allowed to set rules and reimbursement rates favorable to providers when the program was launched.

Another example is the Medicare prescription drug legislation of 2003 in which Congress expressly forbade Medicare from negotiating prices with the pharmaceutical companies. In contrast, the Veterans Administration has been able to negotiate drug prices down to about 58 percent of regular costs. Similarly, the 2003 bill expanded private Medicare Advantage plans, which receive government subsidies of about 13 percent more than in traditional Medicare — even though studies show the private plans offer less choice, are less reliable, are less efficient and involve higher cost-sharing.

As Congress and the administration close in on new national legislation, those lessons should be recalled. We simply can’t trust the insurance and drug companies to change their pricing practices or control costs, as Massachusetts lawmakers, who are now capping enrollment and cutting services, have learned.

The most effective and sustainable way to contain costs and make health care more affordable for all Americans would be to enact a single-payer system based on a non-privatized and improved Medicare model.

John Geyman is a physician and past president of Physicians for a National Health Program (www.pnhp.org). Deborah Burger, a registered nurse, is co-president of the California Nurses Association/National Nurses Organizing Committee (www.calnurses.org).

By Eric Zorn
Chicago Tribune
Friday, August 07, 2009

Nice poker play last week by U.S. Rep. Anthony Weiner.

As the House Energy and Commerce Committee was marking up health-care reform legislation, the New York Democrat offered up an amendment to abolish Medicare.

His point? Not to get rid of the program that provides insurance for America’s seniors on the 44th anniversary of President Lyndon Johnson’s signing of the Medicare Act of 1965, as he explained in his speech. But “to clarify one of the great, enduring mysteries.” Where do “my Republican friends stand on the issue of government-run health-care?”

Members of the GOP do carry on quite a bit about how awful it is, he observed, quoting several of them arguing that publicly funded health plans such as those now being proposed will lead to inefficiencies, rationing and the breaking of the doctor-patient bond.

But Medicare — along with comprehensive coverage for active military, veterans and American Indians — “is not only government-run health care, but it’s remarkably efficient,” Weiner said. Imperfect in some ways, of course, but “a pretty darn good model of what a public plan [covering everyone] might look like.”

His voice moist with sarcasm, Weiner addressed Republicans on the committee: “This is your opportunity . . . to eliminate the Medicare Act. Once and for all, stamp out the scourge of public, government-run, government-administered, single-payer health care. This is your chance. . . . I dare ya. I double dare ya. Vote ‘yes’ on this and then go home and explain to your constituents, how you’re so philosophically opposed to publicly funded health care that you voted to eliminate Medicare.” (Read or watch his whole five-minute speech here)

Lacking a triple-dog dare, the Republicans on the committee — along with the Democrats — unanimously voted no on Weiner’s amendment.

See, Medicare, despite its faults, is an extremely popular and entrenched program. I could find no public opinion polls in the modern era that have even bothered to ask if it should be abolished and grandma and grandpa dumped back into the private health-care insurance market. Similarly, I couldn’t find any recent polls in Canada that asked Canadians if they wanted to abandon their national health-care program in favor of an American-style system.

A Harris-Decima poll released last month showed 82 percent of Canadians prefer their nation’s health-care delivery system to ours.

A June, 2008, poll commissioned by the Globe and Mail newspaper and the CTV Television Network found 91 percent of Canadians saying the same.

An Ipsos/McClatchy poll last month found 65 percent of Canadians (and 49 percent of Americans) tending to agree with the statement “I currently have access to all of the health-care services I need without it costing me more than I can afford.”

Admittedly, that same poll found 74 percent of Canadians (and 53 percent of Americans) saying they had to “wait a long time for an appointment when . . . referred to a specialist.” Few would deny that there are gaps and delays in Canada’s system, and a Health Council of Canada report on public perceptions found 54 percent of Canadians in 2004 saying the health system north of the border needs “some fairly major repairs.”

Yet an unscientific Canadian Broadcasting Corp. poll taken that same year named Tommy Douglas — who led that nation’s fight for universal health care in the 1960s — as the Greatest Canadian of all time.

What this suggests is that if, somehow, the Democrats overcome the well-funded campaign against significant health-care reform and create a Medicare-style program for everyone, it, too, will eventually become untouchably popular.

Forty-four years from now, to prove a point, some wag in Congress will raffishly, ironically rise to propose a return to the pre-2010 health-care system in which more than 40 million Americans were uninsured and those who were fortunate enough to be covered had private bureaucrats standing between them and their doctors.

His proposal will go down to unanimous defeat. And some other wag in what used to be called a newspaper will praise him for his poker play.

Staff, salary has ballooned since inception

By Hillary Chabot and Joe Dwinell
The Boston Herald
Thursday, August 6, 2009

The payroll at the agency steering the state’s controversial universal health care effort has swollen to more than four times its original size in just 18 months – with a top-heavy bureaucracy led by dozens of high-paid managers, newly released records show .

The Commonwealth Health Insurance Connector’s staff and salary explosion – including 17 managers now paid more than $100,000 a year and numerous contracted employees – has continued despite protest from Beacon Hill lawmakers.

“At a minimum, all of the salaries need to be frozen and reviewed with an eye towards cutting them, and there should be a hiring freeze,” said Sen. Mark Montigny (D-New Bedford), vice chairman of the Legislature’s public health committee. “We’re in a crisis. That’s what happens when we’re in a crisis.”

The Massachusetts universal health coverage mandate – the creation of former Gov. Mitt Romney – is being ripped by critics of President Obama’s health care plan as a glaring example of out-of-control costs, jacked-up insurance rates and failed goals.

In a recent letter to the Minnesota congressional delegation, Gov. Tim Pawlenty compared Obama’s plan to the Bay State’s, noting: “That state’s experience should caution Congress against this approach” because “costs have been significantly higher than expected.”

Despite the national spotlight on its first-in-the-nation work, the Connector agency has in just a year and a half larded its bureaucracy with a dozen directors and assistant directors, and 14 bosses with the word “manager” in their titles. It also doled out 3 percent raises this year. The agency has 89 staffers on its payroll and is headed by Executive Director Jon M. Kingsdale, who makes $238,703.

Richard Powers, spokesman for the Connector, defended the salaries, saying they are in line with the employees’ “experience, knowledge and responsibilities.”

“There are people who came here from the private sector who took a cut in pay just to be involved in something that’s cutting edge,” Powers said.

Saying the agency was in “ramp-up mode” when there were only 22 employees in 2007, Powers said they had always projected a roughly 50-member staff.

The Connector has signed up 439,000 newly insured Bay State residents since it was created by the Legislature in 2006. Customers pay between 3.5 to 4.5 percent from their insurance costs for the agency’s salaries, Powers said.

The state, which has struggled with subsidizing the new law, spent $800 million to insure low-income residents last year.

In some cases, the Connector’s titles appear redundant. There is, for example, a chief communication officer, chief information officer, director of public affairs and chief marketing officer – all at six-figure salaries.

“The agency has exceeded my worst expectations. It’s clearly bloated and top-heavy with a number of positions that seem to be expendable,” said David Tuerck of the Beacon Hill Institute, a conservative think tank.

Rick Lord, head of Associated Industries of Massachusetts, who sits on the unpaid board that oversees the Connector, said he would be open to re-examining the higher payroll now that the state has insured all but 2.6 percent of the population. “It’s always good to revisit these issues on some kind of regular basis,” Lord said.

The Connector is just one of 52 quasi-state agencies under review by Gov. Deval Patrick, who announced the study after his disastrous push to install Sen. Marian Walsh as the $175,000 assistant director of the Health and Education Facilities Authority.

“The very life of these quasis should be in jeopardy,” said Montigny. “Their only purpose is to provide inflated salaries and bury patronage hires, and they’re generally less accountable and less effective.”

Article URL: http://www.bostonherald.com/news/politics/view.bg?articleid=1189479