PNHP

Who will run health care?

Who will run health care?

by Bob Balhiser
Queen City News
Wednesday, July 15, 2009

To the Editor:

With Barack Obama as our new president, Americans will never have a better opportunity to take our political system back from the lobbyists who are in control now. An ideal place to start would be with health-care reform. To illustrate just how ripe the opportunity is, ask yourself why the health-insurance lobby is spending $1.4 million every day running scare ads designed to prevent meaningful health-care reform.

Even Max Baucus recognizes that our health-care system is the most expensive in the industrialized world. For this, we can thank health-insurance companies that siphon off nearly 30 cents of every health-care dollar for administrative costs and outrageous executive salaries, not to mention the huge collateral costs they impose on doctors, hospitals, and pharmacies, which must pass them on to patients. Isn’t it time we said enough?

The trillion-dollar question before us now is whether we will let lobbyists continue to run health care, or will we regain control? We CAN change the way we pay for health care, and we don’t need to invent a whole new system to accomplish this. I have Medicare and, except for the “parts” managed by private insurers, it works quite well. Let’s upgrade Medicare, make it a “pure” government entity, and make it available to all American citizens. In doing so, we should incorporate some best practices from other successful systems to create an affordable, “world-class” universal health-care system that is the envy of the world.

Fixing A Sick Health Care System

By George E Curry
NNPA Columnist
6/17/2009

The debate over universal health care heats up this week amid false charges that President Obama wants to institute “socialized medicine” and health reform hurts those already covered by private insurers. One of the most important facts to keep in mind is that although the United States spends twice as much as other industrialized nations on healthcare ($7,129 per capita, it is at or near the bottom when it comes to such indicators as infant mortality and life expectancy.

If providing free, universal health care to all citizens is such a bad idea, why has it been adopted in England, Canada, Brazil, Israel, Germany, Australia and Scotland? In fact, the United States is the only industrialized nation in the world that does not provide universal health care for its citizens. Consequently, at least 43 million Americans are without health insurance and that figure is certain to grow with rising unemployment.

“The reason we spend more and get less than the rest of the world is because we have a patchwork system of for-profit payers,” Physicians for a National Health Program noted on its Web site. “Private insurers necessarily waste health dollars on things that have nothing to do with care: overhead, underwriting, billing, sale and marketing departments as well as huge profits and exorbitant executive pay. Doctors and hospitals must maintain costly administrative staffs to deal with the bureaucracy.

“Combined, this needless administration consumes one-third (31 percent) of Americans’ health dollars.”

By switching to a singlepayer system that covers all medical necessities, it is estimated that savings will amount to more than $350 billion per year.

Obama has made health reform one of his top priorities. Not unexpectedly, some leading Republicans are accusing him of favoring socialized medicine and urging the government to not meddle in affairs that should be handled by the private sector.

A group calling itself Conservatives for Patients’ Rights has already begun running spots on CNN designed to scare the public, saying Obama’s “government-run” plan would cut consumers’ choices.

Factcheck.org notes, “That’s not the type of public plan President Obama has proposed. Nor is such a plan gaining acceptance on Capitol Hill.”

A House summary of the United States National Health Care Act (H.R. 676) introduced by Rep. John Conyers and making its way through Congress states, “The bill would create a publicly financed, privately delivered healthcare system that uses the already existing Medicare program by expanding and improving it to all U.S. residents and all residents living in U.S. territories. The goal of this legislation is to ensure that all Americans will have access, guaranteed by law, to the highest quality and most cost effective healthcare services regardless of their employment, income, or healthcare status. With over 45-75 million uninsured Americans, and another SO million under-insured, the time has come to change our inefficient and costly fragmented non-healthcare system.”

The summary continues, “The program will cover all medically necessary services, including primary care, inpatient care, outpatient care, emergency care, prescription drugs, durable medical equipment, long term care, mental health services, dentistry, eye care, chiropractic, and substance abuse treatment. Patients have their choice of physicians, providers, hospitals, clinics, and practices. No co-pays or deductibles are permissible under this act.”

A recent poll by the New York Times and CBS News found that 57 percent of Americans would be willing to pay higher taxes if it meant universal coverage for all Americans. Thirty-eight percent opposed the idea. Not only is universal health care sound public policy, it can provide an economic advantage as well.

Writing in Canada’s Financial Post, Diane Francis said:

“Universal health care is a cornerstone of smart economic policy. Take, for example, the effect of guaranteed health care on economic activity, business expansion or the public’s sense of wellbeing. If a worker in Canada or Europe or Japan loses his or her job this recession, it’s a psychological and financial blow. But if an American loses his or her job, the family faces financial ruin if sickness strikes any member because they are without healthcare coverage.”

She continued, “Bridge coverage is available but unaffordable for anyone but the wealthy. Worse yet, if a major illness is diagnosed during unemployment, a worker becomes unemployable, bringing about a life sentence of poverty.

“Little wonder, then, that consumer spending has ground to a halt in the United States, which makes the economic meltdown that much harder to combat or ever solve.”

It’s time for the United States to catch up with the rest of the industrialized world by providing universal health care.
[Author Affiliation]

George E. Curry, former editor-in-chief of “Emerge” magazine and the NNPA News Service, is a keynote speaker, moderator, and media coach. He can be reached through his Web site, www.georgecurry.com.

Healthcare and Free Press: Two Human Rights We Lack

By David Swanson
July 23, 2009

President Obama said on Tuesday night:

“Now, the truth is that, unless you have a — what’s called a single-payer system, in which everybody is automatically covered, then you’re probably not going to reach every single individual because there’s always going to be somebody out there who thinks they’re indestructible and doesn’t want to get health care, doesn’t bother getting health care, and then, unfortunately, when they get hit by a bus, end up in the emergency room and the rest of us have to pay for it.”

Another name for “what’s called a single-payer system” would be: healthcare as a human right, not a commodity to be purchased. Many humans have this right. They just aren’t Americans.

Obama’s mention of single-payer, in passing, as something that would be better than anything else, but something that mysteriously lies out of reach, is typical of the very few mentions of single-payer healthcare in the U.S. corporate media.

I just did some searches in the Lexis Nexis databases of major US and world publications, news wire services, and TV and Radio broadcast transcripts. Searching for “healthcare” in July 2009 found over 1,000 documents, the maximum number that Lexis Nexis will display. In fact, searching just the past two days found over 1,000 documents. Another search confirmed that this is “Michael Jackson” level coverage. And another search confirmed that virtually none of these documents mentioned single-payer at all, much less told anyone what it was. A search for documents later than July 1st containing single-payer OR “single payer” turned up only 197 documents.

Americans have consistently told pollsters for decades that they want single-payer. But America’s government refuses to provide it, and therefore America’s state media refuses to discuss it. Of the 197 records of the media mentioning single-payer in July, almost half were congressional records or press releases or otherwise not media reports at all. Others were articles in medical trade publications. Even so, those articles tended to mention single-payer very briefly and dismiss it — in the unfortunate phrase used by Kaiser Health News — as “dead on arrival.” Several others were transcripts of unidentified local shows that mentioned the word in passing. Others were blurbs in local newspapers announcing events. And several were reports and columns in British and Canadian newspapers. The Canadians, by the way, seem to be under the impression that President Obama is seeking to create single-payer healthcare. Several more documents — by far the best and most extensive US coverage of single-payer — consisted of letters to the editor.

A Boston Globe editorial mentions single-payer in a list but says nothing about it. A four-sentence Associated Press report on an event mentions the word. A Washington Post column by Dana Milbank attempts to mock all humanity and somehow mentions single-payer in the process. Several articles report on town hall forums at which people have asked President Obama why he doesn’t support single-payer. The Washington Times complained that such questions were permitted. The Washington Post praised Obama for appearing ready for such a question and answering it “calmly.” No word on whether his answer made any sense or not. There’s a report of an event at which the Secretary of Health and Human Services opposed single-payer. There are several reports of a press conference held by the White House Press Secretary at which someone apparently shouted out “single payer” for a laugh and got it.

There are a number of reports and transcripts that attack single-payer without explaining what it is. Most of them attack the so-called “public option” as leading to single-payer. That is to say, the media is afraid that people will overwhelmingly prefer precisely what the media opposes, and the media opposes it precisely because people would prefer it. The public option could only lead to single-payer if everyone decided they prefered it to the high costs and poor health provided by the for-profit insurers. The reports taking this approach include a CNBC interview in which the host makes this claim, a Washington Times column by Senator Judd Gregg, an Associated Press story quoting Senator Gregg, a transcript of the Ed Schultz Show on which another Republican senator made the same claim, another MSNBC transcript with Senator Charles Grassley, a Copley News column by Phyllis Schlafly, a Fox News interview by Sean Hannity of Louisiana Governor Bobby Jindal, a Fox News transcript with Congressman John Fleming, and a transcript of Chris Matthews interviewing Senator Orin Hatch. Other transcripts attack single-payer more directly, if no more substantively. Two of these are from Fox News. One is from CNN. Two are from Bloomberg TV.

There’s a short New York Times interview of Howard Dean opposing single-payer. There’s an NPR Morning Edition transcript of Congressman Jerrold Nadler saying he’d like single-payer but that it’s “off the table.” There’s an NPR Talk of the Nation transcript that briefly mentions single-payer. There’s an NPR Fresh Air transcript in which Terry Gross asks a guest whether he would really prefer single-payer and the guest says “Yes, but . . . .” There’s a four-sentence editorial by the Boston Globe explaining that “Harry and Louise” advertisements are false because single-payer is not under consideration. There’s a Washington Times article suggesting that Obama might move away from single-payer. Never mind that Obama has not supported it for years. There’s a Toronto Star report on Wal-Mart’s proposal to solve the US healthcare crisis. There’s a Copley News column complaining that the Bill Moyers’ Journal on PBS has covered single-payer. There’s a Washington Post column by Harold Meyerson complaining, in passing, that citizens will not create a movement for single-payer, even though it was that movement that put single-payer on Bill Moyers’ program.

There are five transcripts from the Ed Schultz Show, some of them treating single-payer honestly, including an interview of Dennis Kucinich. There are interviews of Senator Bernie Sanders by Fox News as well as Ed Schultz. And there are reports in print. One article from McClatchy reports on a poll finding that Canadians prefer their system. A lengthy St. Petersburg Times article compares the US and Canadian systems, making Canada appear the winner. One Boston Globe column by Jonathan Cohn supports single-payer. And a short op-ed, accompanied by two opposing op-eds, in the Los Angeles Times, was written by a Brit who wants to know what in the world is wrong with single-payer. He won’t find an answer in the U.S. media, which is barely even willing to explain what single-payer is.

But an excerpt from a recent Washington Post article that did not mention single-payer may help make clear where our government and our government media are coming from:

“Private insurers have effectively engaged in rationing, so they’re doing the dirty work for everybody else,” said Jeff D. Emerson, a former health plan chief executive. “It’s a thankless job . . . but somebody has to do it or health care will be even more expensive than it is now.” Private insurers might be better situated than the government to do the unpopular work of saying no, said Paul B. Ginsburg, president of the Center for Studying Health System Change, because they are less susceptible to political pressure.”

There you have it. For-profit companies best serve the public interest precisely because they are not subject to public control. Why? Because the public wants what is worst for the public. And how does the Washington Post know this? It has dinner with all the right people, and charges them for the privilege.

By the way, a similar search in Lexis Nexis’ blogs database turned up another 139 reports, with much more substance and honesty. And most blogs are not included in the search engine.

For-profit insurance: No value added

By JAMES C. MITCHINER
Detroit Free Press
July 27, 2009

In the health care debate, the one question we should be asking is: What is the marginal value of having private health insurance?

After all, if the purpose of health insurance is to mitigate the financial consequences of catastrophic illness or injury, the current level of medical bankruptcy shows that having such “insurance” is, for many Americans, anything but. Recent research from Harvard University and Ohio University showed that 78% of the individuals whose illness led to bankruptcy had health insurance at the onset of the illness that pushed them or their families into bankruptcy court.

Yet we continue to trust private insurers. Policymakers and federal legislators seem to have blind faith in their ability to solve the problems of American health care.

In order to maintain their profit margins, insurance companies are raising premiums while pushing more of the costs of care onto individual policyholders. Premiums are increasing annually at a rate that is three times the rate of inflation. Fewer employers, especially small firms, continue to offer comprehensive coverage, and for workers with employer-based insurance, out-of-pocket expenses increased 34% between 2004 and 2007. Those who have been laid off are finding that extension coverage under COBRA is overpriced and unaffordable.

Moreover, it is hard to argue that premium money spent on administration, marketing, public relations, lobbying, inflated CEO salaries and corporate profits is preferred to spending money on actual patient care.

Aside from costs, for-profit insurance companies will tell you that they facilitate high-quality health care and offer more choices than a government plan would offer. Really? There is no evidence of which I’m aware that for-profit insurers consistently provide better quality of care than their nonprofit private and public plan counterparts.

The argument that for-profits preserve choice of medical providers is also invalid, given that the “choices” are made for you through the insurers’ selective contracting with provider networks that include a limited number of physicians and hospitals. In addition, those who feel that they can go to any doctor of their choice without incurring additional costs should remember that over 90% of metropolitan areas are served by only one or two insurers.

But there is a viable alternative. Single-payer health insurance is simply a way to finance universal health care. By replacing the 1,200 private insurance companies — each having its own set of regulations, provider networks, prescription drug formulary, pre-authorization forms, 1-800 number and Web site — into a single insurance entity, such a single-payer system would reap the benefits of economies of scale, reduce administrative waste, mitigate bureaucratic duplication, sever the link between health insurance and employment, reduce health care disparities, and at last provide creditable coverage for the millions who lack it now.

And, unlike so-called socialized medicine — which requires you to go to a doctor employed by the government and receive treatment at a government hospital — single-payer utilizes private physicians and private hospitals, chosen by you and not by your employer, your health plan or the government. It is basically a simplified, commonsense Medicare-for-All program, a plan that characterizes universal health care in Canada and is the established norm in most Western European countries.

In most polls where various health reform options are listed, a universal, tax-supported single-payer plan is preferred by the majority of respondents. Single-payer is supported by thousands of physicians, hundreds of labor unions, several large medical and public health organizations, over 80 members of Congress, and three Nobel laureates.

A bill, HR 676, the U.S. National Health Care Act, has been introduced by U.S. Rep. John Conyers of Detroit. And, although he evidently doesn’t like to admit it, single-payer was at one time publicly supported by candidate Barack Obama.

President Obama’s goals for health reform are to expand access to high quality affordable care, control costs and preserve choice. Single-payer health insurance is the only plan that will simultaneously and synergistically accomplish all three goals, and without breaking the bank. We should stop pretending that the private insurance industry can do it better.

James Mitchiner, M.D., is an Ann Arbor emergency physician and the former president of the Washtenaw County Medical Society.

Media advisory: Doctor to tell House Judiciary panel about rising tide of medical bankruptcy

Dr. Steffie Woolhandler, founder of Physicians for a National Health Program and co-author of Harvard bankruptcy study, to call for single-payer health care program

Media Advisory

Contact:
Mark Almberg, Physicians for a National Health Program, (312) 782-6006, cell: (312) 622-0996, mark@pnhp.org
David Lerner or Karmen Ross, Riptide Communications, (212) 260-5000

WASHINGTON – Dr. Steffie Woolhandler, a founder of Physicians for a National Health Program and co-author of the first nationwide study on medical causes of bankruptcy, will testify on Tuesday, July 28, at 11 a.m. EDT before a subcommittee of the House Judiciary Committee, convened by Chairman John Conyers Jr., on the alarming rise in the share of all bankruptcies caused by illness and medical bills.

Woolhandler and her co-authors at the Harvard Medical School, Harvard Law School and Ohio University recently published a study in the American Journal of Medicine that shows nearly two-thirds of all personal bankruptcies in 2007 were linked to medical bills or illness. The authors further note that most of those who filed for bankruptcy were middle-class and had health insurance when they became sick. Between 2001 and 2007, the proportion of all bankruptcies attributable to medical problems rose by 50 percent.

Dr. Woolhandler will present the findings as part of a call for a single-payer national health insurance program, a publicly funded and privately delivered national health care program similar to Medicare.

According to Dr. Woolhandler, a professor of medicine at Harvard and a primary care physician in Cambridge, Mass.: “Only single-payer national health insurance can make universal, comprehensive coverage affordable by saving the hundreds of billions we now waste on insurance overhead and bureaucracy. Reforms that expand phony insurance — stripped-down plans riddled with co-payments, deductibles and exclusions — won’t stem the rising tide of medical bankruptcy.”

The hearing is scheduled to be webcast on the House Judiciary Committee web site, judiciary.house.gov, at 11 a.m. EDT.

What
Hearing before House Judiciary Subcommittee on Commercial and Administrative Law: “Medical debt – Is our health care system bankrupting Americans?” convened by Rep. John Conyers Jr. (D-Mich.)

Who
Dr. Steffie Woolhandler, professor of medicine at Harvard and co-founder of Physicians for a National Health Program.
Other witnesses to be announced.

Where
2141 Rayburn House Office Building, Washington, D.C.

When
Tuesday, July 28, 11 a.m. EDT

A copy of the study is available at https://pnhp.org/new_bankruptcy_study. The authors have also prepared a supplementary “Fact Sheet” and a “Q&A” on medical bankruptcy, both of which detail the study’s methods and findings. See same link above.

“Medical bankruptcy in the United States, 2007: Results of a national study,” David U. Himmelstein, M.D; Deborah Thorne, Ph.D.; Elizabeth Warren, J.D.; Steffie Woolhandler, M.D., M.P.H. American Journal of Medicine, June 4, 2009 (online).

A selected number of patient stories in which individuals describe their experiences with medical bankruptcy are available through Physicians for a National Health Program. Contact Mark Almberg for details.

Dr. Steffie Woolhandler is a professor of medicine at Harvard Medical School and co-director of the school’s General Internal Medicine Fellowship program. She is also a primary care physician at Cambridge Hospital in Cambridge, Mass. She worked in 1990-91 as a Robert Wood Johnson Foundation health policy fellow at the Institute of Medicine and the U.S. Congress. Dr. Woolhandler is a founder of Physicians for a National Health Program and is currently a member of its board. She is a principal author of many PNHP articles published in the JAMA, the New England Journal of Medicine and other professional journals.

Physicians for a National Health Program is a membership organization of over 16,000 physicians who support a single-payer national health insurance program. (www.pnhp.org).

Testimony of Steffie Woolhandler, M.D., M.P.H., on medical bankruptcy

Before the Subcommittee on Administrative and Commercial Law
House Judiciary Committee
July 28, 2009

Mr. Chairman, members of the Committee. I’m Steffie Woolhandler. I am a primary care doctor in Cambridge, Massachusetts, and professor of medicine at Harvard. I am also senior author of two studies on medical causes of bankruptcy, one published in Health Affairs in 2005, and the latest in the August 2009 issue of the American Journal of Medicine. Both studies were done in collaboration with colleagues at Harvard Law School and Ohio University.

In our most recent study, medical bills and illness contributed to 62.1 percent of all personal bankruptcies. Between 2001 and 2007, the proportion of all bankruptcies attributable to medical problems rose by 49.6 percent. The striking conclusion from our study is that private health insurance is a defective product that leaves millions of middle-class families vulnerable to financial ruin. Unfortunately, the health reform plan now under consideration in the House would do little to address this grave problem.

We found that most of the medical bankruptcy were middle class — before their financial crisis hit. Two-thirds were homeowners and three-fifths had gone to college. In many cases, high medical bills were part of a cascade of problems that resulted from illness, along with lost income as illness forced a breadwinner to lose time from work. Often illness led to job loss, and with it the loss of health insurance.

The overwhelming majority of those bankrupted by illness in our study had health insurance. Seventy-eight percent were insured at the start of the bankrupting illness; 60.3 percent who had private coverage. These families had done everything right. They worked hard, paid their premiums and thought they were covered. Yet when illness hit they found themselves unprotected, ruined by co-payments, deductibles and bills for uncovered services like home care and physical therapy. Medically bankrupt families with private insurance ran up uncovered medical bills that averaged $17,749.

Our study raises a warning flag that leaving most Americans to rely on private insurance plans means leaving them unprotected. And a public plan option that mimics the rules and coverage of private plans won’t help.

In Massachusetts, we have three years of experience with the kind of plan the House is now debating, and it’s a sad experience. Reform hasn’t made care affordable for the middle class, and it has decimated the safety net that the poor continue to rely on. In 2007, only 5.4 percent of Massachusetts were uninsured — the lowest in the nation. Yet, medical problems underlay 3 out of 5 bankruptcies — the same proportion as in the rest of the country.

In our state, failure to buy insurance is illegal, punishable by a $1,000 fine — as big a fine as for beating your wife or making a terrorist threat. For a middle-income 56-year-old, the cheapest coverage available through the Connector — the state’s insurance exchange — costs $4,900 for a policy with a $2,000 deductible before it pays for any care, and a 20 percent co-payment after that. A diabetic with such coverage is almost certain to lay out $10,000 each year for medical care. In two years he’d accumulate $20,000 in medical bills — more than the amount that bankrupted the average family in our study. This kind of insurance — sold with the stamp of approval of the Connector — is a cruel joke which Congress should not repeat.

And for everyone financially ruined by illness, many more suffer physically because they don’t get the care they need. Access to an insurance policy is not the same thing as access to health care. By 2008, only 3 percent remained uninsured in Massachusetts, yet among those WITH health insurance, 18 percent skipped care because they couldn’t afford it. Moreover, those unable to afford care find safety net hospitals and clinics shuttered. Our governor and Legislature — desperate to keep the reform afloat as costs escalate more rapidly than predicted — have drained funds from the safety net.

Reform needs to replace the defective private insurance that most families have with insurance that is always there, and that covers all medically necessary care without co-payments or deductibles. That’s the kind of coverage people in other wealthy nations get through single-payer national health insurance. Only single-payer national health insurance can make universal, comprehensive coverage affordable by saving the hundreds of billions we now waste on insurance overhead and bureaucracy . In nations like Canada that have single payer health plans, medical bankruptcy is rare. You have a historic opportunity to make real reform happen this year. But overwhelming evidence indicates that the reform you seem poised to pass will fail to protect American families.

Public option leads nosedive on reform

Bait and switch: How the “public option” was sold

By Kip Sullivan
Physicians for a National Health Program
July 20, 2009
When the “public option” campaign began, its leaders promoted a huge “Medicare-like” program that would enroll about 130 million people. Such a program would dwarf even Medicare, which, with its 45 million enrollees, is the nation’s largest health insurer, public or private. But today “public option” advocates sing the praises of tiny “public options” contained in congressional legislation sponsored by leading Democrats that bear no resemblance to the original model.
According to the Congressional Budget Office, the “public options” described in the Democrats’ legislation might enroll 10 million people and will have virtually no effect on health care costs, which means the “public options” cannot, by themselves, have any effect on the number of uninsured. But the leaders of the “public option” movement haven’t told the public they have abandoned their original vision. It’s high time they did.
For reform advocates, the full article is a “must read”:
https://pnhp.org/blog/2009/07/20/bait-and-switch-how-the-“public-option”-was-sold/

What a mess.
The progressive community has really blown it. The decision was to make “choice” the rallying cry for comprehensive reform – choosing to keep the insurance you have if that’s what you want, or to choose a program like the members of Congress have. It seemed not to matter that the public didn’t understand that FEHBP was basically an exchange of private plans offered to government employees, much less how a Medicare-like program might play a role.
That decision secured a solid role for the private insurance industry in any comprehensive reform proposal. All the industry had to do was to be certain that any government option could not be an effective competitor to the private industry, and they have done just that. AHIP has already destroyed the original concept of the public option, although they continue to chisel away at what vestiges remain.
Although an effective public option is a dead issue, the opponents of social insurance are not finished. They have successfully blocked action before the August recess which will allow time to build opposition to some of the remaining elements of the reform proposals.
Perhaps the most important policy in the legislation is the provision of subsidies for the purchase of private plans. If health care is to be affordable, these must be very large subsidies for a very large number of people. But Congress is at an impasse on how to pay for them.
The principles of social insurance require a transfer from the wealthy since low- and moderate-income individuals can no longer pay their full actuarial share. Yet Republicans and conservative Democrats have blocked the tax surcharge on high-income individuals, pulling out one more plank from the platform of social insurance.
Another source would be to tax employer-sponsored plans, but that would threaten losing this important source of health care financing and coverage. Many in Congress recognize that this is a risk that cannot be taken under the current model proposed by the legislation. Unions are particularly concerned that employees would face unacceptably higher costs, so this tax source has been rejected.
Since the private insurers would gain the most by this legislation, some are suggesting that we should tax them. But those taxes would be passed back to us in the form of higher premiums, which would then require still higher subsidies.
Congress has selected the most expensive model of health care reform. When they go home on their break the anti-tax forces will be out in full strength to communicate loudly that we can’t pay for it.
In September, they will face the reality that the subsidies will have to be smaller and the eligibility thresholds lower than currently proposed, simply because they can’t find the revenues to pay for them. There is an easy fix for that, as President Obama stated. We’ll have to issue hardship waivers which will exempt us from the fines that would be assessed for not having the insurance that we can’t afford.
Even there, the number of hardship waivers that would have to be issued has been grossly underestimated. With a typical family income of $60,000 and average family health care costs of almost $17,000, the majority of Americans should qualify for a waiver.
You really should read Kip Sullivan’s article. He shows us that there still is hope. As he states in his article, “at this late date in the 2009 session, it is unlikely that a single-payer bill could be passed even if unity within the universal coverage movement could be achieved. But if the ‘public option’ wing and the single-payer wing join together to demand that Congress enact a single-payer system, December 2009 need not constitute a deadline.”

Public option leads nosedive on reform

Bait and switch: How the "public option" was sold

By Kip Sullivan
Physicians for a National Health Program
July 20, 2009

When the “public option” campaign began, its leaders promoted a huge “Medicare-like” program that would enroll about 130 million people. Such a program would dwarf even Medicare, which, with its 45 million enrollees, is the nation’s largest health insurer, public or private. But today “public option” advocates sing the praises of tiny “public options” contained in congressional legislation sponsored by leading Democrats that bear no resemblance to the original model.

According to the Congressional Budget Office, the “public options” described in the Democrats’ legislation might enroll 10 million people and will have virtually no effect on health care costs, which means the “public options” cannot, by themselves, have any effect on the number of uninsured. But the leaders of the “public option” movement haven’t told the public they have abandoned their original vision. It’s high time they did.

For reform advocates, the full article is a “must read:”
https://pnhp.org/blog/2009/07/20/bait-and-switch-how-the-“public-option”-was-sold/

Comment:

By Don McCanne, MD

What a mess.

The progressive community has really blown it. The decision was to make “choice” the rallying cry for comprehensive reform – choosing to keep the insurance you have if that’s what you want, or to choose a program like the members of Congress have. It seemed not to matter that the public didn’t understand that FEHBP was basically an exchange of private plans offered to government employees, much less how a Medicare-like program might play a role.

That decision secured a solid role for the private insurance industry in any comprehensive reform proposal. All the industry had to do was to be certain that any government option could not be an effective competitor to the private industry, and they have done just that. AHIP has already destroyed the original concept of the public option, although they continue to chisel away at what vestiges remain.

Although an effective public option is a dead issue, the opponents of social insurance are not finished. They have successfully blocked action before the August recess which will allow time to build opposition to some of the remaining elements of the reform proposals.

Perhaps the most important policy in the legislation is the provision of subsidies for the purchase of private plans. If health care is to be affordable, these must be very large subsidies for a very large number of people. But Congress is at an impasse on how to pay for them.

The principles of social insurance require a transfer from the wealthy since low- and moderate-income individuals can no longer pay their full actuarial share. Yet Republicans and conservative Democrats have blocked the tax surcharge on high-income individuals, pulling out one more plank from the platform of social insurance.

Another source would be to tax employer-sponsored plans, but that would threaten losing this important source of health care financing and coverage. Many in Congress recognize that this is a risk that cannot be taken under the current model proposed by the legislation. Unions are particularly concerned that employees would face unacceptably higher costs, so this tax source has been rejected.

Since the private insurers would gain the most by this legislation, some are suggesting that we should tax them. But those taxes would be passed back to us in the form of higher premiums, which would then require still higher subsidies.

Congress has selected the most expensive model of health care reform. When they go home on their break the anti-tax forces will be out in full strength to communicate loudly that we can’t pay for it.

In September, they will face the reality that the subsidies will have to be smaller and the eligibility thresholds lower than currently proposed, simply because they can’t find the revenues to pay for them. There is an easy fix for that, as President Obama stated. We’ll have to issue hardship waivers which will exempt us from the fines that would be assessed for not having the insurance that we can’t afford.

Even there, the number of hardship waivers that would have to be issued has been grossly underestimated. With a typical family income of $60,000 and average family health care costs of almost $17,000, the majority of Americans should qualify for a waiver.

You really should read Kip Sullivan’s article. He shows us that there still is hope. As he states in his article, “at this late date in the 2009 session, it is unlikely that a single-payer bill could be passed even if unity within the universal coverage movement could be achieved. But if the ‘public option’ wing and the single-payer wing join together to demand that Congress enact a single-payer system, December 2009 need not constitute a deadline.”

Why we must vote on the public health care plan

By Rep. Anthony Weiner
Politico
July 22, 2009

It seems that big legislation isn’t complete until it develops a collection of catchphrases. (“Shovel ready,” everyone? “Cash for clunkers,” perhaps?) The effort to tackle the long list of failings of our health care system and the way we pay for it has been no exception. This time, we are arguing over the so-called public option.

The phrase has become something of a Rorschach test for lobbyists, commentators and legislators. To the president and to bill writers in Congress, the public option has come to mean that a government-run plan is the only way to truly keep private insurance companies honest, by guaranteeing that at least one provider is focused on something more than the bottom line.

To insurance company lobbyists and — from the sound of it — nearly every Republican, the public option is more a confirmation of their fear that the Obama administration is out to nationalize another industry. They argue that the public option would soon become the only option because it would have too many advantages in the marketplace.

Without acknowledging it, both sides seem to agree with the argument for a single-payer system. But instead of having a debate about its value, both sides have turned the idea into an odd punching bag. The right uses the term “single-payer” to condemn the White House approach, while the White House — and my colleagues in the House and Senate — quickly decry the scurrilous charge and concoct legislative language to make their public option look less, well, public.

By conceding that the public option would have less overhead, be more efficient and have the freedom to focus on health care rather than profits, opponents of the public option are in fact arguing for it. Isn’t complaining about the marketplace “advantage” of the public plan just another way of saying that people are going to want it?

The public option would prompt Americans to ask a basic question of the insurance company that is chasing their business: “What is it that you guys do, exactly?” Insurance companies don’t really do anything to make people healthier. They need to be efficient gatekeepers on behalf of their shareholders. Profits at 10 of the country’s largest health insurance companies rose 428 percent from 2000 to 2007. So if you think that the private “option” won’t be selected by citizens, it stands to reason that they want a public one.

Democrats who have been tasked with drafting the health care bill have been going to great lengths to assure everyone that it will not be a single-payer system. This is more a testament to a branding problem than a policy one. (Remember: It wasn’t a “bailout”; it was a “recovery.”)

But the arguments for a public option do leave you wondering why you would need or want a private insurance plan. We know that insurance companies rely on a formula to provide as little health care as possible for each dollar they take in. This isn’t because they are uncaring. It is because they are good business people.

With taxpayers, consumers and workers paying an enormous amount more than necessary because of this model, it seems odd that we would be so concerned about protecting it.

What would a public-only or a single-payer system look like? It would look like Medicare for everyone. We are all aware of the problems facing Medicare: looming deficits; incentivizing expensive institutional care rather than alternatives; squeezing doctors; etc.

But these are not a reflection of a failure of the single-payer system. They are failures to make smart decisions about what we pay for and how. There is no doubt that we must fix our present single-payer system, but none of its problems change the fact that Medicare is a popular, well-understood, amazingly efficient form of — wait for it — socialized medicine.

The dean of the House of Representatives, John Dingell, had it right when he introduced the notion of Medicare for all in 2006. We can correct the many gaps in today’s Medicare, not by buying stock in an insurance company or by staying on hold for a “benefits specialist” or by complaining to a state insurance commissioner. We do it by passing a law or a regulation that reflects the best interests of the nation.

Implicit in the Democratic plan — and the Republican opposition to it — is a tacit recognition that single-payer health plans like Medicare are the best way to go. I want to engage in this debate and will offer a single-payer plan to a vote as my colleagues and I mark up the health care bill. Maybe this issue is important enough that we can do the right thing even without a great catchphrase.

Rep. Anthony Weiner (D-N.Y.) is a member of the Energy and Commerce Committee’s Subcommittee on Health.

President Obama speaks the truth about single payer

News Conference

President Barack Obama
The White House
July 22, 2009
Question: …is this bill going to cover all 47 million Americans that are uninsured…?
President Obama: I want to cover everybody. Now, the truth is that unless you have a what’s called a single-payer system in which everybody is automatically covered, then you’re probably not going to reach every single individual…
There might still be people left out there who, even though there’s an individual mandate, even though they are required to purchase health insurance, might still not get it, or despite a lot of subsidies are still in such dire straits that it’s still hard for them to afford it, and we may end up giving them some sort of hardship exemption.
http://www.whitehouse.gov/the_press_office/News-Conference-by-the-President-July-22-2009/

Yes, but… why would hardship exemptions ever be preferred to automatic coverage of everyone under single payer?

President Obama speaks the truth about single payer

News Conference

President Barack Obama
The White House
July 22, 2009

Question: …is this bill going to cover all 47 million Americans that are uninsured…?

President Obama: I want to cover everybody. Now, the truth is that unless you have a what’s called a single-payer system in which everybody is automatically covered, then you’re probably not going to reach every single individual…

There might still be people left out there who, even though there’s an individual mandate, even though they are required to purchase health insurance, might still not get it, or despite a lot of subsidies are still in such dire straits that it’s still hard for them to afford it, and we may end up giving them some sort of hardship exemption.

http://www.whitehouse.gov/the_press_office/News-Conference-by-the-President-July-22-2009/

Comment:

By Don McCanne, MD

Yes, but… why would hardship exemptions ever be preferred to automatic coverage of everyone under single payer?

More of the Same Is Not Health Care Reform, It's a Placebo

Prepared by Leonard Rodberg, PhD, Professor of Urban Studies at Queens College/CUNY and Research Director of the NY Metro Chapter of Physicians for a National Health Program

Summary

There is little reform, and no serious cost control, in the health care reform plans that President Obama and the Congress are proposing:

Most people will continue to get their coverage through private insurance companies and will be forced to buy insurance of questionable value.

Employer-based insurance will continue unchanged, with employers free to change coverage at any time, insurers free to change their physician and hospital networks, and employees still locked into their jobs if they want to keep their coverage.

While the uninsured will be mandated by law to purchase health insurance, the Congressional bills place no limit on what the private insurance companies can charge for premiums or how great their deductibles and co-pays can be.

The structure of health care finance is in no way changed, and no serious cost control measures are built into these plans.

The “health insurance exchange” and its “public option,” the only new structural features of these plans, will affect little more than 10% of the population and will have no significant impact on the overall health care system. Those who receive insurance through their employer are not permitted to access the exchange or the public option.

The “public option” must be self-sustaining and follow the same rules as private insurers. Once set up, it will receive no government funds.
The subsidies for low- and moderate-income individuals and families are completely inadequate. Many will find insurance unaffordable, and underinsurance will continue.

Tens of millions of people will continue to be uninsured.

These plans are not reform; they are little more than a placebo, a detour from the path to true reform of our health care system.

President Obama has enunciated a set of goals for health care reform. These include (from his budget statement in February):

Aim for universality… put the United States on a clear path to cover all Americans.

Make health coverage affordable… reduce growing premiums and administrative costs.

Guarantee choice… provide a choice of physicians… keep your doctor.

Provide portability of coverage… workers not locked into their job just to secure health coverage.

We share the President’s goals. And yet the proposals coming out of Congress will not achieve them.

Unique among the nations of the world, the United States relies on private, for-private insurance companies to provide health insurance for the majority of its citizens. The plans that Congress is developing do not change this. In fact, they reinforce the very system that, in our view, is responsible for the problems we face. They simply delay movement toward the kind of system that can truly address them effectively. They are a detour on the path to true reform of our health care system.

In fact, employer-provided health insurance, on which 60% of us depend, will be little changed, even if Congress creates a “public option” or a new “health insurance exchange.” Actually, employer-based insurance will become even more prominent, as employers are required either to provide insurance to their employees or pay a fee to government that will fund subsidies that will enable them to purchase insurance through the “exchange.” (One change is proposed for employer-provided insurance: it could not include any annual or lifetime limits on coverage. While this is clearly desirable, by thus incorporating catastrophic insurance into basic plans, this will undoubtedly raise their cost).

Employer-based insurance will continue unchanged: Private health insurance companies will continue to operate exactly as they do now. Employers will be free to change coverage at any time; insurers will be free to change their physician and hospital networks; and employees will still be locked into their jobs, if they want to keep the same doctor, hospital or insurance coverage they now have.

President Obama’s mantra “if you like what you have, you can keep it” has been converted into “if you already have insurance, you have to keep it.” Everyone is required to have insurance, and employees offered insurance by their employers are required (if the price is not too high) to take it. The House and Senate bills only allow access to the “exchange” to people who don’t have insurance through their employer, and employees have to accept whatever plans their employer offers. They cannot choose the public option.

Obama has said his goal is health reform that will “ensure that you won’t lose your coverage even if you lose your job, or if you change your job,” but nothing in these bills provides this assurance. Again, employer-provided insurance is not touched by these plans.


Everyone will be required (or “mandated”) to have health insurance, either from their employer or purchased on their own. If their incomes are below 133% of the Federal poverty level, they will be eligible for Medicaid. The rest will have to purchase insurance through the new health insurance “exchange” and will there have access to the new “public option.”

Congress is specifying that only those who are uninsured or who do not receive insurance from their employers will have access to the “exchange” and the subsidies available through it. The Congressional Budget Office (CBO) estimates that between 30 and 40 million people might obtain coverage through the exchange. These Congressional plans, which are supposed design to “overhaul a broken system,” actually will affect barely 10% of the American people.

Clearly, a health insurance exchange that affects only 10% of the population cannot have a great much impact on the rising cost of health care. In particular, a “public option” that is accessible only through the exchange will have such a small member base that it could have only a marginal impact on the overall health care system. Perhaps they understand that, if a public plan, that was less expensive than private insurance and better “behaved” in reimbursing for claims, were to be opened to everyone, that could well be the end of private insurance as we know it.

The subsidies to help the uninsured purchase private health insurance are likely to be totally inadequate. A family of four earning $88,000 per year will receive no subsidy. Since the average family policy today costs more than $12,500, a family without subsidy will have to spend 14% of their income on just the premium alone. Add in the co-pays and deductibles not covered by insurance, and health care will be completely unaffordable for this family. While the uninsured will be mandated by law to purchase health insurance, the Congressional bills place no limit on what the private insurance companies can charge for premiums, or how great their deductibles and co-pays can be. And no limits are placed on drug prices, nor is there any plan to have the government negotiate drug prices with the pharmaceutical companies, as many advocates have urged for the Medicare program.

If we look at what has happened in Massachusetts, whose “universal health care” plan is the model for the Congress, we can see how inadequate will be the insurance that the uninsured will be required to buy. Individuals in Massachusetts face deductibles of at least $2,000 per year, and families’ deductibles are $4,000 per year. Even after spending thousands of dollars on private health insurance premiums, they must spend thousands of dollars more before the insurance actually provides them with any coverage at all.

Would the existence of a “public option” change this? The public plan that the Congress has designed is required to be financially self-sustaining, just like the private insurance with which it competes. Why would such a plan be attractive to consumers, other than perhaps its “public” label and its likely lower cost, estimated by the CBO to be about 10% below the cost of comparable private plans? The proposed public option will provide three kinds of plans — “basic, enhanced, and premium plans” just like private insurance. Since the public option has to operate under the same financial rules as private insurance, it is, in fact, just private insurance masquerading as a public entity.

Finally, central to Obama’s goals is holding down health care costs. However, the structure of health care finance is in no way changed by these Congressional bills, and no serious cost control measures are built into them. Administrative costs will not be reduced. In fact, the director of the CBO has said, “We do not see the sort of fundamental changes that would be necessary to reduce the trajectory of federal health spending by a significant amount.”

Most people will continue to get their insurance coverage through multiple employer-provided private insurance companies, while those who are currently uninsured will be forced to buy insurance of questionable value. The “health insurance exchange,” the only new structural feature of these plans, will affect such a small portion of the population that it could have no significant impact on the overall cost of the health care system.

The CBO also finds that, even after spending more than $1 trillion in the next ten years, nearly twenty million people will remain uninsured. We estimate that, to cover everyone and remove all financial barriers to care would require that we spend between $200 and $300 billion more each year on health care. Where would we get that amount of money? The only answer, but one which the leading committees of the Congress have steadfastly ignored, is through adoption of a single payer system, that is, an improved and expanded Medicare-for-All. This would achieve, by our best estimates, as much as $400 billion savings each year by eliminating the excessive overhead and administrative costs of the private insurance industry, along with the administrative and billing costs which that industry imposes on physicians, hospitals, and every other health care provider.

A great deal of effort has gone into developing a plan that will manifestly fail. Had Congress focused instead on developing a single payer, Medicare for All program, which address both the need for broad access to care and the need to contain costs, they would have made much more progress toward the health care system that would really serve the American people. The struggle for real health care reform will go on.

More of the Same Is Not Health Care Reform, It’s a Placebo

Prepared by Leonard Rodberg, PhD, Professor of Urban Studies at Queens College/CUNY and Research Director of the NY Metro Chapter of Physicians for a National Health Program

Summary

There is little reform, and no serious cost control, in the health care reform plans that President Obama and the Congress are proposing:

Most people will continue to get their coverage through private insurance companies and will be forced to buy insurance of questionable value.

Employer-based insurance will continue unchanged, with employers free to change coverage at any time, insurers free to change their physician and hospital networks, and employees still locked into their jobs if they want to keep their coverage.

While the uninsured will be mandated by law to purchase health insurance, the Congressional bills place no limit on what the private insurance companies can charge for premiums or how great their deductibles and co-pays can be.

The structure of health care finance is in no way changed, and no serious cost control measures are built into these plans.

The “health insurance exchange” and its “public option,” the only new structural features of these plans, will affect little more than 10% of the population and will have no significant impact on the overall health care system. Those who receive insurance through their employer are not permitted to access the exchange or the public option.

The “public option” must be self-sustaining and follow the same rules as private insurers. Once set up, it will receive no government funds.
The subsidies for low- and moderate-income individuals and families are completely inadequate. Many will find insurance unaffordable, and underinsurance will continue.

Tens of millions of people will continue to be uninsured.

These plans are not reform; they are little more than a placebo, a detour from the path to true reform of our health care system.

President Obama has enunciated a set of goals for health care reform. These include (from his budget statement in February):

Aim for universality… put the United States on a clear path to cover all Americans.

Make health coverage affordable… reduce growing premiums and administrative costs.

Guarantee choice… provide a choice of physicians… keep your doctor.

Provide portability of coverage… workers not locked into their job just to secure health coverage.

We share the President’s goals. And yet the proposals coming out of Congress will not achieve them.

Unique among the nations of the world, the United States relies on private, for-private insurance companies to provide health insurance for the majority of its citizens. The plans that Congress is developing do not change this. In fact, they reinforce the very system that, in our view, is responsible for the problems we face. They simply delay movement toward the kind of system that can truly address them effectively. They are a detour on the path to true reform of our health care system.

In fact, employer-provided health insurance, on which 60% of us depend, will be little changed, even if Congress creates a “public option” or a new “health insurance exchange.” Actually, employer-based insurance will become even more prominent, as employers are required either to provide insurance to their employees or pay a fee to government that will fund subsidies that will enable them to purchase insurance through the “exchange.” (One change is proposed for employer-provided insurance: it could not include any annual or lifetime limits on coverage. While this is clearly desirable, by thus incorporating catastrophic insurance into basic plans, this will undoubtedly raise their cost).

Employer-based insurance will continue unchanged: Private health insurance companies will continue to operate exactly as they do now. Employers will be free to change coverage at any time; insurers will be free to change their physician and hospital networks; and employees will still be locked into their jobs, if they want to keep the same doctor, hospital or insurance coverage they now have.

President Obama’s mantra “if you like what you have, you can keep it” has been converted into “if you already have insurance, you have to keep it.” Everyone is required to have insurance, and employees offered insurance by their employers are required (if the price is not too high) to take it. The House and Senate bills only allow access to the “exchange” to people who don’t have insurance through their employer, and employees have to accept whatever plans their employer offers. They cannot choose the public option.

Obama has said his goal is health reform that will “ensure that you won’t lose your coverage even if you lose your job, or if you change your job,” but nothing in these bills provides this assurance. Again, employer-provided insurance is not touched by these plans.


Everyone will be required (or “mandated”) to have health insurance, either from their employer or purchased on their own. If their incomes are below 133% of the Federal poverty level, they will be eligible for Medicaid. The rest will have to purchase insurance through the new health insurance “exchange” and will there have access to the new “public option.”

Congress is specifying that only those who are uninsured or who do not receive insurance from their employers will have access to the “exchange” and the subsidies available through it. The Congressional Budget Office (CBO) estimates that between 30 and 40 million people might obtain coverage through the exchange. These Congressional plans, which are supposed design to “overhaul a broken system,” actually will affect barely 10% of the American people.

Clearly, a health insurance exchange that affects only 10% of the population cannot have a great much impact on the rising cost of health care. In particular, a “public option” that is accessible only through the exchange will have such a small member base that it could have only a marginal impact on the overall health care system. Perhaps they understand that, if a public plan, that was less expensive than private insurance and better “behaved” in reimbursing for claims, were to be opened to everyone, that could well be the end of private insurance as we know it.

The subsidies to help the uninsured purchase private health insurance are likely to be totally inadequate. A family of four earning $88,000 per year will receive no subsidy. Since the average family policy today costs more than $12,500, a family without subsidy will have to spend 14% of their income on just the premium alone. Add in the co-pays and deductibles not covered by insurance, and health care will be completely unaffordable for this family. While the uninsured will be mandated by law to purchase health insurance, the Congressional bills place no limit on what the private insurance companies can charge for premiums, or how great their deductibles and co-pays can be. And no limits are placed on drug prices, nor is there any plan to have the government negotiate drug prices with the pharmaceutical companies, as many advocates have urged for the Medicare program.

If we look at what has happened in Massachusetts, whose “universal health care” plan is the model for the Congress, we can see how inadequate will be the insurance that the uninsured will be required to buy. Individuals in Massachusetts face deductibles of at least $2,000 per year, and families’ deductibles are $4,000 per year. Even after spending thousands of dollars on private health insurance premiums, they must spend thousands of dollars more before the insurance actually provides them with any coverage at all.

Would the existence of a “public option” change this? The public plan that the Congress has designed is required to be financially self-sustaining, just like the private insurance with which it competes. Why would such a plan be attractive to consumers, other than perhaps its “public” label and its likely lower cost, estimated by the CBO to be about 10% below the cost of comparable private plans? The proposed public option will provide three kinds of plans — “basic, enhanced, and premium plans” just like private insurance. Since the public option has to operate under the same financial rules as private insurance, it is, in fact, just private insurance masquerading as a public entity.

Finally, central to Obama’s goals is holding down health care costs. However, the structure of health care finance is in no way changed by these Congressional bills, and no serious cost control measures are built into them. Administrative costs will not be reduced. In fact, the director of the CBO has said, “We do not see the sort of fundamental changes that would be necessary to reduce the trajectory of federal health spending by a significant amount.”

Most people will continue to get their insurance coverage through multiple employer-provided private insurance companies, while those who are currently uninsured will be forced to buy insurance of questionable value. The “health insurance exchange,” the only new structural feature of these plans, will affect such a small portion of the population that it could have no significant impact on the overall cost of the health care system.

The CBO also finds that, even after spending more than $1 trillion in the next ten years, nearly twenty million people will remain uninsured. We estimate that, to cover everyone and remove all financial barriers to care would require that we spend between $200 and $300 billion more each year on health care. Where would we get that amount of money? The only answer, but one which the leading committees of the Congress have steadfastly ignored, is through adoption of a single payer system, that is, an improved and expanded Medicare-for-All. This would achieve, by our best estimates, as much as $400 billion savings each year by eliminating the excessive overhead and administrative costs of the private insurance industry, along with the administrative and billing costs which that industry imposes on physicians, hospitals, and every other health care provider.

A great deal of effort has gone into developing a plan that will manifestly fail. Had Congress focused instead on developing a single payer, Medicare for All program, which address both the need for broad access to care and the need to contain costs, they would have made much more progress toward the health care system that would really serve the American people. The struggle for real health care reform will go on.