PNHP

May 30th: National Day of Action

May 30th: National Day of Action

Nationwide Rallies for Improved Medicare for All

Join thousands of single-payer supporters in a nationwide week of action to support improved Medicare for all (HR 676). Single-payer activists will be gathering all over the country to say, “Healthcare, yes; Insurance companies, no,” and to show solidarity with demonstrations at the AHIP (American Health Insurance Plans, a private health insurance lobby) conference in San Diego.

If an action isn’t already in your city, plan your own day of action! It can be a town hall meeting, demonstration in front of a local insurance company, film showing, vigil, or your own unique idea. Let us know what you’d like to start planning by contacting info@healthcare-now.org.

47 million Americans are uninsured. Private insurance rates are rising faster than inflation and our incomes. By 2025 the cost of private health insurance will exceed our projected income.

A national, single-payer healthcare system is the only healthcare reform option that will cover every American resident while saving us billions of dollars. The majority of Americans want it. The majority of physicians want it. The only thing missing is the political will in Washington.

Improved Medicare for All: We can do it!

Sponsored by:

The Leadership Conference for Guaranteed Health Care
Healthcare-NOW!
Progressive Democrats of America
CNA/National Nurses Organizing Committee
Physicians for a National Health Program
Americans for Democratic Action

Relman/Angell letter in The New York Times

Taming Runaway Health Care Costs

Letters
The New York Times
May 16, 2009
To the Editor:
David Leonhardt, in his May 13 column (“Health Care, a Lesson in Pain,” Economic Scene), is quite right that “the only way to have a sustainable universal health care system is to control costs.” But in analyzing the experts’ testimony before the Senate Finance Committee on how to pay for health care, he did not mention a solution that neither the experts nor the committee wants to consider: major reform of the system.
Runaway costs are due largely to high overhead expenses throughout the system, and to the excessive use of expensive technology. Both of these result from a health care system that is organized like a profit-seeking industry instead of a social service.
If we want health care to be a universal entitlement, it cannot be controlled by market forces and the financial interests of insurers and providers (and the investors who own such a large part of the system).
Some kind of government-regulated single-payer insurance plan and a reorganized nonprofit medical care delivery system may be “off the table” for policy makers right now, but we will never achieve affordable universal coverage without major reform that deals with the real causes of medical inflation.
We don’t need more money; we need a new system.
Arnold S. Relman
Marcia Angell
Cambridge, Mass.
The writers, medical doctors, are former editors in chief of The New England Journal of Medicine.
http://www.nytimes.com/2009/05/16/opinion/l16health.html

Although single payer advocates were not allowed to testify at the Senate Finance Committee roundtable on reform, the New York Times seems to agree that the concept of comprehensive reform is worthy of their Letters page.
When will the opinion editors decide that the concept is worthy of a guest op-ed? More importantly, when will the news editors decide that the the suffering, financial hardship, and death is worthy of a news report on the political suppression of policies that would greatly improve the health and financial outcomes of those who face significant medical problems? Shouldn’t that be an above-the-fold front page story?
Addendum: Today “single payer health care” was discussed on The Diane Rehm Show by guests Dr. David Himmelstein, Sen. Bernie Saunders, Roger Hickey, and Susan Dentzer. The program is archived at:
http://wamu.org/programs/dr/09/05/18.php#26151

Relman/Angell letter in The New York Times

Taming Runaway Health Care Costs

Letters
The New York Times
May 16, 2009

To the Editor:

David Leonhardt, in his May 13 column (“Health Care, a Lesson in Pain,” Economic Scene), is quite right that “the only way to have a sustainable universal health care system is to control costs.” But in analyzing the experts’ testimony before the Senate Finance Committee on how to pay for health care, he did not mention a solution that neither the experts nor the committee wants to consider: major reform of the system.

Runaway costs are due largely to high overhead expenses throughout the system, and to the excessive use of expensive technology. Both of these result from a health care system that is organized like a profit-seeking industry instead of a social service.

If we want health care to be a universal entitlement, it cannot be controlled by market forces and the financial interests of insurers and providers (and the investors who own such a large part of the system).

Some kind of government-regulated single-payer insurance plan and a reorganized nonprofit medical care delivery system may be “off the table” for policy makers right now, but we will never achieve affordable universal coverage without major reform that deals with the real causes of medical inflation.

We don’t need more money; we need a new system.

Arnold S. Relman
Marcia Angell
Cambridge, Mass.

The writers, medical doctors, are former editors in chief of The New England Journal of Medicine.

http://www.nytimes.com/2009/05/16/opinion/l16health.html

Comment:

By Don McCanne, MD

Although single payer advocates were not allowed to testify at the Senate Finance Committee roundtable on reform, the New York Times seems to agree that the concept of comprehensive reform is worthy of their Letters page.

When will the opinion editors decide that the concept is worthy of a guest op-ed? More importantly, when will the news editors decide that the the suffering, financial hardship, and death is worthy of a news report on the political suppression of policies that would greatly improve the health and financial outcomes of those who face significant medical problems? Shouldn’t that be an above-the-fold front page story?

Addendum: Today “single payer health care” was discussed on The Diane Rehm Show by guests Dr. David Himmelstein, Sen. Bernie Saunders, Roger Hickey, and Susan Dentzer. The program is archived at:
http://wamu.org/programs/dr/09/05/18.php#26151

Baucus Healthcare Plan: Arrest Doctors, Nurses

by John Nichols
The Nation
05/13/2009

Senate Finance Committee chairman Max Baucus, the insurance industry-friendly Democrat who is managing show hearings on healthcare reform, has come up with a novel way to express his commitment to care for the almost 50 million Americans who have no healthcare and roughly equal number who have inadequate care.

The senior senator from Montana is ordering the arrest of doctors and nurses.

Medical practitioners who have shown up at Baucus-chaired “roundtable discussions” to demand consideration of a real fix — the single-payer, genuinely-public reform that assures all Americans will have health care while at the same time holding down costs — are being taken into custody and removed from the hearing rooms.

At the first Finance Committee session last week, Dr. Margaret Flowers and seven others were taken into custody when they urged Baucus to include witnesses who support single-payer.

Dr. Flowers discussed her arrest on Ed Schultz’s MSNBC show, explaining that physicians, nurses and reform groups representing more than 20 million Americans had repeatedly asked to be heard by Baucus and his colleagues.

But the answer from Baucus, who has been charged by the Obama administration with shaping a health-care plan, has been to call in the cops.

“They just don’t want to hear from single-payer,” explained Dr. Flowers, a pediatrician from Maryland. “We’ve been trying for months now, meeting with members of Congress, to be included in the hearings at the events that they are holding and they keep excluding us.”

After reviewing the details of the Baucus overreaction, Schultz asked: “President Obama: Do you support excluding people from the discussion?”

Obama has not responded.

But Baucus has.

On Tuesday, at the second Finance Committee session, dozens of California Nurses Association/National Nurses Organizing Committee members and their allies showed up to protest the heavy-handed tactics. At the opening of the hearing, roughly thirty of them rose and turned their backs to Baucus. On their backs were signs reading: “Pass Single-Payer” and “Nurses Say: Patients First.” Other signs, reading “Stop AHIP,” protested the collaboration by the Obama administration and Baucus with the country’s most powerful industry lobby, the America’s Health Insurance Plans group.

While the health-insurance lobby has been welcomed to the roundtable discussions organized by Baucus, the nurses and their allies were told to leave. When five objected to their exclusion from the hearing, and to the the exclusion of single-payer from the debate about how to fix a broken private healthcare system, they were arrested. Among those taken into custody were Dr. Judy Dasovich, Dr. Steven Fenichel and California nurses DeAnn McEwen and Sue Cannon.

Their crime? As healthcare professionals, they dared to dissent from the Baucus-led attempt to impose an insurance company approved plan under the guise of “reform.”

Dr. Dasovich, a physician from Springfield, Missouri, dared to say, “We request that single-payer advocates be allowed at the table. Healthcare should be for patients, not for profits.” Nurse Cannon said, “People at the table have failed Americans for 30 years. We want single-payer at the table. We want guaranteed health care so we can give the care we need, when we need to give it.”

When the doctors, nurses and their allies left the Capitol, activist David Swanson reported, members of the CNA/NNOC, Progressive Democrats of American, Code Pink and allied single-payer advocates chanted: “Lock Up Baucus!” and hoisted a sign reading: “Most Physicians Want a Single-Payer National Health System.”

At the White House, reporter Helen Thomas asked Obama administration spokesman Robert Gibbs: “Did anyone represent single-payer at this meeting today?”

Gibbs tried to spin it.

“Well, I don’t think it was a full meeting of those that might be at the table,” the scrambling spokesman said. “I believe that people of varying opinions have been here for different meetings, have been part of the larger healthcare reform summit that was done earlier this year, and I don’t doubt that in the coming days differing viewpoints about how to achieve cost savings in increased coverage will be part of that discussion.”

If that sounded like a dodge, it was.

But single-payer advocates weren’t fooled.

They’re raising the banner of real reform higher, with events such as Tuesday’s Florence Nightingale Day Protest organized by the California Nurses Association/National Nurses Organizing Committee and Physicians for a National Health Program. Explained CNA/NNOC: “May 12 is Florence Nightingale’s Birthday – an opportunity to honor her advocacy of healthcare by protesting Congressional hearings that have been stacked in favor of the big insurance companies while silencing the voices of nurses and doctors who favor guaranteed healthcare, as in a single-payer, expanded Medicare-for-all system with a single standard of quality care.”

Those physicians and nurses groups, along with Progressive Democrats of America and other members of the Leadership Conferences for Guaranteed Health Care rallied Wednesday with feature key congressional advocates for single-payer healthcare, including Vermont Senator Bernie Sanders and Michigan Congressman John Conyers, as well as CNA/NNOC executive director Rose Ann DeMoro, Dr. Flowers and actor Mike Farrell.

The rally was held at Washington’s Upper Senate Park, a location outside the Capitol where doctors and nurses are able to talk about curing what ails American healthcare without facing arrest.

Doctor: Single-payer system would solve health-care woes

By Allison Ryan
News Tribune (LaSalle, Ill.)
Thursday, May 14, 2009

Anne Scheetz, a Chicago-area doctor, is dedicated to single-payer health care as the only pragmatic solution for the nation’s health care problems.

A member of Physicians for a National Health Care Progam and its Illinois chapter, Health Care for All Illinois, Scheetz is the Chicago co-chairmanl of Illinois Single Payer Coalition.

“I’ve been in practice for more than 25 years and I’ve watched the health care system collapse around me, and really I’m ashamed. I’m ashamed to be an American physician,” Scheetz told a small group at a Wednesday night event sponsored by Illinois Valley Center for Independent Living.

The shame hits when she’s waiting for appointments with her own doctor, or taking her mother to the eye doctor, and seeing people with Medicaid or with no insurance get refused treatment, or when she herself has to turn down a patient whose Medicaid does not cover home visits.

Single-payer health care means all health care services are billed to the government and paid with funds collected from taxpayers. Under such a system, everyone in the country would have access to health care, regardless of income.

Scheetz said it’s a social justice issue. Members of the movement rally behind the slogans, “Everybody in, nobody out” and “One nation, one plan.”

“We consider ourselves to be in the tradition of the great human rights movements — the abolition of slavery, votes for women, civil rights, all of those… We cannot live in a country where some people make billions of dollars out of depriving people of medical care and leaving them homeless from their medical bills,” Scheetz said. “I think the single-payer people are pragmatists. We’re sometimes accused of being ‘pie-in-the-sky’ers. It’s pie in the sky to say you can regulate the insurance industry,” Scheetz said.

Sheetz and her husband, Jim Rhodes, said the current system hurts employers and municipalities, too, because of the amount they have to pay for employees or retirees. She pointed to the financial trouble at large companies such as GM and Caterpillar, which she said involves the high cost of health care for union employees. Jim said municipalities, for whom employee benefits are often a heavy burden, could benefit from a single-payer system, too.

Medicare beats employer-sponsored plans

Meeting Enrollees’ Needs: How Do Medicare And Employer Coverage Stack Up?

By Karen Davis, Stuart Guterman, Michelle M. Doty, Kristof M. Stremikis
Health Affairs
May 12, 2009
One key issue in health reform concerns the relative roles of coverage offered through private insurance and public programs. This paper compares the experiences of aged Medicare beneficiaries with those of people under age sixty-five who have private employer coverage. Compared with the employer-coverage group, people in the Medicare group report fewer problems obtaining medical care, less financial hardship due to medical bills, and higher overall satisfaction with their coverage. Although access and bill payment problems increased across the board from 2001 to 2007, the gap between Medicare and private employer coverage widened.
http://content.healthaffairs.org/cgi/content/abstract/hlthaff.28.4.w521v1

Very few individuals, especially those already covered by Medicare, will be surprised by this study. It demonstrates that, compared to people under 65 with private employer-sponsored coverage, Medicare beneficiaries over 65 have fewer problems with access to care, have less financial hardship due to medical bills, and have higher overall satisfaction with their coverage.
The private insurance industry has been taking quite a beating lately, and appropriately so. Much of the criticism has been targeted to the individual and small group insurance market, especially since these more innovative plans have been quite ineffective in preventing financial hardship for those who need care.
In contrast, policy makers and legislators in Washington are claiming that the employer-sponsored segment of the private insurance market is working quite well for us, and reform should include policies to expand this market. But this study isolated the employer-sponsored segment and compared it specifically with Medicare. No contest. Medicare is clearly superior to employer-sponsored plans.
This study will be cited by those who support a Medicare-like option within a market of private plans. But what is the implication for the taxpayers?
An employer-sponsored plan is no longer affordable for average-income workers, and already is subsidized through the tax system. It is absolutely inevitable that additional taxpayer subsidies would be required to pay for private plans, whether through tax credits, tax deductions or vouchers. It is morally wrong to require taxpayers to subsidize inferior private health plans when they could be replaced with a superior, more efficient public insurance program – an expanded and improved Medicare for all.
It’s our tax money. We have a right to demand higher value in health care purchases made by our public stewards – precisely the value that a single payer national health program would bring us.

Medicare beats employer-sponsored plans

Meeting Enrollees' Needs: How Do Medicare And Employer Coverage Stack Up?

By Karen Davis, Stuart Guterman, Michelle M. Doty, Kristof M. Stremikis
Health Affairs
May 12, 2009

One key issue in health reform concerns the relative roles of coverage offered through private insurance and public programs. This paper compares the experiences of aged Medicare beneficiaries with those of people under age sixty-five who have private employer coverage. Compared with the employer-coverage group, people in the Medicare group report fewer problems obtaining medical care, less financial hardship due to medical bills, and higher overall satisfaction with their coverage. Although access and bill payment problems increased across the board from 2001 to 2007, the gap between Medicare and private employer coverage widened.

http://content.healthaffairs.org/cgi/content/abstract/hlthaff.28.4.w521v1

Comment:

By Don McCanne, MD

Very few individuals, especially those already covered by Medicare, will be surprised by this study. It demonstrates that, compared to people under 65 with private employer-sponsored coverage, Medicare beneficiaries over 65 have fewer problems with access to care, have less financial hardship due to medical bills, and have higher overall satisfaction with their coverage.

The private insurance industry has been taking quite a beating lately, and appropriately so. Much of the criticism has been targeted to the individual and small group insurance market, especially since these more innovative plans have been quite ineffective in preventing financial hardship for those who need care.

In contrast, policy makers and legislators in Washington are claiming that the employer-sponsored segment of the private insurance market is working quite well for us, and reform should include policies to expand this market. But this study isolated the employer-sponsored segment and compared it specifically with Medicare. No contest. Medicare is clearly superior to employer-sponsored plans.

This study will be cited by those who support a Medicare-like option within a market of private plans. But what is the implication for the taxpayers?

An employer-sponsored plan is no longer affordable for average-income workers, and already is subsidized through the tax system. It is absolutely inevitable that additional taxpayer subsidies would be required to pay for private plans, whether through tax credits, tax deductions or vouchers. It is morally wrong to require taxpayers to subsidize inferior private health plans when they could be replaced with a superior, more efficient public insurance program – an expanded and improved Medicare for all.

It’s our tax money. We have a right to demand higher value in health care purchases made by our public stewards – precisely the value that a single payer national health program would bring us.

Insurers place burden on physician practices

What Does It Cost Physician Practices To Interact With Health Insurance Plans?

By Lawrence P. Casalino, Sean Nicholson, David N. Gans, Terry Hammons, Dante Morra, Theodore Karrison, Wendy Levinson
Health Affairs
May 14, 2009
Physicians have long expressed dissatisfaction with the time they and their staffs spend interacting with health plans. However, little information exists about the extent of these interactions. We conducted a national survey on this subject of physicians and practice administrators. Physicians reported spending three hours weekly interacting with plans; nursing and clerical staff spent much larger amounts of time. When time is converted to dollars, we estimate that the national time cost to practices of interactions with plans is at least $23 billion to $31 billion each year.
http://content.healthaffairs.org/cgi/content/abstract/hlthaff.28.4.w533

And…

Peering Into The Black Box: Billing And Insurance Activities In A Medical Group

By Julie Ann Sakowski, Jeffrey M. Newman, James G. Kahn, Richard G. Kronick, Harold S. Luft
Health Affairs
May 14, 2009
Billing and insurance-related functions have been reported to consume 14 percent of medical group revenue, but little is known about the costs associated with performing specific activities. We conducted semistructured interviews, observed work flows, analyzed department budgets, and surveyed clinicians to evaluate these activities at a large multispecialty medical group. We identified 0.67 nonclinical full-time-equivalent (FTE) staff working on billing and insurance functions per FTE physician. In addition, clinicians spent more than thirty-five minutes per day performing these tasks. The cost to medical groups, including clinicians’ time, was at least $85,276 per FTE physician (10 percent of revenue).
http://content.healthaffairs.org/cgi/content/abstract/hlthaff.28.4.w544

Much has been said about the large amount of premium dollars that are spent on the administrative excesses of the private insurance industry. These two important studies add additional evidence that the excesses of the private plans also increase the administrative burden placed on physicians and their co-workers.
The price paid for continuing to tolerate our dysfunctional, multi-payer system is tallied not only in manpower hours lost, but also in the monetary value of this wasteful burden placed on our health care professionals. Not quantified here is the price paid in loss of job satisfaction and the potential negative impact that could have on the enthusiasm for advocating for the best patient care possible within the resources made available.
Yesterday President Obama, boiling it down to basics, said, “But whatever plans emerge, both from the House and the Senate, I do believe that they’ve got to uphold three basic principles: first, that the rising cost of health care has to be brought down; second, that Americans have to be able to choose their own doctor and their own plan; and third, all Americans have to have quality, affordable health care.”
Americans have to be able to choose their own plan? Instead of having all essential care covered automatically by a single program, we have to choose a plan that limits coverage and limits choice of health care professionals? And for that we have to pay much more to cover the wasteful administrative costs of the insurers and the physicians? Why is that a basic principle?

Health Insurance Exchange and private plan behavior

Expanding Health Care Coverage: Proposals to Provide Affordable Coverage to All Americans

Description of Policy Options

Senate Finance Committee
May 14, 2009 (released May 11)

Health Insurance Exchange

Proposed Options

Plan Participation. All state-licensed private insurers in the non-group and small group markets, and the public health insurance option if applicable, operating nationally, regionally, statewide, or locally would be required to participate in the Health Insurance Exchange. Private insurers would also be permitted to sell these policies directly to purchasers.

http://finance.senate.gov/sitepages/leg/LEG%202009/051109%20Health%20Care%20Description%20of%20Policy%20Options.pdf

And…

What Health Insurance Exchanges or Choice Pools Can and Can’t Do About Risks and Costs

By Rick Curtis and Ed Neuschler
Institute for Health Policy Solutions
May 2009

Health Plan Participation and Perspectives

Where health insurance pools or exchanges are an optional coverage venue, and there are no incentives or requirements for their use, exchanges that are expected to offer licensed health insurance plans need those plans more than the health plans need the exchange.

Most health plans strongly prefer direct contracts with with whole employer groups over enrollment through such purchasing pools. Their reasons include:

* Maintaining their business role. Many plans do not want to cede — to pools or to anyone else — administrative functions such as premium collection and enrollment. …they are concerned about losing revenues and functions that are a key component of their resource base and their value-added role as a business.

* Resistance to being “commoditized.” Health plans generally do not like competing head-to-head on price for the same benefit package.

* Fear of adverse selection where the pool, rather than the plan, controls marketing, eligibility, rating, enrollment, etc. Plans fear that, overall, purchasing pools will attract less healthy groups that can’t get coverage elsewhere — at least not as easily.

For these reasons, health plans are reluctant to participate in a pool or exchange that largely competes against plans’ own direct contracting with small employers or individuals. If they agree to participate, they likely will not offer lower prices to the pool/exchange than they charge for their outside business. Further, the general point made earlier is worth repeating: Most established health plans are unlikely to cooperate in helping a pool that competes for their direct enrollment. They generally have no desire to create a larger purchaser with more bargaining clout out of smaller, weaker employer groups or individuals.

http://www.allhealth.org/briefingmaterials/WhatHealthInsuranceExchangesorChoicePoolsCanandCantDoAboutRisksandCosts-1459.pdf

Comment:

By Don McCanne, MD

What was the campaign rhetoric? Something like, “You can keep the insurance you have if that’s what you want, and, if you prefer, you can choose a plan like the members of Congress have.”

Although no final decisions have been made, our congressional leaders have made it clear that reform will be built on the existing model of private plans and public programs. Although the private insurance industry has promised full cooperation with reform, most moderates and progressives understand that legislated insurance market reforms will be essential if the industry is expected to live up to its promises.

Rather than a revolutionary transformation of the private insurance industry into a highly regulated social insurance program, Congress seems intent on establishing a Health Insurance Exchange, as described in the Senate Finance policy option paper. So that “you can keep the insurance you have,” the private insurance industry would be allowed to continue to offer their products directly to individuals and employers.

But think about that. Private insurers will continue to do what private insurers do well. They will do whatever is necessary to continue to insure the large numbers of individuals who are healthy, while shunning those with greater health care needs.

Employer-sponsored plans are often touted as the sector of health care coverage that is working well for us, though rising costs are a growing threat to the stability of these plans. These plans do work fairly well for some of us because they cover the low-cost healthy workforce and their young healthy families, they spread risk through larger, less expensive pools, and they have lower administrative costs than the individual and small group plans. The private insurance industry, either as insurers or as administrators for self-insured plans, will continue to thrive in this market.

So what is the purpose of the Health Insurance Exchange? It is a way of requiring plans to provide coverage to the much neglected individual and small group markets. The private insurance industry is already very wary of this market, and has responded with risk-avoidance behaviors that we find to be so repulsive. As Curtis and Neuschler explain in their report, the insurance industry will be “unlikely to cooperate in helping a pool that competes for their direct enrollment.” Again, private insurers being what they are, they will make every effort to be certain that their own subsidiaries in the Exchange will fail in their efforts to compete successfully with their private plans sold directly to purchasers.

Now step back and think about this. The comments here discuss only one paragraph in a 61 page report about policy options for reform, and this is only one of three reports that the Senate Finance Committee is releasing. The complexities of building reform on the U.S. business model of private plans make it absolutely impossible to create an equitable, efficient and affordable health care financing system for everyone. And the House leaders pledged today that they will pass a comprehensive reform bill by July 31! If you think the Clinton proposal was a
disaster, just wait!

Can Health Insurers Be Cost-Cutters?

Laura S. Boylan
Letter to the Editor
New York Times
May 11, 2009

To the Editor:

Paul Krugman outlines proposed cost-cutting by the “medical-industrial complex.” Why, thank you, medical- industrial complex! How nice to suggest lowering costs.

At the risk of seeming ungrateful, I wish to point out that the problem with voluntary cost reduction is that it’s voluntary. As long as the logic of our system is set by a huge for-profit multipayer bureaucracy, we will continue to get low value on the health care dollar.

Our nation’s ability to afford decent health care for all our citizens must not depend on voluntary self-regulation of for-profit entities. We need single-payer national health insurance. Let’s circle the wagons around health care, not around private insurance companies and Big Pharma.

The writer, a clinical associate professor of neurology at New York University School of Medicine, is on the board of directors of Physicians for a National Health Program, Metro New York.