PNHP

Dr. Steffie Woolhandler on Radio Times

Dr. Steffie Woolhandler on Radio Times

Radio Times with Marty Moss-Coane
WYCC
Wednesday 4/15/2009

When Barak Obama outlined his proposal for reforming the health care system, the concept of a single-payer system was once again left out of the equation. But there still is a strong and vocal voice for the concept. What is a single payer system and why is it, or isn’t, the solution to our health care crisis? Our guests are ROBERT MOFFIT of the Heritage Foundation and STEFFIE WOOLHANDLER of Physicians for a National Health Program

Click here to listen (mp3)

Crisis = Opportunity for Single-Payer

Fiscal crises may force Obama to save costs via a single-payer plan.

By Roger Bybee
Dollars & Sense
Issue 281 – March/April 2009

President Obama seems ready to proceed full-throttle toward a health care reform plan, but one that will keep private insurers at the center of the system. The plan, termed “guaranteed affordable choice,” would allow workers to “keep the insurance they like,” find a rival private insurer, or opt into a Medicare-style public plan.

To date, Obama has sensibly insisted that quick action on health care is imperative. “It’s not something that we can put off because of the [financial] emergency,” Obama declared in December. “This is part of the emergency.” Questioned about the wisdom of launching a $100 billion health care program at a time of mounting government deficits, “I ask a different question,” Obama countered. “How can we afford not to?”

He’s right: economic meltdown is making health care reform more urgent by the day. Hospitals are hurting; while “the number of paying patients and profitable elective procedures is down . . . ,” the LA Times reported recently, “the number of uninsured patients whom hospitals treat is rising.” At the same time, escalating health care costs are squeezing private employers and governments alike. “The new Congressional Budget Office report shows that rising health care costs are the largest driver of the nation’s long-term budget problems,” budget watchdog Robert Greenstein of the Center on Budget and Policy Priorities told Congress last fall.

But Obama’s hybrid, public-private plan is likely to hit a fiscal wall as federal spending balloons, and along with it the deficit. In the end, both popular sentiment and fiscal barriers may force him to follow a different course.

The administration’s plan subsidizes lower-income Americans to enable them to buy private health insurance. Contrary to Obama’s statements during the campaign, his plan will “need to require” all individuals to have health insurance, concludes the respected Commonwealth Fund. Such a mandate would be crucial to securing industry concessions necessary to move toward universal coverage, particularly a ban on excluding people with pre-existing conditions from coverage.

If so, the plan would eventually deliver tens of millions of new enrollees –the number of uninsured is about 47 million–to the insurance companies. Some 31% of their premiums, in many cases government-subsidized, will go into overhead and insurance company profits–an estimated $400 billion annual burden weighing down the health care system.

But this plan is on a collision course with the fiscal realities. On top of the budget wreckage left by the Bush years, the federal government’s fiscal demands are exploding. Health care reform faces daunting competition from a $787 billion stimulus package; the president’s $72 billion decision to delay repealing the Bush tax cuts for high earners; a Wall Street, bank, and insurance company bailout at $700 billion to date and likely to grow; and the ongoing Iraq and Afghanistan wars, together costing $170 billion in “extra” defense spending in FY2009.

Still, a leading advocate of the Obama plan, political scientist Jacob Hacker, argues that it can be billed as an important economic stimulus and thus escape the fierce budgetary competition. In December, Hacker cheerfully declared in The New Republic that the Obama plan offers nothing less than a “magic bullet” that will yield “short-term spending and long-term saving”–a perfect combination as the economy moves deeper into recession.

However, it is likely that Hacker seriously overstates the long-term savings while underestimating the clash of government priorities that lies just ahead. First, Obama-style individual mandate plans have run aground in at least six states that have tried them. With no mechanism to control the premiums charged by private insurers, the ever-higher cost of subsidizing low-income residents’ premiums soon exhausts available funds. Nor will sufficient savings be derived from Obama’s plan for electronic recordkeeping and more treatment of chronic illness, recent studies by the Congressional Budget Office and others suggest.

To many, a single-payer plan is the obvious way to ensure universal health coverage while containing costs. In addition to the dramatic reduction in administrative costs, single-payer plans offer other opportunities for controlling costs. For instance, they allow government–the “single payer” –to negotiate for lower costs with providers like doctors, hospitals, and pharmaceutical companies.

Unfortunately, Obama’s statements and key appointments suggest he has already disqualified single-payer as a serious option.

Tom Daschle, tapped for Health and Human Services secretary and “point man” on the health care reform effort until tax problems forced him to withdraw his name in February, appeared unwilling to let the private insurance industry go. His basic policy direction emerged in an interview last May. In a remark that seems staggering in hindsight, Daschle said, “And I would ask the question, if you think our banking system today is reasonably regulated, why not try the same model for our health-care system?”

Obama’s initial pick for surgeon general was TV health expert Dr. Sanjay Gupta. Gupta was trounced by Michael Moore in a televised debate over Moore’s documentary “Sicko,” and was then forced to retract some of the factually inaccurate criticisms of single-payer he had offered.

Another key player is Senate Finance Chair Max Baucus, author of a plan similar to Obama’s. Baucus recently dismissed the single-payer option on this basis: “We are Americans; we’re different from Canada, we’re different from the United Kingdom.” Baucus was probably not referring to the United States’ poorer health outcomes at vastly higher costs when he spoke of the American “difference.”

Promoted by this kind of team, Obama’s health-care plan could prove to be the most vulnerable component of his domestic program. The Republicans feel confident about their ability to brand Obama’s plan as overly complex and a threat to consumer choice in medical care, as they did so successfully with the Clinton plan in the 1990s.

The Obama plan’s “pay or play” component, giving employers a choice between insuring their employees or paying a tax to help finance the government plan, will no doubt open it up to conservative criticism as a coercive, big-government program. This line may also strike a chord among moderate-income citizens who earn too much to qualify for a subsidy and consequently lose enthusiasm for reform once they start to pay mandatory health premiums.

The single-payer approach, on the other hand, would disarm many of the most explosive Republican arguments. It is far less costly to both employers and individuals–nearly 50% lower per person in Canada than the United States, for instance–and there is no billing of patients or other complexity. Every citizen enjoys the right to health care and a free choice of doctors and hospitals. Start-up costs would be minimal, especially if Medicare were simply expanded to cover the entire public.

Back in 2003, Barack Obama told the Illinois AFL-CIO: “I happen to be a proponent of a single-payer universal health care program. I see no reason why the United States of America, the wealthiest country in the history of the world, spending 14% of its Gross National Product on health care, cannot provide basic health insurance to everybody . . . a single-payer health care plan, a universal health care plan. And that’s what I’d like to see. But as all of you know, we may not get there immediately. Because first we have to take back the White House, we have to take back the Senate, and we have to take back the House.”

Now that Obama himself occupies the White House and health care costs consume nearly 17% of GNP, the new president may rediscover that single-payer is the truly pragmatic course on health care reform. Hemmed in on all sides by the enormous costs facing the federal government, Obama may find–despite his misgivings–that pursuing a single-payer reform plan is the sole means of creating a low-cost and appealing alternative to the health-care status quo.

Roger Bybee is the former editor of the union weekly Racine Labor and is now a consultant and freelance writer whose work has appeared in Z Magazine, The Progressive, Extra!, The Progressive Populist, In These Times, commondreams.org, and other national publications and websites. Visit his webpage at www.zmag.org/zspace/rogerdbybee.

SOURCES: Jacob S. Hacker, “A Healthy Economy,” The New Republic, Dec. 31, 2008; S. Woolhandler, T. Campbell, and D. Himmelstein, “Costs of Health Care Administration in the United States and Canada,” New England Journal of Medicine, Aug. 21, 2003; Physicians for a National Health Program, “Barack Obama on single payer in 2003,” posted June 4, 2008; Maggie Mahar, “On Healthcare Reform Stimulating the Economy: the Massachusetts Example,” Health Beat blog (Century Foundation, Dec. 12, 2008); Sara Collins et al., “An Analysis of Leading Congressional Health Care Bills, 2007-2008: Part I, Insurance Coverage,” Commonwealth Fund, Jan. 9, 2009; Kevin Freking, “Health secretary pick seeks health care overhaul,” Associated Press, Jan. 10, 2009.

Politico lets Gingrich attack public health insurance plan without disclosing financial ties to insurance companies

Summary: Politico quoted Newt Gingrich’s criticisms of including a public health insurance plan option in a health care reform proposal without noting his financial ties to several major health insurance companies.

In an April 14 article, Politico’s Carrie Budoff Brown reported that Newt Gingrich — identified as “the former Republican House Speaker from Georgia and founder of the Center for Health Transformation” — “argues that government intervention in the financial and auto industries will sour voters on a deep reach into health care.” Budoff Brown went on to quote Gingrich’s criticisms of the inclusion of a public insurance plan option in a health care reform proposal, including his remark: “There is always interest in it in general — until you start describing it, then it collapses.” But Budoff Brown did not note that the Center for Health Transformation is a for-profit entity that receives annual membership fees from several major health insurance companies, which have a direct interest in whether a public insurance plan is part of health care reform. Moreover, Gingrich himself reportedly profits from his involvement in the Center for Health Transformation. Indeed, the group’s website notes that “[t]he Center for Health Transformation and The Gingrich Group are corporate for-profit organizations not affiliated with any other corporation or organization” [emphasis added].

According to the Center for Health Transformation’s website, members pay tiered annual membership fees, providing varying degrees of “[a]ccess to Newt Gingrich on your company’s strategy,” among other benefits. Insurance groups UnitedHealth Group, the parent of UnitedHealthcare, and WellPoint Inc. are listed as “Charter” members, BlueCross BlueShield Association is listed as a “Platinum” member, and AHIP is listed as a “Premier” member.

Additionally, Gingrich has reportedly profited from his work with the Center. In a January 16, 2005, article, The New York Times described Gingrich as “a well-paid broker of ideas and influence in the field of health care policy” and reported that “[b]ase camp for Mr. Gingrich’s health policy work is his Center for Health Transformation, a for-profit organization that occupies new office space overlooking K Street, the main street for Washington lobbyists.” The Times also reported that the center’s members “pay yearly fees of up to $200,000.” Further, The Washington Post reported in a July 13, 2004, article (accessed via Nexis) that according to Gingrich aide Rick Tyler, the center’s for-profit status — as opposed to being a registered as a nonprofit lobbying group — enabled Gingrich to operate ” ‘under the radar.’ ” The article further quoted “former adviser Rich Galen” saying of Gingrich: “He’s making more money than he ever thought possible and doesn’t have to tell everybody where it’s coming from.”

From the Post article (accessed via Nexis):

Gingrich’s center is a “brilliantly packaged way of offering his services as former speaker and a man who can open doors to push along what he calls health transformation,” said Joseph Antos, a health policy expert at the American Enterprise Institute. “In other words, lobbying.”

Gingrich is not a registered lobbyist. The think tank is for-profit, he said, because “you get more drive and energy” from employees when money is at stake and “I believe in entrepreneurship.”

Aide Rick Tyler, however, acknowledged there were political reasons for diverging from the standard nonprofit lobby group model.

Having been formally reprimanded by the House in 1997 for violations associated with the political use of tax-exempt organizations — which were structured similarly to the new center — Gingrich decided that a nonprofit would have invited enormous scrutiny. Organizing as a for-profit company, however, permits him to operate “under the radar,” Tyler said.

“He’s making more money than he ever thought possible and doesn’t have to tell everybody where it’s coming from,” marveled former adviser Rich Galen. “He has the amount of influence he chooses to have. I suspect there is virtually no one in this town of either party who will not take a call from Newt Gingrich, if only to hear what he has to say.”

— M.W.

Hacker says that public option/private exchange would EXPAND private insurance market

Extended discussion of Lewin Group

By Jacob Hacker
Institute for America’s Future
April 11, 2009
Put simply, Health Care for America is a pure, undiluted proposal for public plan choice. So it’s notable that under my proposal, according to the Lewin Group’s analysis of a couple years ago, the public plan ends up with much lower enrollment in the public plan than projected in the Lewin Group’s new analysis (90 million versus over 131 million). (For aficionados, the national insurance exchange in my proposal would have larger enrollment, but around 38 million people in the exchange would choose private plans instead of the public plan.)
In short, the Lewin Group’s hypothetical proposal has three features that guarantee the public plan will be big. Whatever “131 million enrollees in the public plan” represents, it does not represent an accurate picture of Obama’s campaign pronouncements, or Max Baucus’s “White Paper,” or my plan, or any other proposal under serious consideration today.
To get an estimate of how many people will end up in the public plan, therefore, we need to go back to the Lewin Group’s analyses of proposals more or less like what Obama proposed during the campaign–namely, play-or-pay plans with an exchange that features a competing public plan, and without extensive new rules on employment-based insurance. Those analyses (of my proposal or the Commonwealth Fund proposal) show that enrollment in the public plan is likely to be much, much smaller than the Lewin Group’s analysis estimates. Indeed, if you look at the Lewin Group’s analysis of my proposal (again, the maximalist public plan choice approach), more Americans have private insurance after reform than do before–either through their employer or through the new national insurance exchange.
http://institute.ourfuture.org/healthcare/hacker/lewin-group-analysis%20

Offering a public plan option within a market of private health plans has been one of the more controversial proposals during the current national dialogue on health care reform.
The opponents of the public option, especially the private insurance industry and the Republican members of Congress, insist that a government-sponsored plan would be an unfair competitor and drive the private insurance industry out of business. Theoretically, the government would do this by extracting unfair concessions from the health care providers, pricing the public option at a lower level than the private insurance sector could ever meet. (This ignores the more important evidence such as the demonstrated greater efficiencies of our public Medicare program when contrasted with the private Medicare Advantage plans.)
The supporters of a public option, especially the progressive community, contend that the public option would be a superior product made more affordable by reducing administrative inefficiencies. They contend that competition would motivate a massive shift to the public option, bringing us much closer to the single payer model that many in the progressive community prefer. (Much has been said about why this approach actually sacrifices most of the single payer advantages and would likely never lead to a single payer system.)
Professor Jacob Hacker of the University of California at Berkeley (and formerly at Yale) has been a leading proponent of reform based on a national insurance exchange of private plans with the addition of a public plan option. And what does he have to say about the impact that a public plan option would have on market share for the private health plans? He says that under his proposal, “more Americans have private insurance after reform than do before — either through their employer or through the new national insurance exchange.”
Get That? Even with a Medicare-like public plan option, the market for the private insurers will expand! That is the real tragedy of this debate over a public plan option. It has led us away from the debate we should be having instead: an affordable single payer national health program for everyone, versus expansion of our over-priced, inequitable, and inefficient system of financing health care through private plans and public programs
Forget about the public plan option! Let’s get rid of the private health plans, and go with single payer!

Hacker says that public option/private exchange would EXPAND private insurance market

Extended discussion of Lewin Group

By Jacob Hacker
Institute for America’s Future
April 11, 2009

Put simply, Health Care for America is a pure, undiluted proposal for public plan choice. So it’s notable that under my proposal, according to the Lewin Group’s analysis of a couple years ago, the public plan ends up with much lower enrollment in the public plan than projected in the Lewin Group’s new analysis (90 million versus over 131 million). (For aficionados, the national insurance exchange in my proposal would have larger enrollment, but around 38 million people in the exchange would choose private plans instead of the public plan.)

In short, the Lewin Group’s hypothetical proposal has three features that guarantee the public plan will be big. Whatever “131 million enrollees in the public plan” represents, it does not represent an accurate picture of Obama’s campaign pronouncements, or Max Baucus’s “White Paper,” or my plan, or any other proposal under serious consideration today.

To get an estimate of how many people will end up in the public plan, therefore, we need to go back to the Lewin Group’s analyses of proposals more or less like what Obama proposed during the campaign–namely, play-or-pay plans with an exchange that features a competing public plan, and without extensive new rules on employment-based insurance. Those analyses (of my proposal or the Commonwealth Fund proposal) show that enrollment in the public plan is likely to be much, much smaller than the Lewin Group’s analysis estimates. Indeed, if you look at the Lewin Group’s analysis of my proposal (again, the maximalist public plan choice approach), more Americans have private insurance after reform than do before–either through their employer or through the new national insurance exchange.

http://institute.ourfuture.org/healthcare/hacker/lewin-group-analysis%20

Comment:

By Don McCanne, MD

Offering a public plan option within a market of private health plans has been one of the more controversial proposals during the current national dialogue on health care reform.

The opponents of the public option, especially the private insurance industry and the Republican members of Congress, insist that a government-sponsored plan would be an unfair competitor and drive the private insurance industry out of business. Theoretically, the government would do this by extracting unfair concessions from the health care providers, pricing the public option at a lower level than the private insurance sector could ever meet. (This ignores the more important evidence such as the demonstrated greater efficiencies of our public Medicare program when contrasted with the private Medicare Advantage plans.)

The supporters of a public option, especially the progressive community, contend that the public option would be a superior product made more affordable by reducing administrative inefficiencies. They contend that competition would motivate a massive shift to the public option, bringing us much closer to the single payer model that many in the progressive community prefer. (Much has been said about why this approach actually sacrifices most of the single payer advantages and would likely never lead to a single payer system.)

Professor Jacob Hacker of the University of California at Berkeley (and formerly at Yale) has been a leading proponent of reform based on a national insurance exchange of private plans with the addition of a public plan option. And what does he have to say about the impact that a public plan option would have on market share for the private health plans? He says that under his proposal, “more Americans have private insurance after reform than do before — either through their employer or through the new national insurance exchange.”

Get That? Even with a Medicare-like public plan option, the market for the private insurers will expand! That is the real tragedy of this debate over a public plan option. It has led us away from the debate we should be having instead: an affordable single payer national health program for everyone, versus expansion of our over-priced, inequitable, and inefficient system of financing health care through private plans and public programs

Forget about the public plan option! Let’s get rid of the private health plans, and go with single payer!

Options for health care cost control

The Obama Administration’s Options for Health Care Cost Control: Hope Versus Reality

By Theodore Marmor, PhD; Jonathan Oberlander, PhD; and Joseph White, PhD
Annals of Internal Medicine
April 7, 2009
In short, if medical costs are to be controlled, no substitute exists for constraining prices and capping expenditures. Frank talk about these cost-control realities, however, is politically difficult. It immediately elicits alarms from the medical care and insurance industries about “rationing” (ignoring the fact that the United States could realize significant savings from lower prices and administrative costs). Others, particularly the pharmaceutical industry, raise alarms about the effect that cost control would have on the pace of medical innovation. In addition, spending targets constrain medical providers’ income and thereby prompt intense political struggles. The Obama team’s limited treatment of cost-control realities — including the absence of global budgets and spending targets or caps — seems to reflect a desire to avoid such political controversies.
We write this essay, then, as a cautionary tale. Claims of savings from health information technology, prevention, P4P, and comparative effectiveness research are politically attractive. Their political appeal lies largely in the embrace of widely supported goals, including better health and improved quality of medical care. In theory, these reforms — more research, more preventive screenings, and better organized patient data — sound like benign devices to moderate medical spending. For many purposes, such reforms are substantively very desirable. But these reforms are ineffective as cost-control measures. If the United States is to control health care costs, it will have to follow the lead of other industrialized nations and embrace price restraint, spending targets, and insurance regulation. Such credible cost controls are, in the language of politics, a tough sell because they threaten the medical industry’s income. The illusion of painless savings, however, confuses our national debate on health reform and makes the acceptance of cost control’s realities all the more difficult.
http://www.annals.org/cgi/content/full/150/7/485

High health care costs are the primary driving force behind the renewed effort for reform. Everyone agrees that high costs are straining personal, business and government budgets, and something must be done to make health care affordable for all of us.
Some of us are also concerned about health care justice. We want to see that everyone has affordable access to high quality care. It is more than fortuitous that the most effective methods of reducing excess health system spending also achieve the social justice goal of health care for everyone.
Much has been written on what does work and what doesn’t work in controlling spending. This paper provides an excellent, brief summary of the concepts being floated, and is well worth downloading. We should be very concerned that the leading mechanisms proposed, as summarized in this article, would not have a significant impact on slowing spending, and would likely actually increase our costs. Nor would they be effective in achieving health care justice for all.
If we are going to address costs seriously, there is no other option than to fundamentally restructure our health care financing system. As the authors state, “no substitute exists for constraining prices and capping expenditures.” We can never achieve that by relying on our wasteful, fragmented multi-payer system of financing health care. As all other nations have shown us, there is no other option than central, public control.
It is true that some nations do use private insurers. But private insurers in their countries organized into social insurance programs serving the public good have almost nothing in common with private insurers in the United States that shun organization in order to serve their own business interests. Adding a few regulations to our current fragmented system will increase costs but cannot transform a self-serving business model into a public-serving social insurance model.
We really have only two effective choices that would achieve both of our goals. We can dismiss our current private insurers and bring in new private insurers with a mission of serving the public good, but that is the most expensive model of reform, and it compromises equity and efficiency. Our other choice would be to eliminate our fragmented financing system and replace it with a single payer national health program. That would allow us to constrain prices and cap expenditures while achieving our other goal of providing all necessary care for everyone.
We can do it, but the people, through our elected representatives, are going to have to tell the special interests that we’ve had enough.

Options for health care cost control

The Obama Administration's Options for Health Care Cost Control: Hope Versus Reality

By Theodore Marmor, PhD; Jonathan Oberlander, PhD; and Joseph White, PhD
Annals of Internal Medicine
April 7, 2009

In short, if medical costs are to be controlled, no substitute exists for constraining prices and capping expenditures. Frank talk about these cost-control realities, however, is politically difficult. It immediately elicits alarms from the medical care and insurance industries about “rationing” (ignoring the fact that the United States could realize significant savings from lower prices and administrative costs). Others, particularly the pharmaceutical industry, raise alarms about the effect that cost control would have on the pace of medical innovation. In addition, spending targets constrain medical providers’ income and thereby prompt intense political struggles. The Obama team’s limited treatment of cost-control realities — including the absence of global budgets and spending targets or caps — seems to reflect a desire to avoid such political controversies.

We write this essay, then, as a cautionary tale. Claims of savings from health information technology, prevention, P4P, and comparative effectiveness research are politically attractive. Their political appeal lies largely in the embrace of widely supported goals, including better health and improved quality of medical care. In theory, these reforms — more research, more preventive screenings, and better organized patient data — sound like benign devices to moderate medical spending. For many purposes, such reforms are substantively very desirable. But these reforms are ineffective as cost-control measures. If the United States is to control health care costs, it will have to follow the lead of other industrialized nations and embrace price restraint, spending targets, and insurance regulation. Such credible cost controls are, in the language of politics, a tough sell because they threaten the medical industry’s income. The illusion of painless savings, however, confuses our national debate on health reform and makes the acceptance of cost control’s realities all the more difficult.

http://www.annals.org/cgi/content/full/150/7/485

Comment:

By Don McCanne, MD

High health care costs are the primary driving force behind the renewed effort for reform. Everyone agrees that high costs are straining personal, business and government budgets, and something must be done to make health care affordable for all of us.

Some of us are also concerned about health care justice. We want to see that everyone has affordable access to high quality care. It is more than fortuitous that the most effective methods of reducing excess health system spending also achieve the social justice goal of health care for everyone.

Much has been written on what does work and what doesn’t work in controlling spending. This paper provides an excellent, brief summary of the concepts being floated, and is well worth downloading. We should be very concerned that the leading mechanisms proposed, as summarized in this article, would not have a significant impact on slowing spending, and would likely actually increase our costs. Nor would they be effective in achieving health care justice for all.

If we are going to address costs seriously, there is no other option than to fundamentally restructure our health care financing system. As the authors state, “no substitute exists for constraining prices and capping expenditures.” We can never achieve that by relying on our wasteful, fragmented multi-payer system of financing health care. As all other nations have shown us, there is no other option than central, public control.

It is true that some nations do use private insurers. But private insurers in their countries organized into social insurance programs serving the public good have almost nothing in common with private insurers in the United States that shun organization in order to serve their own business interests. Adding a few regulations to our current fragmented system will increase costs but cannot transform a self-serving business model into a public-serving social insurance model.

We really have only two effective choices that would achieve both of our goals. We can dismiss our current private insurers and bring in new private insurers with a mission of serving the public good, but that is the most expensive model of reform, and it compromises equity and efficiency. Our other choice would be to eliminate our fragmented financing system and replace it with a single payer national health program. That would allow us to constrain prices and cap expenditures while achieving our other goal of providing all necessary care for everyone.

We can do it, but the people, through our elected representatives, are going to have to tell the special interests that we’ve had enough.

Indicting the insurance companies and the system that supports them

based on evidence from many sources including the SiCKO film

Denial of Access to Insurance

Count #1: That insurance companies charge such high insurance premiums that millions of Americans cannot afford to purchase any insurance at all, leading to 18,000 deaths every year.

Count #2: That insurance companies deny access to insurance for people who may have one of a long list of diseases, rather than make arrangements to see that they receive the care they need.

Count #3: That insurance companies drop people from coverage while they are sick, when they can no longer work at the job from which they get their insurance or can no longer pay their premiums.

Count #4: That insurance companies retroactively cancel insurance because of presumed undisclosed pre-existing conditions, even after the patient has received care and incurred financial liability for the care.

Denial of Coverage

Count #5: That insurance companies often cover such a small portion of necessary medical costs that millions of Americans with insurance end up bankrupt.

Count #6: That insurance companies require prior approval for large numbers of medically-necessary tests and procedures, adding needless expense, delay, and stress for doctors and hospitals. Prior approval is often required even in emergency situations when it is physically difficult or impossible to obtain such approval.

Count #7: That insurance companies deny access to care on the grounds that drugs or procedures are experimental, even when there is good evidence that the drug or procedure is potentially life-saving.

Count #8: That insurance companies deny coverage for tests or treatments without any review by the responsible Medical Director or other medically-qualified person on their staff.

Count #9: That pharmaceutical companies charge such high prices for drugs, and insurance companies cover such a small portion of their cost, that millions of Americans are denied the medications they need to recover, survive, and live comfortable lives.

Perversion of the Medical Profession

Count #10: That insurance companies pervert the medical profession by providing financial incentives that lead their Medical Directors and other medical personnel on their staff to deny access to care and thereby to harm patients.

Count #11: That insurance companies impose medical decisions without the direct interaction with patients required of treating physicians.

Misuse of Funds

Count #12: That insurance companies file fraudulent claims for payment from government insurance programs (Medicare and Medicaid).

Count #13: That insurance companies use our money to pay their CEOs hundreds of millions of dollars that could be used to provide us with more and better medical care.

Count #14: That insurance companies draft legislation behind the scenes and without public disclosure that include financial giveaways to themselves and their pharmaceutical company allies.

Count #15: That insurance companies use our money to make political contributions in order to avoid government regulation and to resist proposals that would replace them with a public program that would provide better, more comprehensive, life-saving care.

Count #16: That insurance companies use our dollars to support the publication of propaganda that provides false and distorted information on the health care programs of other countries.

Count #17: That insurance companies use our dollars to support the publication of propaganda that seeks to persuade the American people that they do not have a right to health care when they need it and that health care is a consumer commodity that only those with the ability to pay are entitled to receive.

Count #18: That insurance companies mislead the American public by offering choices of plans while denying them their choice of doctor and hospital, often including, in emergencies, denying them access to the nearest hospital.

Count #19: That insurance companies support a system that requires that Americans have the right job to qualify for health care.

Count #20: That insurance companies support a system that sets the price of medical tests and procedures out of reach of millions of Americans, even though little additional cost would be incurred by treating the patient.

Compiled by Len Rodberg, Research Director, New York Metro Chapter of Physicians for a National Health Program

New York Metro Chapter, Physicians for a National Health Program
PO Box 50193, Brooklyn, NY 11205. Tel: 718-222-9266 Fax: 718-222-1140
Email: pnhpnymetro@nyc.rr.com

Focusing on doctor pay misses point

By PAUL DEMARCO
The State, South Carolina
Monday, Mar. 23, 2009

I hate to disagree with my friend John Black, the president-elect of the S.C. Medical Association; he is a good man, a good clinician and a passionate advocate for primary care physicians. But his recent column, “Medicaid: a fair price must be paid,” misses the point.

Doctors complaining about Medicaid rates in the current health-care climate are about as tone-deaf as the crew of a sinking ship complaining to the passengers about their low pay. Yes, Medicaid rates are too low and need to be addressed, but Black approaches the problem from the wrong direction. We must put patients first, not doctors.

The Medical Association must make access to decent health care for all South Carolinians its central focus. When I took the Hippocratic Oath, I took it to mean that I would care for any patient who made it to the threshold of my office, no questions asked, and that my fellow physicians would do the same. The issue of how the patient was going to pay was only a secondary concern.

I don’t deny the business aspect of medicine. Physicians endure rigorous training for years, sometimes incurring tremendous debt. When we finally begin practice, we have a right to make a good living. Most physicians realize the privilege we have in serving our patients and provide free or low-cost care to some. Black rightly points out that there is a limit to physicians’ generosity; however, his comparison of physicians and car dealers is misplaced (“the car dealer is not expected to sell for a loss”). We chose medicine over selling cars for a reason. We wanted to take care of patients, to provide them healing and compassion impossible in the car business. And we knew that would involve taking all comers.

Unfortunately, some physicians look for ways to avoid taking care of the poor and uninsured. It is a discouraging fact that part of the unraveling of the medical safety net has been physicians’ doing. Some physicians drop out of Medicaid and Medicare legitimately, but others do it to preserve a certain high salary expectation. This is an abdication of their duty to the medical profession and to their patients.

Black’s warning that the situation is grave and that physicians “can no longer pay essential bills to keep our offices open” is an overstatement. First, there is no evidence that significant numbers of physician practices are closing because of payment issues.

Second, plenty of high-paying openings are available to physicians looking for jobs in South Carolina. I found more than 100 on MDsearch.com. One listing for a family practitioner in Clinton advertised “excellent income potential in excess of $250,000.”

Third, it is not physicians who are most at risk in the current system; it is patients. Forty-six million have no coverage, and 25 million more are underinsured. According to one report, in 2001, medical expenses helped push an estimated 2 million Americans into bankruptcy.

As physicians, we must roll our sleeves up, but not in the service of padding our own pockets. We must work together to craft a system that covers all the patients that we care so deeply about. As we remake America’s health care system, we’ll ensure that its physicians are adequately compensated, but that must be a byproduct of our effort. The patient always, always, always comes first.

Dr. DeMarco is a spokesman for South Carolinians for Universal Health Care. Reach him at pvdemarco@bellsouth.net.

National call-in day on April 15

Dear Single-Payer Supporter:

On April 15th, the Leadership Conference for Guaranteed Health Care is launching a nationwide call-in day for single-payer national health care. Our message is clear: “Tax payer dollars should go to people, not profits. Support single-payer national health care now.”

Lesser reform proposals will have our taxes subsidizing insurance company profits, not paying for real health care. We must fix our health care system by putting everybody in, and removing for-profit interests that are responsible for the sky-rocketing cost of health care. The only plan that meets these criteria is a single-payer national health care system.

So on April 15th, 2009, we ask that you join with thousands of others to call Congress, to support single-payer legislation in both the House (HR 676) and the Senate (S703).

If you don’t know your Congresspersons, or want a script, all of the information you need is on our National Call-In Day page – http://www.healthcare-now.org/campaigns/call/

If you know your Representative and Senators, the Capitol Switchboard number is 866-338-1015*. Ask to be connected, and then ask him or her to support HR 676 or S703. If they are already a co-sponsor, thank them.

The injustice in our healthcare system must end. If our Congress is serious about health reform, they will support single-payer health care now.

Health and Justice,

Katie Robbins
Assistant National Coordinator, Healthcare-NOW!
Support Staff, Leadership Conference for Guaranteed Health Care
o: 800.453.1305
c: 330.618.6379
f: 212.475.8350
healthcarenow08@gmail.com
www.healthcare-now.org
339 Lafayette St
New York, NY 10012

*If you cannot make phone calls, information for your US Representatives and Senators can be found at www.votesmart.org

National call-in day on April 15

Dear Single-Payer Supporter:

On April 15th, the Leadership Conference for Guaranteed Health Care is launching a nationwide call-in day for single-payer national health care. Our message is clear: “Tax payer dollars should go to people, not profits. Support single-payer national health care now.”

Lesser reform proposals will have our taxes subsidizing insurance company profits, not paying for real health care. We must fix our health care system by putting everybody in, and removing for-profit interests that are responsible for the sky-rocketing cost of health care. The only plan that meets these criteria is a single-payer national health care system.

So on April 15th, 2009, we ask that you join with thousands of others to call Congress, to support single-payer legislation in both the House (HR 676) and the Senate (S703).

If you don’t know your Congresspersons, or want a script, all of the information you need is on our National Call-In Day page – http://www.healthcare-now.org/campaigns/call/

If you know your Representative and Senators, the Capitol Switchboard number is 866-338-1015*. Ask to be connected, and then ask him or her to support HR 676 or S703. If they are already a co-sponsor, thank them.

The injustice in our healthcare system must end. If our Congress is serious about health reform, they will support single-payer health care now.

Health and Justice,

Katie Robbins
Assistant National Coordinator, Healthcare-NOW!
Support Staff, Leadership Conference for Guaranteed Health Care
o: 800.453.1305
c: 330.618.6379
f: 212.475.8350
healthcarenow08@gmail.com
www.healthcare-now.org
339 Lafayette St
New York, NY 10012

*If you cannot make phone calls, information for your US Representatives and Senators can be found at www.votesmart.org

Why Has the Press Failed Us In Reporting on Health Care Reform?

An Open Letter to Bill Keller, Executive Editor, New York Times, and Clark Hoyt, Public Editor, New York Times

Benjamin Day
April 10, 2009

Dear Bill Keller and Clark Hoyt — For the first time in the span of a generation, national health care reform is back on the horizon, and I’m writing to you to step back for a moment into the history of the Times’s reporting on health care reform. Last year I began a research project with two researchers from Harvard Medical School, Drs. David Himmelstein and Steffie Woolhandler, to look at the history of major state health reforms such as TennCare, the Oregon Health Plan, MinnesotaCare, and many others. A sweeping health reform bill had been passed into law in Massachusetts in 2006 that was being hailed as a unique, first-of-its-kind bipartisan strategy to achieve universal or near-universal health coverage without raising taxes or adding new regulations on the health care industry. We initially set out to find how unique the Massachusetts health reform law really was compared to previous state efforts, and to see if by analyzing the outcomes of those earlier reform efforts we could learn some lessons about what to expect in Massachusetts.

What we found surprised us, and a summary write up of our findings was published in the International Journal of Health Services.[i] We found that, aside from the “individual mandate” in Massachusetts requiring many of the uninsured to purchase their own private health plan or face tax penalties, many reforms in other states — indeed, even in our own state in the recent past — were almost identical to the Mass plan in their goals and structure. They also all failed to achieve their stated goals of reducing the uninsured population in their respective states and/or of controlling rising health care costs. The most ambitious of these, TennCare in 1994 and a large Medicaid expansion in Massachusetts also in the mid-1990s, were able to reduce the uninsured in their respective states for a period of several years. However, the financing of these plans all proved unsustainable over time, enrollment was often capped or benefits eroded, and a few short years after passage every state found itself back where it started: with high and rising health care costs and a large and growing uninsured population. We titled our article “State Health Reform Flatlines.”

What we found even more surprising than this history of failed reform efforts, though, was media coverage of the legislation. Articles by our most respected news organizations hailed state reform after state reform as pioneering, likely to serve as models for the nation, and designed to control costs and extend health coverage to the uninsured. No reasonable reader of the news available at the time these laws were passed would expect that they might fail entirely to reduce the uninsured over time, or that they might not succeed in controlling costs at all.

Florida in April 1993 launched the first of what would be many “managed competition” plans for controlling costs and extending health coverage, a scheme that would serve as virtually the only cost control component of Bill Clinton’s proposed health reform bill of 1994. The New York Times wrote “The Florida Legislature approved a sweeping overhaul of the state’s overburdened health-care system early today, making Florida the first state in the nation to combine free market competition and government regulation in a way similar to the Clinton Administration’s plans for controlling soaring medical costs… Florida’s plan, which will try to cover most people eventually and at the same time to control health costs, is taking place on a larger scale than anything seen elsewhere.”[ii] Managed competition did not control costs in Florida or anywhere else, nor was the uninsured population reduced.

Exactly one year previous in April of 1992 Minnesota passed its “HealthRight” plan — later renamed “MinnesotaCare.” USA Today wrote of it: “Minnesota is about to embark on a plan to solve the health-insurance crisis that could hold lessons for other states and the nation… HealthRight… will begin signing up families with children in the fall and will be fully open to Minnesota’s estimated 370,000 eligible uninsured by 1994.”[iii] The Associated Press wire coverage of the law repeated state estimates that almost 40 percent of those uninsured should be covered by 1997, and quoted the head of the National Conference of State Legislatures calling the bill “the first complete reform proposal in the United States.” MinnesotaCare did not reduce the percentage of uninsured in Minnesota even in the short-term.

A few other quotes should be enough to convey the sense that there is a recurring problem in the news we receive on health reform in America. A Vermont bill also passed in 1992 elicited this opening description in the New York Times: “Gov. Howard Dean, the only governor who is a physician, signed a law Monday in Bennington that sets in motion a plan to give Vermont universal health care by 1995.”[iv] The Oregon Health Plan of 1992, which attempted to reduce benefits for Medicaid beneficiaries in order to expand coverage to the uninsured, was described in a Washington Post article as “The most far-reaching health care reform in the nation.”[v] The New York Times began its coverage by stating that “The Clinton Administration today approved Oregon’s proposal to guarantee health services for poor people by rationing care.”[vi] Neither Vermont’s reform nor Oregon’s reduced the percentage of uninsured in the state, and the poor in Oregon were not covered.

These are selective quotes: the broader coverage has often provided good descriptions of what the laws are intended to accomplish. Moreover, they have included extremely effective reporting on the politics of the health reform process — particularly when the process is contentious, or where well-organized groups have mobilized opposition. However, in the United States we have a long history of reforms that have survived the political process only to fail economically, and it is clear in retrospect that the media sources — both local and national — with large market share have not done their due-diligence in reporting on the economic viability of health reform efforts. I believe this would be borne out by analyzing coverage of many other significant reforms in Washington, Tennessee, Massachusetts, Hawaii, Maine, California, Utah, and nationally.

This becomes particularly clear by comparing coverage of health care reform with medical reporting in virtually any paper. The Christian Science Monitor on April 8, for example, carried a story that is typical of this approach to health politics reporting entitled “Healthcare battle brewing: political groups gear up: A public insurance alternative is likely to be the most contentious of the reform proposals.”[vii] The story states that the Obama administration hopes to introduce a Medicare-like public buy-in plan available to individuals and businesses as an alternative to private health coverage. It goes on to cite the Heritage Foundation’s opposition to the plan, the support of groups such as MoveOn.Org and Democracy for America, and public polling from Harvard Professor Robert Blendon. The article follows a “he-said/she-said” format, with the Heritage Foundation contending that such a plan would not allow private insurance to compete on a level playing field, advocates urging that it will bring down costs and hold the private insurance industry accountable, and the CEO of Families USA urging that both sides attempt to find a common ground.

What is missing from this narrative of contending arguments is a discussion of evidence about the likely impacts of a public plan option. There have been forms of public-private health insurance competition implemented under Medicare for a number of years, and there are many other countries that allow competition between public and private health insurers. Peer-reviewed studies of public-private competition are not hard to find, nor are experts with varying opinions. Compare the CSM discussion with almost any medical news story in the New York Times Health Section on the same day: there is a report on a new study by two Stanford professors assessing the impact of George W. Bush’s AIDS Relief program in Africa; two studies about the impact of light exercise for heart failure patients; three reports on the role of “brown fat” in burning calories; and others. In short, medical reporting and the coverage of public disagreements revolve around evidence, there are standards for credible sources, and it is common to read about the limitations of available evidence. Although I am personally an advocate and an organizer coming from a single-payer health care perspective, what strikes me most after reading hundreds of news reports on health reform is the lack of academic perspectives, held to academic standards, concerned with basic questions of the economic efficacy and sustainability of health policy proposals.

At the state level this has often been exacerbated by bi-partisan legislation. Many of the reforms that have failed to achieve or even approach their stated goals have been passed with support from the Democrats and Republicans holding one or both legislative houses or the governor’s office. This has a particularly chilling effect on politics-based health reform coverage. Reporting on the Oregon Health Plan, for example, focused almost exclusively on the attempt to ration services for Medicaid enrollees — would this plan harm the disabled or the poor, was it just? — while the basic question of whether the law, even taking rationing for granted, would succeed in reducing the uninsured in the state, went unasked. In Tennessee, similarly, the spectacle of almost one million Medicaid enrollees being moved into managed care plans occluded the basic question of whether the proposal to extend coverage to another half a million uninsured residents was economically viable, or if it would succeed in reducing the state’s uninsured over time — these latter goals being the entire point of moving Medicaid recipients into managed care plans in the first place.

This shortcoming has also been exacerbated by the subject material. Increasing access to health care is what makes health reform morally compelling for most people, but financing and cost controls are what make efforts to expand access sustainable or unsustainable. These are topics not well-suited to personal interest stories, and they are often bewilderingly complex. In Massachusetts alone, residents have been promised universal health care or dramatic reductions in the uninsured at least four times in the last twenty years. A few years after each reform passes, the dry logic of costs and financing has left residents back where they started, and yet when the politics of health reform begin again we are provided with very little information in the public sphere to sort out the snake-oil from the genuine, sustainable reform proposals.

I write to you not because I believe the New York Times is particularly at-fault in leaving its reading public unprepared to determine the viability of different health reform proposals, but because the scope of the Times’s coverage has meant that it has reported on a wide range of state and national efforts, which gives us a good window on the history of health reform coverage in the United States. This year, many national commentators are measuring the ongoing process of health policy development against the failed Health Security Act of the Clinton era. This has led many advocates to be particularly concerned with crafting politically viable proposals. I believe this makes the burden on reporters to effectively assess whether the proposals are likely to achieve their stated goals sustainably all the more important.

I would urge the Times not to report health policy disputes in a he-said/she-said format divorced from evidence-based standards. Reporters should challenge interviewees to source their economic claims, include those sources in their write-ups, and not shy away from evaluating the quality of evidence offered from different perspectives. Furthermore, we have learned time and again that where there is political harmony, there is not necessarily economic rationality. The burden of evidence-based evaluation of health policy cannot stop at the borders of political skirmishes.

I thank you for your consideration of this open letter,

Sincerely,

Benjamin Day
Executive Director
Mass-Care: The Massachusetts Campaign for Single Payer Health Care
33 Harrison Ave — 5th floor
Boston, MA 02111
Phone: 617-723-7001
Fax: 617-723-7002
Email: info@masscare.org

This is the first of seven open letters on national health reform. Subsequent letters will address the politics of cost control; a discussion on whether public-private health insurance competition is likely to control costs; a report on the “cost control industry” in the United States and the problem with trying to do more to spend less; a discussion of whether we want the health care Congress has, and whether a public clearinghouse for private insurance would be an effective proposal; whether individual mandates are a viable road to universal health care; and a discussion of what the chances are that national health reform will reduce health disparities.

[i] Steffie Woolhandler, Benjamin Day, and David U. Himmelstein, “State Health Reform Flatlines,” International Journal of Health Services, Volume 38, Number 3, Pages 585–592, 2008. Available online at https://pnhp.org/states_flatline/

[ii] Larry Rohter, “Florida Blazes Trail to a New Health-Care System,” The New York Times, April 4, 1993, Sunday.

[iii] Kevin Anderson, USA Today, April 21, 1992.

[iv] Fox Butterfield, “UNIVERSAL HEALTH CARE ADOPTED IN VERMONT,” New York Times News Service, May 12, 1992.

[v] Michael Abramowitz, “Oregon Blazes a Trail; Doctor/Legislator John Kitzhaber Sets Off Political Fireworks With His Plan to Ration Medical Services While Expanding Coverage,” The Washington Post, June 9, 1992, Tuesday.

[vi] ROBERT PEAR, “U.S. Backs Oregon’s Health Plan for Covering All Poor People,” The New York Times, March 20, 1993, Saturday.

[vii] Alexandra Marks, “Healthcare battle brewing: political groups gear up: A public insurance alternative is likely to be the most contentious of the reform proposals,” The Christian Science Monitor, April 8, 2009.