PNHP

President Bill Clinton on single payer

President Bill Clinton on single payer

Bill Clinton on Health Care Reform

CNN Larry King Live
March 11, 2009
Dr. Sanjay Gupta, CNN chief medical correspondent: Tonight, Bill Clinton exclusive on the nightmare that keeps 45 million Americans from seeing a doctor — the health care disaster.
****
GUPTA: All right. Let’s drill down specifically on something you said earlier. When it comes to sort of creating these silos of health care reform — you have sort of single payers and more governmental involvement on one send — one end, free market involvement solely on the other end. Single payer never has really caught traction politically. Is it politically unpalatable or is it a bad idea?
Bill CLINTON: Well, I think it’s more politically unpalatable than it is a bad idea, because single payer is not socialized medicine. Canada has a single payer system and a private health care provider system. Our single payer systems are Medicare and Medicaid.
GUPTA: Sure.
CLINTON: And Medicare is quite popular.
The good thing about single payer is the administrative costs are quite low. We probably waste $200 billion a year between the insurance administrative costs, the doctors and other health care providers’ administrative costs and employers’ administrative costs in health care that we would not waste if we had any other country’s system.
On the other hand, if you look at the experience of Germany, France, Japan — that don’t have pure single payer systems, they have more mixed systems — their costs are actually slightly lower overall than Canada’s. So there’s something to be said for having a mixed system if you can get the administrative costs down, because then the systems have enough competition in them to try to restrain costs and it’s not all up to the political bodies.
In Canada, because it’s all financed through the government, it’s more difficult sometimes for the politicians to say no than for just the regular management of the health care system to cut the costs.
So I think you can have a mixed system. If you look at the French system, which scores very high on every international measure…
GUPTA: Yes.
CLINTON: …it’s mostly publicly financed, but there’s enough private in there that there’s some tension that’s creative and positive.
GUPTA: Do you think there is a degradation quality of care with a single payer system? Is that a concern? Should that be a concern?
CLINTON: Well there’s no evidence of that in Canada that I’m aware of, except for excessive delays, which they always try to come to grips with. The British, you know, do have a completely government-run system, but they allow people who can afford it to get outside the system. And they’ve also started running hospitals almost like charter schools in America, that is, they have these trust hospitals that perform very well and therefore they’re given more control over setting their priorities, specializing and cutting delays.
There are all kinds of different ways to do it. But first, you do have to cover everybody. And then you have to stop people from gaming the system. There’s a lot of gaming going on now in the American system so that we spend more than anybody else and get loss for it.
I think that once you get the universal coverage, I think the health insurers then could play a more positive role than they do now, which is often involved in — you know, they make a lot of money through saying no and sort of the inordinate paperwork burdens that are put on doctors and hospitals and other providers.
GUPTA: What is it about the insurance industry that you just brought up? They tried to scuttle the health care reform plan of ’93. Now they’re saying we also believe in universal health care. A politically tactile question, I guess, are you buying it? Do you think they’re being honest?
CLINTON: I think some of them really do want it. Yes. If you look at their new organization, the person who heads it came out of a progressive background and favored, as a philosophical matter, coverage.
Secondly, I think they now understand that, in terms of the health of America and the well-being of our economy, we can’t go on basically giving them more and more dollars every year — the insurance industry — and getting people sicker and sicker and leaving more and more people behind.
I mean look at all the healthcare problems. The child obesity problem, which is my obsession, is the most glaring manifestation of a system that treats sick people and doesn’t keep people well. And that’s one where, I think, by the way, we can get broad bipartisan support on trying to — to do more on wellness. And that will save money.
I think the insurance industry realizes that they — a lot of the smarter ones realize that they could kill the goose that laid the golden egg here, that America can no longer go on spending more money and getting less for it and having all this money go to them and that they can make a lot of money and do well by making us healthier at a more affordable price.
http://transcripts.cnn.com/TRANSCRIPTS/0903/11/lkl.01.html

Former President Bill Clinton makes two very important points here. (1) Single payer dramatically reduces administrative waste, and he implies that it would be popular, as is Medicare now. (2) The private insurers “make a lot of money through saying no,” and “we can’t go on basically giving them more and more dollars every year — the insurance industry — and getting people sicker and sicker and leaving more and more people behind.” Single payer is good; private insurers are bad.
In contrast, his comments suggesting that private insurers could play a beneficial role in a system of universal coverage are not supported by the facts.
He says that private plans in other nations provide competition which helps to lower costs below that of Canada. Wrong. First, our experience with the Medicare Advantage plans demonstrates that competing private plans increase costs instead of decreasing them. Second, there are many factors that influence health care spending besides the structure of the financing system.
According to the OECD, “Whatever the role played in a health system, private health insurance has added to total health expenditure.” According to the WHO, “Evidence shows that private sources of health care funding are often regressive and present financial barriers to access. They contribute little to efforts to contain costs and may actually encourage cost inflation.” Spending in the nations cited by President Clinton would be even lower if they had a pure single payer system. (qotd 8/21/07)
As for his optimism for a beneficial role of private insurers in our future, he had to take that one from his wish list. It’s been on all of our wish lists for decades. Isn’t it time to quit wishing, accept the fact that they’re incorrigible, and move on with our own single payer national health program?

President Bill Clinton on single payer

Bill Clinton on Health Care Reform

CNN Larry King Live
March 11, 2009

Dr. Sanjay Gupta, CNN chief medical correspondent: Tonight, Bill Clinton exclusive on the nightmare that keeps 45 million Americans from seeing a doctor — the health care disaster.

****

GUPTA: All right. Let’s drill down specifically on something you said earlier. When it comes to sort of creating these silos of health care reform — you have sort of single payers and more governmental involvement on one send — one end, free market involvement solely on the other end. Single payer never has really caught traction politically. Is it politically unpalatable or is it a bad idea?

Bill CLINTON: Well, I think it’s more politically unpalatable than it is a bad idea, because single payer is not socialized medicine. Canada has a single payer system and a private health care provider system. Our single payer systems are Medicare and Medicaid.

GUPTA: Sure.

CLINTON: And Medicare is quite popular.

The good thing about single payer is the administrative costs are quite low. We probably waste $200 billion a year between the insurance administrative costs, the doctors and other health care providers’ administrative costs and employers’ administrative costs in health care that we would not waste if we had any other country’s system.

On the other hand, if you look at the experience of Germany, France, Japan — that don’t have pure single payer systems, they have more mixed systems — their costs are actually slightly lower overall than Canada’s. So there’s something to be said for having a mixed system if you can get the administrative costs down, because then the systems have enough competition in them to try to restrain costs and it’s not all up to the political bodies.

In Canada, because it’s all financed through the government, it’s more difficult sometimes for the politicians to say no than for just the regular management of the health care system to cut the costs.

So I think you can have a mixed system. If you look at the French system, which scores very high on every international measure…

GUPTA: Yes.

CLINTON: …it’s mostly publicly financed, but there’s enough private in there that there’s some tension that’s creative and positive.

GUPTA: Do you think there is a degradation quality of care with a single payer system? Is that a concern? Should that be a concern?

CLINTON: Well there’s no evidence of that in Canada that I’m aware of, except for excessive delays, which they always try to come to grips with. The British, you know, do have a completely government-run system, but they allow people who can afford it to get outside the system. And they’ve also started running hospitals almost like charter schools in America, that is, they have these trust hospitals that perform very well and therefore they’re given more control over setting their priorities, specializing and cutting delays.

There are all kinds of different ways to do it. But first, you do have to cover everybody. And then you have to stop people from gaming the system. There’s a lot of gaming going on now in the American system so that we spend more than anybody else and get loss for it.

I think that once you get the universal coverage, I think the health insurers then could play a more positive role than they do now, which is often involved in — you know, they make a lot of money through saying no and sort of the inordinate paperwork burdens that are put on doctors and hospitals and other providers.

GUPTA: What is it about the insurance industry that you just brought up? They tried to scuttle the health care reform plan of ’93. Now they’re saying we also believe in universal health care. A politically tactile question, I guess, are you buying it? Do you think they’re being honest?

CLINTON: I think some of them really do want it. Yes. If you look at their new organization, the person who heads it came out of a progressive background and favored, as a philosophical matter, coverage.

Secondly, I think they now understand that, in terms of the health of America and the well-being of our economy, we can’t go on basically giving them more and more dollars every year — the insurance industry — and getting people sicker and sicker and leaving more and more people behind.

I mean look at all the healthcare problems. The child obesity problem, which is my obsession, is the most glaring manifestation of a system that treats sick people and doesn’t keep people well. And that’s one where, I think, by the way, we can get broad bipartisan support on trying to — to do more on wellness. And that will save money.

I think the insurance industry realizes that they — a lot of the smarter ones realize that they could kill the goose that laid the golden egg here, that America can no longer go on spending more money and getting less for it and having all this money go to them and that they can make a lot of money and do well by making us healthier at a more affordable price.

http://transcripts.cnn.com/TRANSCRIPTS/0903/11/lkl.01.html

Comment:

By Don McCanne, MD

Former President Bill Clinton makes two very important points here. (1) Single payer dramatically reduces administrative waste, and he implies that it would be popular, as is Medicare now. (2) The private insurers “make a lot of money through saying no,” and “we can’t go on basically giving them more and more dollars every year — the insurance industry — and getting people sicker and sicker and leaving more and more people behind.” Single payer is good; private insurers are bad.

In contrast, his comments suggesting that private insurers could play a beneficial role in a system of universal coverage are not supported by the facts.

He says that private plans in other nations provide competition which helps to lower costs below that of Canada. Wrong. First, our experience with the Medicare Advantage plans demonstrates that competing private plans increase costs instead of decreasing them. Second, there are many factors that influence health care spending besides the structure of the financing system.

According to the OECD, “Whatever the role played in a health system, private health insurance has added to total health expenditure.” According to the WHO, “Evidence shows that private sources of health care funding are often regressive and present financial barriers to access. They contribute little to efforts to contain costs and may actually encourage cost inflation.” Spending in the nations cited by President Clinton would be even lower if they had a pure single payer system. (qotd 8/21/07)

As for his optimism for a beneficial role of private insurers in our future, he had to take that one from his wish list. It’s been on all of our wish lists for decades. Isn’t it time to quit wishing, accept the fact that they’re incorrigible, and move on with our own single payer national health program?

Attendees at White House forum voice health care reform ideas

By Jay Greene
Crain’s Detroit Business
Mar. 12, 2009

Reducing costs and improving health care quality through comprehensive reform can make the struggling Detroit 3 auto industry more competitive with foreign companies, said several speakers Thursday at a White House health care reform forum in Dearborn.

Health care costs add $1,200 to $1,600 to the price of every car made in Detroit, making reform a competitive necessity, said Michigan Gov. Jennifer Granholm, who helped moderate the two-hour forum held at the Ford Conference and Event Center.

The forum — the first of five to be held nationally over the next month — was also led by Wisconsin Gov. Jim Doyle and Melody Barnes, director of the White House Domestic Policy Council.

“We spend far more in the U.S. for health care than any other country and we have lower outcomes,” Granholm said. “Health care is an issue that we must address if we want to compete globally.”

More than 25 attendees spoke about their own experiences with the health care system or to express suggestions on how to improve the health care delivery system.

Absent from the discussion, however, was how to pay for expanding access and making health care insurance more affordable.

Barnes said savings can come from adopting electronic medical records, reducing costly chronic diseases through early detection with prevention and wellness programs, and using evidence-based medical treatments.

Congressmen John Dingell Jr., D-Dearborn, and John Conyers, D-Detroit, agreed reforming the health care industry is long overdue.

Conyers, who has introduced single-payer legislation, H.R. 676, said improving access to care is complex, “but not as hard as people may think.”

Dingell, who said his father introduced the nation’s first health care reform plan in 1948, said “health care is a right, not a privilege.”

Dr. Jim Mitchiner, an emergency physician from Clawson who supports a single-payer system, said health care insurance should not be linked to a job that can be lost or taken away.

“I see people every day who have lost their job and have no insurance. It makes no sense. You lose a job and they don’t take away your life or auto insurance policy,” Mitchiner said. “I have lost complete faith in the private insurance industry.”

Under single-payer, private insurance companies would be abolished and health care would be financed through the government. The private delivery system of hospitals, doctors and other providers would be maintained.

Addressing the half dozen people who also spoke out in favor of a single-payer system, Barnes said President Barack Obama wants to reach a pragmatic solution to health care reform, one that can be achieved this year.

“The president believes we need to be building on our current health care system (that maintains the current private health insurance industry),” Barnes said. “It is the most expeditious way to go.”

But Barnes said if Obama could create a health care system from scratch, the president would go with a single-payer system.

“We believe in the employer-based system, but we need a public-private partnership,” said Dan Loepp, CEO of Blue Cross Blue Shield of Michigan.

Unlike 15 years ago when the insurance industry strongly opposed President Clinton’s effort to reform health care, Loepp said the industry now favors reform.

“We support guarantee issue with an individual mandate (to be covered with health insurance),” Loepp said.

But illustrating one of the flaws in the current health insurance system, Adrian Campbell-Montgomery, a mother of two, described how Blue Cross in 2004 denied payment to a Southeast Michigan hospital where she was treated for cancer.

“I was 22-years-old and needed surgery. I got a bill for $8,000 that I couldn’t pay,” Campbell-Montgomery said. “Blue Cross denied payment because there were recommendations you needed to be 26 years or older for that kind of surgery.”

Two weeks ago, Campbell-Montgomery received more bad news. She was diagnosed with ovarian cancer.

“I already owe $10,000 for that. I am trying to get Medicaid. Where does this end? You have to stop denying people,” she said.

Sister Mary Ellen Howard, executive director of the Cabrini Clinic in Detroit, asked who in the audience is going to help Campbell-Montgomery. Cabrini is the nation’s oldest free clinic.

“I am mad. Who is going to help her? Mr. Loepp?” Howard said. “People are dying. We need to do something about it.”

Before Loepp could respond, however, Mike Duggan, CEO of Detroit Medical Center, offered to take care of Campbell-Montgomery.

“We will take care of you at DMC,” said Duggan, noting that up to 25 percent of the Medicaid recipients in Michigan receive some care at DMC.

“The system is crazy. Hospitals close in the city. It is more profitable to go elsewhere,” he said. “A lot of things need to be done to (reduce) costs.”

Ricardo Guzman, CEO of Community Health and Social Services Center in Detroit, said the five federally qualified health centers in Detroit need funds to rebuild their aging facilities. CHASS has three clinic locations.

“Our mission is to provide services to the uninsured and under-insured,” Guzman said. “We keep people out of the emergency department and we save insurers money. We need money for infrastructure. Our buildings are falling apart.”

Nurses should be at the table when the health care reform legislation is drafted, said Teresa Cervantez Thompson, dean of nursing and health at Madonna University in Livonia.

“Nursing should be the foundation of reform,” she said. “We need more coordination and case management of care.”

VT: Single-payer advocates plan to protest health care forum

By DANIEL BARLOW
Rutland Herald
March 13, 2009

MONTPELIER — Vermont doctors and other medical professionals who support a single-payer health care system plan to protest next week’s Burlington health care reform forum organized by President Barack Obama’s administration.

Deb Richter of the organization Vermont Health Care for All said Thursday that some single-payer advocates have been invited to attend the forum, moderated by Vermont Gov. James Douglas and Massachusetts Gov. Deval Patrick, but that the issue will not be seriously considered.

“It’s clear that a single-payer approach is not favored by inside the beltway politicians and the two governors headlining the event,” said Richter, a physician. “We saw the same thing with their health care event in D.C. … supporters of a single-payer system were shut out of the meeting.”

Douglas, a Republican, and Patrick, a Democrat, were handpicked by Obama earlier this month to headline the health care reform forum — one of five that will be held across the country as the new president prepares an overhaul of the system.

Douglas walks a fine line on health care reform. He vetoed a major public expansion of health care pushed by Democratic lawmakers several years ago and later compromised with the same lawmakers on the creation of Catamount Health, a public-private insurance program for the uninsured.

But next week’s forum comes at the same time as Douglas has proposed eliminating 38 Vermont Department of Health employees as part of his 2010 budget plan, including several who work on the Blueprint for Health — one of Vermont’s top health care reform efforts that Douglas is expected to promote next week.

“I find it particularly ironic you would propose to cut people in a program you are going to be bragging about next week,” House Speaker Shap Smith said.

Douglas said he hopes all such layoffs will be avoided by the union agreeing to pay cuts and other concessions.

“This is not an easy process,” said Douglas, who added that departments and agencies make recommendations about where to make cuts. “Yesterday was a very difficult one for my team.”

Christine Finley, deputy commissioner for public health, said that the potential layoffs — a couple of which may involve positions that work on the blueprint — will not weaken the state’s commitment to the program. The department is now working on how to manage those cuts if the layoffs do prove to be necessary, she said.

“The work of the blueprint is clearly a priority for the health department,” Finley said. “We have not changed our priority.”

It is hard to define how many health department workers help on the blueprint because most of those engaged in the department in helping Vermonters manage or avoid chronic diseases — from asthma work to anti-tobacco efforts — work on the blueprint in some capacity.

“It really is our effort to prevent chronic disease in the state and it cuts across what we do,” Finley said.

The single-payer demonstration will begin around noon outside of the Davis Center on the University of Vermont campus, according to Richter, and end around 1 p.m., the start time of the forum inside.

Richter said she was invited to the session earlier this week and will attend. But with a running time of 90 minutes — and an expected televised message from Obama to kick start the session — there is no way a massive overhaul of the health care industry can be debated that day, she said.

“We need a massive overhaul,” Richter said. “These Band-Aids will not work anymore.”

Richter said she expects doctors and health professionals from Massachusetts, Maine, New Hampshire, New York and Connecticut to travel to Burlington next Tuesday to participate in the demonstration.

During his weekly press conference Thursday, Douglas was surprised to hear that single-payer advocates will demonstrate outside of the forum. While he noted that Obama does not prefer the single-payer approach for this round of reforms, he said advocates with that position have been invited to the session.

“There will be single-payer advocates at the meeting,” Douglas said. “We are interested in hearing a broad range of viewpoints.”

Rebecca Deusser, the deputy press secretary for Gov. Patrick, had no comment Thursday on next week’s demonstrations or the governor’s position on single-payer health care. She said Patrick supports Obama’s approach to health care reform.

“Successful health care reform in Massachusetts has become a national model — with more than 98 percent of residents covered by health insurance,” she said in a prepared statement. “The governor looks forward to joining the discussion on how best to make quality health care available to all Americans, while containing skyrocketing costs.”

The Vermont Public Interest Research Group, a Montpelier organization that has advocated for a single-payer health care system, will be participating in next week’s forum — although they share the concerns of others that the issue will not be given a full hearing.

Susan Baker, the health care advocate for VPIRG, said the group’s ultimate goal is a single-payer system, but they recognize that an incremental approach that relies on a partnership between governments and the private insurance companies has stronger public support.

“We think it is great that people will be demonstrating outside and pushing the issue,” Baker said. “But we also believe that it will be productive to be inside and part of the discussion.”

Louis Porter contributed to this report.

daniel.barlow@timesargus.com

Single-payer is the cure

By John Nichols
Capital Times
3/10/2009

Health care reform is a vital and engaging concern for tens of millions of Americans.

But you would not have known it from Thursday’s White House Forum on Health Reform, which was so narrowly focused and uninspiring that it almost made Hillary Clinton’s bumbling efforts of the 1990s look good.

President Barack Obama sounded some of the right notes. “Now I know people are skeptical about whether Washington can bring about this change. Our inability to reform health care in the past is just one example of how special interests have had their way, and the public interest has fallen by the wayside Ć¢ā‚¬Ā¦ (But) this time, there is no debate about whether all Americans should have quality, affordable health care — the only question is, how?

Unfortunately, that is a mighty major “only question.”

And Thursday’s forum made little room for those capable of answering it.

The White House was packed with the political insiders, corporate lobbyists and a few administration-designated “everyday Americans,” who helped to illustrate the depth of the crisis that the insiders have allowed to metastasize over the past decade or so.

Only a handful of serious reformers were allowed in.

Thanks to pressure from the Leadership Conference for Guaranteed Healthcare, Physicians for a National Health Program, Unions for Single Payer Health Care and the Progressive Democrats of America, an invitation was extended to House Judiciary Committee Chair John Conyers, D-Mich., the sponsor of H.R. 676, legislation that seeks to create a single-payer insurance program, which would take profiteering out of the health care system.

Also present was Dr. Oliver Fein, President of Physicians for a National Health Program.

But right before him on the White House list of “Community Leaders and Stakeholders Expected to Attend” were the CEOs of Pfizer and Pharmaceutical Research and Manufacturers of America (PhRMA).

While the doctor’s name was missing from the speaker lists, the names of the CEOs were on it, along with representatives of the U.S. Chamber of Commerce, America’s Health Insurance Plans, the Blue Cross Blue Shield Association and the Business Roundtable.

The weight of opinion at what was supposed to be a wide-ranging discussion of health reform was — at best — on the side of tinkering with the existing for-profit system.

“Change we can believe in” was not on the agenda.

Who could have put it there?

Dr. Quentin Young, the Chicago doctor who served as the Rev. Martin Luther King Jr.’s personal physician and whose medical office cared for the Obama family, ought to be at the table. “(Single-payer) no longer is the best solution,” he says. “It’s the only solution.”

Why wasn’t Dr. Young on the speaker list?

Where was his longtime ally, Dr. Linda Farley, the Dane County physician who has been honored with the American Academy of Family Physicians Presidents Award and named the Wisconsin State Medical Society’s Physician Citizen of the Year? “Health care is a service, not a commodity,” says Farley. “Physicians must be committed to providing quality care to all the people based on their need, not on their ability to pay. (Single-payer) would allow physicians and other health care workers to concentrate on the health of patients and populations, without the hassles of excessive paperwork.”

Where, on the long list of congressional participants, was the name of U.S. Rep. Tammy Baldwin? Elected to Congress as an outspoken advocate for single-payer health care, the Wisconsin Democrat is a member of the key committee in the House that deals with health care issues — Energy and Commerce — and she has succeeded in developing bipartisan coalitions that allow for state experimentation with various reform plans. In other words, she’s a principled yet very practical player in the debate.

Baldwin should have been speaking.

The point here is not to give up on the Obama administration as a vehicle for real reform. White House forums of the sort held Thursday are “for the cameras” events that set the tone — not the policy — of an administration.

The president knows that single-payer is the right fix for what ails the American health care system.

As recently as last August, Obama told a health care forum in New Mexico: “If I were designing a system from scratch, I would probably go ahead with a single-payer system.”

The insurance industry and its allies don’t want to start from scratch and make a system that works.

They want to keep patching up a system that doesn’t work — that fails to provide care to roughly 50 million Americans, that leaves another 50 million underinsured and that is defined more by its cost overruns than its quality — so that they can keep profiteering.

Thursday’s White House sessions provided a great forum for advocates of “patching up” and “tinkering with” a broken system.

But that’s not the treatment that is needed. That’s a prescription for failure.

Obama is better positioned that any president in decades — perhaps ever — to design a system from scratch.

The special interests, corporate insiders and congressional compromisers who made the mess and fear the change won’t remind him of that fact — as Thursday’s forum so amply illustrated.

Real reformers should keep banging on the doors and demanding a place at the table.

Single-payer is not “an alternative.”

It is not one of “various treatment options.”

It is the cure.

John Nichols is the associate editor of The Capital Times.

Blog debate – PNHP versus HCAN reform strategy

Blog Debate: “An Obsolete Model”

By Tim Foley
Change.org
Health Care
March 12, 2009
This is the second day of a blog debate about what approach we should take on health care reform in 2009. Debaters are Dr. Don McCanne, a retired family physician now serving as Senior Health Policy Fellow for Physicians for a National Health Program, and Jason Rosenbaum, a writer and activist, and the Deputy Director of Online Campaigns for Health Care for America Now! Dr. McCanne will be presenting the “single-payer” point of view, and Mr. Rosenbaum will be presenting the “public competitor” point of view.
This is Dr. McCanne’s answer to the question: Is there anything valuable that private insurance brings to the table which, with far more muscular federal regulation, would enhance an American universal health care system?
Dr. McCanne: Everyone agrees that we need comprehensive reform of health care financing if we expect to slow the escalation of costs, while improving allocation of our resources. To achieve these goals, do we need to replace our dysfunctional financing system with an efficient public program, or can we simply use increased regulatory oversight to transform our private insurers into a better functioning system?
Systems using private plans that achieve near-universal coverage, such as Switzerland and Holland, are often cited as examples that we can emulate. These systems are more expensive, with greater administrative complexity, less equity, and fall short of true universality, though they satisfy those who ideologically prefer private to public administration. Some nations also use public programs for low-income individuals, comparable, in principle, to Medicaid in the United States. So how would it work if we were to regulate the private plans and then mandate the purchase of those plans?
There is a very fundamental difference between our private plans and theirs. Other nations that use private plans do so within a program of social insurance. Their plans are designed for the public good, assisting individuals in receiving the care they need without having to be concerned about the source of payment. They fulfill the insurance function by effectively pooling risks, whether through a single risk pool or though various methods of risk adjustment.
Our private plans are based on a business model designed to ensure success in the health care marketplace. Success is defined by the medical loss ratio, spending the least they can on health care. Much of their profound administrative waste is due to their elaborate efforts to avoid paying for care.
The plethora of private plans merely demonstrates the insurers’ innovations in restricting benefits — preventing payment for non-covered services; increasing deductibles and other forms of cost sharing — erecting financial barriers to care; contracting with limited lists of providers — penalizing patients who need care outside of the restricted lists; selective marketing to healthy populations — especially the healthy workforce and their young, healthy families; using underwriting and rescissions to avoid paying for essential care; and on and on. These are great business tools, ensuring success of the insurers, but they are anathema to the more egalitarian goals of social insurance systems. They defeat the insurance function of pooling risk by segregating out the low-cost healthy into their own market, and dumping the high-cost sick onto taxpayer funded programs.
Suppose we heavily regulate our private insurers and require guaranteed issue of plans that actually include all necessary services, and remove barriers to care such as restrictive lists of providers and unaffordable deductibles. This would require a massive, revolutionary transformation of the missions, goals, and administrative functions of our business-model private plans designed to prevent paying for care, into social insurance private plans designed to remove the financial system as a barrier to care.
Anyone who believes that this would be a simple transformation needs to have a conversation with insurance executives with their nine-figure compensation packages or with the large institutional investors who have fared extremely well under our market-based health care financing system.
As if that weren’t enough, there is one more unique problem in the United States. Our health care costs are much higher than in any other nation. If we were effective in covering everyone with a choice of private plans, whether with or without a public option, and if those plans covered the necessary care that people actually need, imagine the premium that would have to be charged.
The Milliman Medical Index has demonstrated that an average family of four with employer-sponsored coverage — a healthy sector — already pays $15,600 for their health care. That is only average; many pay more. With a typical household income of $60,000, that is no longer affordable. Now add into the pool the less healthy members of our population and just imagine what the premium would have to be. Financing our health care system through a specific premium assigned to an individual or family, based on an adequate package of benefits, has become an obsolete model of paying for health care.
We need a single, universal risk pool that is equitably funded. That would most easily be accomplished through progressive taxes. Once we do that, why would we continue to support the intrusion of the wasteful private insurers that do no more than take away our choice of hospitals, physicians and other professionals? Public administration is much more efficient, plus enrollment is a one-time event — absolutely everyone is covered for life.
http://healthcare.change.org/blog/view/blog_debate_an_obsolete_model
For the full debate (in progress):
http://healthcare.change.org/

Members of Physicians for a National Health Program (PNHP) and supporters of the Health Care for America Now! coalition (HCAN) are all passionately dedicated to the goal of achieving reform that will provide affordable, high quality care for everyone. We are bothers and sisters in the cause. The ultimate goals of both organizations are the same, but the strategies are quite different.
The PNHP single payer concept has been around for a couple of decades, but Congress has failed to move on it. The HCAN leadership decided that reform will never occur unless the private insurance industry plays a major role in the future of health care financing, but that the insurers must be challenged with a competing, public Medicare-like option. In theory, the public option would be a better value, and the private plans would fade away as individuals opt to change to the new Medicare program.
There is massive, intense opposition to the public option by the same elements that have been successful in defeating reform in the past. AHIP, PhRMA, the U.S. Chamber of Commerce, the Republican members of Congress, and many others are all opposed to the Medicare-like option.
If the final legislation includes a well-designed public option (adequate benefit package, truly affordable premiums, no excessive cost sharing, the use of private insurer funds for risk adjustment, etc.) then there will be no comprehensive reform. The opponents are powerful enough to defeat it.
If the final legislation includes an emasculated public option, or leaves it out altogether, then reform will be based on a market of private plans.
Following the HCAN strategy, it is absolutely inevitable that private plans will continue to play a major role in financing health care, whether or not comprehensive reform is enacted. The reason that I selected my response on private insurance from our PNHP/HCAN blog debate is that everyone has to understand very clearly why private health plans are an obsolete method of financing an expensive health care system like we have in the United States. Once everyone understands that, we can reject the HCAN strategy and move forward with the program America needs: a single payer national health program.
You are encouraged to follow the debate this week (only four questions) and provide your comments (http://healthcare.change.org/). Tim, Jason and I are very interested in your thoughts, and hopefully the policymakers will be as well.

Blog debate – PNHP versus HCAN reform strategy

Blog Debate: "An Obsolete Model"

By Tim Foley
Change.org
Health Care
March 12, 2009

This is the second day of a blog debate about what approach we should take on health care reform in 2009. Debaters are Dr. Don McCanne, a retired family physician now serving as Senior Health Policy Fellow for Physicians for a National Health Program, and Jason Rosenbaum, a writer and activist, and the Deputy Director of Online Campaigns for Health Care for America Now! Dr. McCanne will be presenting the “single-payer” point of view, and Mr. Rosenbaum will be presenting the “public competitor” point of view.

This is Dr. McCanne’s answer to the question: Is there anything valuable that private insurance brings to the table which, with far more muscular federal regulation, would enhance an American universal health care system?

Dr. McCanne: Everyone agrees that we need comprehensive reform of health care financing if we expect to slow the escalation of costs, while improving allocation of our resources. To achieve these goals, do we need to replace our dysfunctional financing system with an efficient public program, or can we simply use increased regulatory oversight to transform our private insurers into a better functioning system?

Systems using private plans that achieve near-universal coverage, such as Switzerland and Holland, are often cited as examples that we can emulate. These systems are more expensive, with greater administrative complexity, less equity, and fall short of true universality, though they satisfy those who ideologically prefer private to public administration. Some nations also use public programs for low-income individuals, comparable, in principle, to Medicaid in the United States. So how would it work if we were to regulate the private plans and then mandate the purchase of those plans?

There is a very fundamental difference between our private plans and theirs. Other nations that use private plans do so within a program of social insurance. Their plans are designed for the public good, assisting individuals in receiving the care they need without having to be concerned about the source of payment. They fulfill the insurance function by effectively pooling risks, whether through a single risk pool or though various methods of risk adjustment.

Our private plans are based on a business model designed to ensure success in the health care marketplace. Success is defined by the medical loss ratio, spending the least they can on health care. Much of their profound administrative waste is due to their elaborate efforts to avoid paying for care.

The plethora of private plans merely demonstrates the insurers’ innovations in restricting benefits — preventing payment for non-covered services; increasing deductibles and other forms of cost sharing — erecting financial barriers to care; contracting with limited lists of providers — penalizing patients who need care outside of the restricted lists; selective marketing to healthy populations — especially the healthy workforce and their young, healthy families; using underwriting and rescissions to avoid paying for essential care; and on and on. These are great business tools, ensuring success of the insurers, but they are anathema to the more egalitarian goals of social insurance systems. They defeat the insurance function of pooling risk by segregating out the low-cost healthy into their own market, and dumping the high-cost sick onto taxpayer funded programs.

Suppose we heavily regulate our private insurers and require guaranteed issue of plans that actually include all necessary services, and remove barriers to care such as restrictive lists of providers and unaffordable deductibles. This would require a massive, revolutionary transformation of the missions, goals, and administrative functions of our business-model private plans designed to prevent paying for care, into social insurance private plans designed to remove the financial system as a barrier to care.

Anyone who believes that this would be a simple transformation needs to have a conversation with insurance executives with their nine-figure compensation packages or with the large institutional investors who have fared extremely well under our market-based health care financing system.

As if that weren’t enough, there is one more unique problem in the United States. Our health care costs are much higher than in any other nation. If we were effective in covering everyone with a choice of private plans, whether with or without a public option, and if those plans covered the necessary care that people actually need, imagine the premium that would have to be charged.

The Milliman Medical Index has demonstrated that an average family of four with employer-sponsored coverage — a healthy sector — already pays $15,600 for their health care. That is only average; many pay more. With a typical household income of $60,000, that is no longer affordable. Now add into the pool the less healthy members of our population and just imagine what the premium would have to be. Financing our health care system through a specific premium assigned to an individual or family, based on an adequate package of benefits, has become an obsolete model of paying for health care.

We need a single, universal risk pool that is equitably funded. That would most easily be accomplished through progressive taxes. Once we do that, why would we continue to support the intrusion of the wasteful private insurers that do no more than take away our choice of hospitals, physicians and other professionals? Public administration is much more efficient, plus enrollment is a one-time event — absolutely everyone is covered for life.

http://healthcare.change.org/blog/view/blog_debate_an_obsolete_model

For the full debate (in progress):
http://healthcare.change.org/

Comment:

By Don McCanne, MD

Members of Physicians for a National Health Program (PNHP) and supporters of the Health Care for America Now! coalition (HCAN) are all passionately dedicated to the goal of achieving reform that will provide affordable, high quality care for everyone. We are bothers and sisters in the cause. The ultimate goals of both organizations are the same, but the strategies are quite different.

The PNHP single payer concept has been around for a couple of decades, but Congress has failed to move on it. The HCAN leadership decided that reform will never occur unless the private insurance industry plays a major role in the future of health care financing, but that the insurers must be challenged with a competing, public Medicare-like option. In theory, the public option would be a better value, and the private plans would fade away as individuals opt to change to the new Medicare program.

There is massive, intense opposition to the public option by the same elements that have been successful in defeating reform in the past. AHIP, PhRMA, the U.S. Chamber of Commerce, the Republican members of Congress, and many others are all opposed to the Medicare-like option.

If the final legislation includes a well-designed public option (adequate benefit package, truly affordable premiums, no excessive cost sharing, the use of private insurer funds for risk adjustment, etc.) then there will be no comprehensive reform. The opponents are powerful enough to defeat it.

If the final legislation includes an emasculated public option, or leaves it out altogether, then reform will be based on a market of private plans.

Following the HCAN strategy, it is absolutely inevitable that private plans will continue to play a major role in financing health care, whether or not comprehensive reform is enacted. The reason that I selected my response on private insurance from our PNHP/HCAN blog debate is that everyone has to understand very clearly why private health plans are an obsolete method of financing an expensive health care system like we have in the United States. Once everyone understands that, we can reject the HCAN strategy and move forward with the program America needs: a single payer national health program.

You are encouraged to follow the debate this week (only four questions) and provide your comments (http://healthcare.change.org/). Tim, Jason and I are very interested in your thoughts, and hopefully the policymakers will be as well.

Bill Clinton on Health Care Reform

Dr. Sanjay Gupta and former Pres. Bill Clinton
CNN, Larry King Live
March 11, 2009

http://transcripts.cnn.com/TRANSCRIPTS/0903/11/lkl.01.html

——-

GUPTA: All right. Let’s drill down specifically on something you said earlier. When it comes to sort of creating these silos of health care reform — you have sort of single payers and more governmental involvement on one send — one end, free market involvement solely on the other end. Single payer never has really caught traction politically. Is it politically unpalatable or is it a bad idea?

CLINTON: Well, I think it’s more politically unpalatable than it is a bad idea, because single payer is not socialized medicine. Canada has a single payer system and a private health care provider system. Our single payer systems are Medicare and Medicaid.

GUPTA: Sure.

CLINTON: And Medicare is quite popular.

The good thing about single payer is the administrative costs are quite low. We probably waste $200 billion a year between the insurance administrative costs, the doctors and other health care providers’ administrative costs and employers’ administrative costs in health care that we would not waste if we had any other country’s system.

On the other hand, if you look at the experience of Germany, France, Japan — that don’t have pure single payer systems, they have more mixed systems — their costs are actually slightly lower overall than Canada’s. So there’s something to be said for having a mixed system if you can get the administrative costs down, because then the systems have enough competition in them to try to restrain costs and it’s not all up to the political bodies.

In Canada, because it’s all financed through the government, it’s more difficult sometimes for the politicians to say no than for just the regular management of the health care system to cut the costs.

So I think you can have a mixed system. If you look at the French system, which scores very high on every international measure…

GUPTA: Yes.

CLINTON: …it’s mostly publicly financed, but there’s enough private in there that there’s some tension that’s creative and positive.

GUPTA: Do you think there is a degradation quality of care with a single payer system?

Is that a concern?

Should that be a concern?

CLINTON: Well there’s no evidence of that in Canada that I’m aware of, except for excessive delays, which they always try to come to grips with. The British, you know, do have a completely government- run system, but they allow people who can afford it to get outside the system. And they’ve also started running hospitals almost like charter schools in America, that is, they have these trust hospitals that perform very well and therefore they’re given more control over setting their priorities, specializing and cutting delays.

There are all kinds of different ways to do it. But first, you do have to cover everybody. And then you have to stop people from gaming the system. There’s a lot of gaming going on now in the American system so that we spend more than anybody else and get loss for it.

I think that once you get the universal coverage, I think the health insurers then could play a more positive role than they do now, which is often involved in — you know, they make a lot of money through saying no and sort of the inordinate paperwork burdens that are put on doctors and hospitals and other providers.

GUPTA: What is it about the insurance industry that you just brought up?

They tried to scuttle the health care reform plan of ’93. Now they’re saying we also believe in universal health care.

A politically tactile question, I guess, are you buying it?

Do you think they’re being honest?

CLINTON: I think some of them really do want it. Yes. If you look at their new organization, the person who heads it came out of a progressive background and favored, as a philosophical matter, coverage.

Secondly, I think they now understand that, in terms of the health of America and the well-being of our economy, we can’t go on basically giving them more and more dollars every year — the insurance industry — and getting people sicker and sicker and leaving more and more people behind.

I mean look at all the healthcare problems. The child obesity problem, which is my obsession, is the most glaring manifestation of a system that treats sick people and doesn’t keep people well. And that’s one where, I think, by the way, we can get broad bipartisan support on trying to — to do more on wellness. And that will save money.

I think the insurance industry realizes that they — a lot of the smarter ones realize that they could kill the goose that ate the golden egg here, that America can no longer go on spending more money and getting less for it and having all this money go to them and that they can make a lot of money and do well by making us healthier at a more affordable price.

State must act to control costs of top-heavy health-care system

By Dr. Bruce Bender
Worcester Telegram & Gazette
Wednesday, March 11, 2009

Nearly three years after Massachusetts enacted landmark health care reform, the state can point to success in expanding coverage. But it has yet to address another significant issue: cost. By not addressing cost, the state puts the goal of universal coverage and the system in general at risk.

As it is, the cost of the subsidized insurance program, a key component of the reform bill, turned out to be much higher than expected. It will only get more expensive. Experts predict this program will double in size and expense over the next two years — and that was before Massachusetts’ recent economic decline that resulted in 50,000 lost jobs and an unemployment rate of 6.9 percent, the highest in 15 years. The number of residents who may join the ranks of the subsidized program will add to the programs’ costs.

What’s worse, the current program is not able to contain rising health care costs at a time when the state lacks financial flexibility, and is dependent on federal funding, which ends in two years, to help pay for the subsidized program. Even if the program’s costs held steady at today’s level, there’s no guarantee the state will continue to receive federal funding when the agreement ends.

That’s an important reason for Massachusetts to find ways to control costs. Otherwise, Gov. Deval L. Patrick, who has already proposed cuts in his 2010 budget, will have to raise taxes or cut services — or, more likely, do both.

Massachusetts should find ways to reduce the administrative costs of providing health care. Rather than pay an average of 34 to 38 cents of each health-care dollar, we should work to match the same percentage as Canada, 17 cents. This could save $9 billion annually, which could either help prevent the need to cut health-care programs or could be shifted to help our towns, schools, universities, parks, roads, and bridges.

One way to reduce administrative costs is to move to a single-payer system. Employer-sponsored health insurance is an extremely inefficient and expensive way to provide coverage, particularly given the number of small businesses in the state. Administratively, it is hugely expensive to determine which employees are eligible, notify them, explain the options, get them signed up or to sign a waiver sheet, etc. And small businesses are not eligible for the same benefits or prices as large businesses.

This uneven playing field places a substantial burden on business, one that impacts everyone in the state. Increased employer health costs mean increased prices on goods and services.

Employees should oppose employer-sponsored insurance because it is restrictive. An employee who has a special need that is better covered by a different program does not have that option. This is not because of the employer. It is because of the restrictions placed on so-called group insurance plans for small businesses. We cannot even offer all the plans within a single provider.

We provide in-home services to help seniors stay in their homes. This has been recognized by seniors, their families, and Massachusetts as a cost-effective solution. But many of our clients require part-time help Ć¢ā‚¬ā€ and part-timers run into problems because of restrictions placed on us by insurance companies. That’s why, despite paying 150 people each pay period, only about 30 meet the requirements placed on us by the insurers, which excludes 120 employed people from the system. Further, employees should not have to stay at a job that they hate, or work more than they can, or take a job because of the benefits.

The only sensible approach is the one adopted by every other civilized nation: a single-payer system. It would provide far more choice and better care, including preventive care, and be able to provide universal coverage, regardless of age, pre-existing conditions or work status.

Massachusetts has a responsibility to address cost and access issues before it looks for more money for an already failing system. Single-payer health care for Massachusetts can be the answer.

Bruce Bender, M.D., owns the Home Instead Senior Care franchise located in Northboro.

Health care: crisis or opportunity?

Forum examines issue

Joy Slagowski
Daily News-Sun
March 11, 2009

A health-care expert said Tuesday night there is one way to receive comprehensive medical treatment: Go to jail.

“Prisoners are the only people in this country who receive quality care as the result of their constitutional rights,” said Dr. Jonathan Weisbuch,-founder of Arizona Coalition for a State and National Health Plan and former director of the Maricopa County Department of Public Health. “(Maricopa County Sheriff Joe) Arpaio and Maricopa County spend over $20 million a year to serve health needs of people in jail. It’s an extraordinary situation.”

Weisbuch and Rep. Phil Lopes, D-District 27,-author of the Arizona Health Security Act, discussed “The Broken Healthcare System: Crisis or Opportunity” during a forum hosted by the League of Women Voters of Northwest Maricopa County. The event took place at the Unitarian Universalist Church in Surprise. About 50 people attended the session co-sponsored by the Daily News-Sun.

With the economy in crisis and people losing their jobs, the health-care crisis worsens as more people become uninsured, Weisbuch said.

“And 30 percent of Americans are considered uninsurable if they were to buy insurance individually, because of pre-existing conditions,” Weisbuch said.

Health-care costs have increased at a rate of three times the national inflation rate since 1970, he said.

So health-care reform goals need to focus on access to quality care for everyone and adequate reimbursement for medically necessary care, he said.

Weisbuch advocates for HR 676, also known as Conyers Bill, sponsored by Rep. John Conyers of Michigan.

The bill is considered Medicare for all, where patients choose their own doctor and a trust fund pays for care.

Critics call single-payer plans such as the Conyers Bill socialized medicine, but Weisbuch said there are already four socialized medical systems in place in this country: the Department of Defense health system, the veterans health system, Indian health services and the Bureau of Prisons health services.

Lopes said the number of uninsured residents in Arizona is 20 percent of the population.

He has proposed a state plan, based on a plan that New Mexico has been working on for years, to create a 15-member commission to operate the health care for the state and redistribute the money in the system.

“All of the money we are paying out of pocket in co-pays, premiums, what employers are paying for employees, all add up to $30 billion in Arizona,” Lopes said. “We could provide health care for everyone in the state for $30 billion.”

After the meeting, Shirley McAllister of Sun City said she has been a supporter of single-payer health plans since her late husband fought cancer for 20 years and was covered by three different plans.

“We had Medicare, insurance from his university, insurance from my university, and it took so much time and effort to handle the paperwork,”” McAllister said.

“And I thought, if I am having a tough time, how would those with a high school education or less ever keep things straight? That’s when I became a believer,” McAllister said.

Joy Slagowski may be reached at 623-876-2514 or jslagowski@yourwestvalley.com.

The health care summit

By RICHARD DAVIS
Brattleboro Reformer
Wednesday, March 11

Last Thursday, President Obama hosted a health care summit at the White House. He invited 125 of the most influential people involved in health care reform in the U.S.

The list included all of the usual suspects.

There was the infamous Billy Tauzin, former congressman who now heads the pharmaceutical industry’s biggest lobbying company.

Massachusetts Senator Ted Kennedy was elevated to almost Pope-like status in the health care reform world merely by his presence.

The insurance companies and the drug companies and the providers were well represented. There was also a cross section of members of Congress, including Vermont Sen. Bernard Sanders.

Obama was making a public show of trying to get it right this time by inviting people with differing views. He was making it clear that he was moving beyond the mistakes of the past.

We should not be naive enough to think this summit was anything more than a PR event. Of course, that may not be such a bad thing. Symbolism is important. The summit marks the official start of the Obama plan to enact meaningful health care reform before the end of the year. Political pundits think that means that legislation has to make it to the President’s desk by Labor Day.

This event also made it clear that the White House will now be the people’s house. I was able to sit at my computer and watch all of the proceedings of the summit from

Obama’s opening and closing remarks to glimpses of all five breakout sessions. I kept moving from one session to another, trying to figure out who was in the room and whether or not it would be worth hearing what they had to say.

The speechifying was predictable. There were the status quo holders of the drug and insurance industry and there were the coy politicians who really didn’t say what they meant or reveal what that thought, other than to talk around the issue. Yet it was truly an event where just showing up was the most important thing.

From my point of view, as someone who believes we need to enact a national single payer system yesterday, things were disappointing. The prospects for meaningful reform seem slim, but I am cautiously optimistic that a least a few shreds of good will come from the Obama initiative.

The Obama team wants to offer a public insurance plan to compete with private insurance. They are also talking about eliminating exclusions for pre-existing conditions and waiting periods for all insurance.

Opponents are preparing the next round of Harry and Louise ads. They will raise the specter of socialized medicine and the evils of government run health care. Their argument will fail this time not only because it isn’t true, but also because people are hurting so much that they understand what changes need to be made.

Vermonters can feel good about their representation at the summit as well as having strong voices for sensible health care reform in Washington. If it were not for Sanders’ remarks during a breakout session, I think I would have been less hopeful when I finally clicked the last tab to exit the live feed.

The camera was at Sanders’ back and every time someone spoke who had a viewpoint that was antithetical to his, you could see him squirming in his seat. I kept thinking that was me and half the state of Vermont feeling uncomfortable, hearing statements that would kill any hope of serious reform.

When Sanders’ turn came to speak he said, “It is insane that 56 million Americans today do not have access to a doctor.” Then he went on to say that this country needs a single payer system. He even had the courage to confront the power brokers by saying that the insurance companies are the problem with our health care system and that their profiteering is harming people.

I’m sure most of those at Sanders’ session quickly dismissed his remarks as coming from “that socialist from Vermont.” But that guy from Vermont represents the viewpoint of millions of Americans and he will never let his opponents forget that.

Sanders sees hope for reform in increasing support for Federally Qualified Health Centers (FQHC), something he has championed for years.

In remarks before the summit he said, “The United States has to join the rest of the major nations of the world and have a national health care program that addresses the enormous waste and bureaucracy in our current system. I am pleased that we have made significant success in the stimulus bill on primary health care by doubling resources devoted to Federally Qualified Health Centers and tripling the amount for training health care professionals.”

He summed up the day’s event saying, “I think it was a very good meeting. Our health care system is disintegrating and I very much appreciate the president stepping up to the plate and wanting to move rapidly on it. The president understands that we need universal health care for every man, woman and child. So I think we are off to a good start and I applaud the president.”

And I applaud Bernie.

Richard Davis is a registered nurse and executive director of Vermont Citizens Campaign for Health. He writes from Guilford and welcomes comments at rbdav@comcast.net.

Protest set for New England Obama health care forum on March 17

FOR IMMEDIATE RELEASE
March 12, 2009

Contact:
Deborah Richter, M.D., at drdebvt@sover.net or call (802) 371-7754 (cell), (802) 224-9037 (home), (802) 741-7004 (pager)

One of five regional forums on health care reform arranged by the Obama administration will be held at the University of Vermont’s Davis Center on Tuesday, March 17, from noon to 1:30 p.m. Vermont Gov. Jim Douglas and Massachusetts Gov. Deval Patrick are hosting the event.

A publicly financed universal health care system, or as it is sometimes called, a single-payer system, is not on the agenda for discussion. Douglas and Patrick oppose a universal health care system. As for Obama, he stated unequivocal support for single payer in 2003. As a presidential candidate and as president he so far has not repeated his support.

New England is home to a strong universal health care movement. Advocates are marshaling their resources and are staging a large protest outside the university’s Davis Center in Burlington, starting before noon. Their spokespersons describe it as “peaceful and respectful.”

The purpose of the demonstration is to show the enormous support for the single-payer plan and to insist that it be considered as a serious option for reform. Expectations are that hundreds of doctors, nurses and concerned citizens will begin arriving at the Davis Center around 11 a.m. from Maine, New Hampshire, Massachusetts, New York and of course Vermont. Organizers have received responses from hundreds of doctors and nurses in the region indicating they intend to join the protest.

Dr. Deborah Richter, one of the organizers representing Vermont Health Care for All, said, “There will be more discussion of substance outside the Davis Center meeting room than inside.

“All polls,” she continued, “show that we hold the majority opinion. To fix the problems, the focus must include more than the uninsured. All of us are having problems with paying insurance. All the evidence shows that a publicly financed system — something like Medicare — could save money and cover everyone.

“By excluding us from any substantive discussion of health care reform confines us to what we call the marginalized majority. It is time for our leaders to take single payer seriously.”