PNHP

Single payer – over on the side table

Single payer – over on the side table

Canada and the Recession: Angles of Deflection

By Nancy Folbre, a professor of economics at the University of Massachusetts Amherst
The New York Times
Economix
February 19, 2009

As the economist (and fellow Economix blogger) Uwe Reinhardt explains, the single-payer Canadian health care system delivers very good results for about half the per-person cost of ours — with huge savings from reduced paperwork. Economic disparities in access to health care are significantly lower there.

President Obama promises to expand health insurance coverage in the United States with little threat or inconvenience to the private sector. But some Democrats in Congress, led by Representative John Conyers, advocate a single-payer “Medicare for All” bill strongly influenced by the Canadian model.

http://economix.blogs.nytimes.com/2009/02/19/canada-angles-of-deflection/?hp

And…

Worthwhile Canadian Initiative

By Fareed Zakaria
Newsweek
February 7, 2009

(Canada’s) health-care system is cheaper than America’s by far (accounting for 9.7 percent of GDP, versus 15.2 percent here), and yet does better on all major indexes. Life expectancy in Canada is 81 years, versus 78 in the United States; “healthy life expectancy” is 72 years, versus 69. American car companies have moved so many jobs to Canada to take advantage of lower health-care costs that since 2004, Ontario and not Michigan has been North America’s largest car-producing region.

http://www.newsweek.com/id/183670

And…

This Won’t Hurt a Bit

by Jonathan Cohn
The New Republic
February 18, 2009

Advocates of single-payer systems complain frequently that the mainstream political debate doesn’t give their idea the attention it deserves. They are right. Public insurance programs enjoy huge economies of scale; they don’t fritter away money on profits or efforts to skim healthier patients from the population. When it comes to billing, they tend to be a lot simpler than, say, a system with dozens of competing insurance plans. All insurance systems require providers to file a lot of paperwork; single-payer systems, though, require just one set. The centralized power of single-payer systems also gives them unparalleled sway over not just the amount of money they pay but how they dole it out; with that kind of leverage, they can push the medical system toward making key improvements in quality.

In an ideal world, then, single-payer would almost certainly be the best option. But is it politically feasible? Single-payer advocates like to point out that Representative John Conyers has a single-payer bill in Congress with close to 100 co-sponsors. But many of those co-sponsors have signed on because, until now, it has been a cheap, meaningless way to win points with liberal interest groups.

http://www.tnr.com/politics/story.html?id=4d41ab07-8c25-4b22-81d2-02b4d149afe2

And…

How the U.S. measures up to Canada’s health care system

Interview of Uwe Reinhardt
Worldfocus
January 28, 2009

We have a Canadian health plan in America. It’s called Medicare. It works. Don’t tell me Medicare doesn’t work. Tell that to the elderly. One way to test it is to say “Let’s take it away.”

You have to, in the end, cover people. And if you, the private health insurance agency, are not able to do it, we can do it. The government can do it. And we’ll discover this more and more.

http://worldfocus.org/blog/2009/01/28/how-the-us-measures-up-to-canadas-health-care-system/3783/

Comment:

By Don McCanne, MD

The good news is that individuals from the media and from the policy community are acknowledging, on the side, that single payer would cover everyone, would improve health outcomes, and would cost less than the other current proposals for reform. Today’s quotes are only a few examples of a multitude of such comments. Single payer has not been removed from the national dialogue on reform.

The bad news is that all too often these are only side comments as the discussion then moves forward with the need to support “feasible” approaches that do not cover everyone, waste tremendous resources, and cost far more than would a publicly-administered and publicly-financed system.

Are we such automatons that we need to set aside facts about an approach that would benefit all of us, and reflexly accept deficient, perverse policies that would benefit the private insurance industry? Why is gifting our funds to the private insurance industry feasible, while spending those funds on health care that people need is not?

As Sen. Daniel Patrick Moynihan said, we’re entitled to our own opinions, but not our own facts. Let’s dump the opinions and craft reform based on the actual facts. Seriously!

Doctors criticize Massachusetts health law

By Lisa Wangsness
Boston Globe
Healthcare
Thursday, February 18, 2009

WASHINGTON — A trio of Boston doctors says the 2006 Massachusetts healthcare law is a poor model for a national system because it leaves too many people without affordable care.

In an analysis issued earlier today and an accompanying letter signed by nearly 500 Bay State physicians, they urged Senator Edward M. Kennedy to push for a Medicare-for-all style national healthcare system, something Congressional leaders and the White House have rejected as politically unworkable as they consider a major overhaul to the healthcare system this year.

“Any plan that retains private insurers will add layers of bureaucracy and fail to control costs, dooming the noble effort to assure good care for all,” the letter said.

The Massachusetts healthcare law essentially builds on the existing health insurance system, where most people obtain coverage through their employers. It requires virtually all people to buy insurance and provides limited assistance to those who cannot afford it. President Obama and Senate Finance Committee Chairman Max Baucus have endorsed aspects of the plan, making it likely to influence any effort to overhaul the national system.

The doctors’ analysis — written by Rachel Nardin, a neurologist and an assistant professor at Harvard Medical School, and Steffie Woolhandler and David Himmelstein, both primary care doctors and associate professors at Harvard Medical School — questions the quality of data showing that all but 2.6 percent of Massachusetts residents have insurance, arguing the number is probably 5 percent or more.

The doctors also say that the new insurance available to lower middle class people imposes unaffordale out-of-pocket costs, particularly on the chronically ill. And they argue that because the new law is more expensive than anticipated, the state has prematurely cut funding for “safety net” providers who help the poor free of charge, leaving them without a last resort.

“Despite having health insurance, many Massachusetts residents cannot afford care,” Nardin said at a press conference in Washington earlier today. She cited the example of a young diabetic from the Boston area whose costs went from nothing under the old “free care” system to $340 per month under the new law, consuming one-quarter of her take-home pay.

Asked how Congress and the White House might avoid Massachusetts’ mistakes to create a better national system, Woolhandler and Nardin said the main lesson was that a Medicare-for-all style system is the only way to achieve universal health reform.

Supporters of the Massachusetts system dismissed the doctors’ analysis as driven by ideology more than by facts.

“They let the perfect be the enemy of the good,” said MIT economist Jonathan Gruber, a board member of the Commonwealth Health Insurance Connector Authority, which administers the Massachusetts law.

Gruber noted that the Connector has capped out-of-pocket costs and premiums for low-income people, ensuring that someone making less than three times the poverty level — about $32,000 for a single person — will pay no more than around 10 percent of their income each year. He acknowledged, however, that those who earn between three and five times the poverty level may have a harder time finding affordable insurance.

Jon Kingsdale, executive director of the Connector, added that out-of-pocket costs for people who earn two to three times the poverty rate are similar to what most people in that income range pay for insurance through their employer.

“Their criticism that we substantially raised cost-sharing for most of the people we’ve helped… is absolutely untrue,” Kingsdale said.

He also noted that while some low-income Boston and Cambridge residents could obtain comprehensive care free of charge before the law passed, most people living outside the metropolitan area then lacked access to drug benefits and broad range of specialist care. Insurance provides access to comprehensive care, he said.

Data on uninsurance is not perfect, he added, but that surveyors went to great lengths to be accurate.

Kingsdale also said the doctors’ analysis did not accurately portray the cost of subsidized insurance for low-income people; Kingsdale said the cost in the 2008 fiscal year was $800 million, not more than $1 billion.

Seattle City Council endorses single payer health

Strange Bedfellows blog
Seattle Post-Intelligencer
Wednesday, February 18, 2009

Since early days of Bill Clinton’s administration, 16 years ago, Rep. Jim McDermott has carried the torch for a national single-payer health program. A Washington Post profile characterized his devotion to the cause as bordering on religious.

At one point in the early 1990’s, McDermott had nearly 90 House cosponsors for a Canada style national health program.

Single payer seemed like a futile cause during the Bush Administration, which put forward ideals for the partial privatization of Medicare.

Now, with a Democrat back in the White House — and a promise of action on health care – McDermott, and Rep. John Conyers, D-Mich., have introduced versions of a single payer plan in the new Congress.

On Wednesday, they received some support — not in Washington, D.C, but in the “other” Washington.

The Seattle City Council voted unanimously to support the McDermott and Conyers proposals.

The legislation would replace private insurance with guaranteed comprehensive coverage, and be paid for through the tax system. Both the McDermott and Conyers bills would cover all Americans.

Seattle, with a reputation as one of America’s most liberal cities, becomes the 49th city and/or municipal government to pass such a resolution.

The resolution of support was sponsored by Councilman Nick Licata.

Massachusetts' plan is the wrong model for the U.S.

Massachusetts’ Plan: A Failed Model for Health Care Reform

Prepared by Dr. Rachel Nardin, Assistant Professor of Neurology, Harvard Medical School, with Drs. David Himmelstein and Steffie Woolhandler (both Associate Professors of Medicine, Harvard Medical School)
February 18, 2009
Executive Summary
The Massachusetts Health Reform Law of 2006 expanded Medicaid coverage for the poor and made available subsidized, Medicaid-like coverage for additional poor and near-poor residents of the state. It also mandated that middle-income uninsured people either purchase private health insurance or pay a substantial fine ($1,068 in 2009). Smaller fines (up to $295 per employee) were also levied on employers who fail to offer insurance benefits.
The reform law has not achieved universal health insurance coverage, although half or more of the previously uninsured now have some type of insurance policy.
The reform has been more expensive than expected, costing $1.1 billion in fiscal 2008 and $1.3 billion in fiscal 2009. In the face of a state budget crisis in fall 2008, Gov. Deval Patrick announced that he will keep the reform afloat by draining money from safety-net providers such as public hospitals and community clinics.
While the number of people lacking health insurance in Massachusetts has been reduced, several recent surveys demonstrate that substantial problems in access to care remain in the state. While the new health insurance improved access to care for some residents, many low-income patients who previously received completely free care under the state’s old free care program now face co-payments, premiums and deductibles that stop them from getting needed care.
In addition, cuts to safety-net providers have reduced health resources available to the state’s remaining uninsured, as well as to others who rely on safety-net providers for services in short supply in the private sector. These safety-net services include emergency room care, chronic mental health care, and primary care. The net effect of this expensive reform on access to care is at best modest, and for some patients, negative.
By mandating that uninsured residents purchase private health insurance, the law reinforced the economic and political power of health insurance firms. Thus, the reform augments the already high administrative costs of health care. Moreover, the agency that administers the new law (the “Connector”) adds an extra 4 to 5 percentage points to the already high overhead of private health insurance policies.
The reform failed to reduce overreliance on expensive, high-technology services. Indeed, some of its provisions such as changes in Medicaid rates and cuts to safety-net providers (who do more primary care) have further tilted health spending toward expensive, high-technology care.
A single-payer system of non-profit national health insurance could save about $8-$10 billion annually in the state through reduced administrative costs. This money could be used to cover all of the state’s uninsured residents and to improve coverage for those who now have insurance, without any increase in total health care costs.
The Massachusetts reform law is not providing universal access to care, even in a state with highly favorable circumstances, including previously high levels of spending on health care for the poor, high personal incomes, and low rates of uninsurance. It is not a model for the nation.
Report: Massachusetts’ Plan: A Failed Model for Health Care Reform
https://pnhp.org/mass_report/mass_report_Final.pdf
Press release: Massachusetts Is No Model for National Health Care Reform
https://pnhp.org/news/2009/february/massachusetts_is_no_.php

Those supporting the leading Democratic model for reform frequently cite the Massachusetts plan as an example of how building on our current system of health care financing is the best path to success. Unfortunately, they use selected positive numbers to define success, while ignoring the fact that Massachusetts has failed in its efforts to achieve the real goals of reform. You can understand how pathological the politics of reform has become when they have to dig into the data of a failed reform effort in order to redefine failure as a success.
Let’s look at some of the goals, and how Massachusetts has fared:
* Everyone should be included – We should quit being dishonest when we say universal, and start demanding that universal means absolutely everyone. The Massachusetts model has left perhaps five percent of individuals without any coverage whatsoever, and there is little likelihood that the numbers of uninsured will be reduced further because of serious flaws in their model.
* The growth in health care costs must be slowed – The Massachusetts model has been ineffective in addressing the primary causes of excess cost escalation.
* Health care must be affordable for each individual – Insurance premiums and cost sharing in private plans have remained unaffordable for many in Massachusetts, impairing access to care. Insurmountable debt or personal bankruptcy from medical bills remains a very real threat in Massachusetts.
* Under-insurance must be eliminated – Massachusetts has expanded the problem of under-insurance in an attempt to make premiums affordable, failing to achieve either goal of adequate plans or affordable premiums.
* Administrative waste must be reduced – Massachusetts has added complexity to an already complex financing system, significantly increasing the administrative waste in their system.
* Coverage should be automatic, portable, and permanent – Massachusetts has provided further confirmation that no model built on our dysfunctional financing system can achieve these goals.
* Health care must be accessible – The Massachusetts model has further exacerbated the deficiencies in the state’s primary care infrastructure, resulting in increased difficulty in accessing their system. Their fragmented financing model has very little capability of realigning resource allocation to improve access.
* Private intermediaries that waste resources and impair access must be eliminated – But isn’t this what the Massachusetts plan is all about? Their view is that we must use our public agencies and tax funds in an all-out effort to protect the private insurance industry, regardless of the harm to patients in the form of physical suffering and financial hardship.
Suppose Congress and the administration accept the message that the Massachusetts plan is the wrong model for reform. Will they then move forward with a single payer national health program – a model that would actually achieve our goals? It is unlikely, based on all signals emitting from Washington. Instead, they will develop a uniquely American plan designed for Americans.
It will be a plan built on our uniquely American, dysfunctional, fragmented system of financing health care. But it won’t be like the Massachusetts plan that was developed in a wealthy state with greater health care resources, and with fewer financing problems than the rest of the nation. No, it won’t be like Massachusetts. It will be much worse… much, much worse.

Massachusetts' plan is the wrong model for the U.S.

Massachusetts' Plan: A Failed Model for Health Care Reform

Prepared by Dr. Rachel Nardin, Assistant Professor of Neurology, Harvard Medical School, with Drs. David Himmelstein and Steffie Woolhandler (both Associate Professors of Medicine, Harvard Medical School)
February 18, 2009

Executive Summary

The Massachusetts Health Reform Law of 2006 expanded Medicaid coverage for the poor and made available subsidized, Medicaid-like coverage for additional poor and near-poor residents of the state. It also mandated that middle-income uninsured people either purchase private health insurance or pay a substantial fine ($1,068 in 2009). Smaller fines (up to $295 per employee) were also levied on employers who fail to offer insurance benefits.

The reform law has not achieved universal health insurance coverage, although half or more of the previously uninsured now have some type of insurance policy.

The reform has been more expensive than expected, costing $1.1 billion in fiscal 2008 and $1.3 billion in fiscal 2009. In the face of a state budget crisis in fall 2008, Gov. Deval Patrick announced that he will keep the reform afloat by draining money from safety-net providers such as public hospitals and community clinics.

While the number of people lacking health insurance in Massachusetts has been reduced, several recent surveys demonstrate that substantial problems in access to care remain in the state. While the new health insurance improved access to care for some residents, many low-income patients who previously received completely free care under the state’s old free care program now face co-payments, premiums and deductibles that stop them from getting needed care.

In addition, cuts to safety-net providers have reduced health resources available to the state’s remaining uninsured, as well as to others who rely on safety-net providers for services in short supply in the private sector. These safety-net services include emergency room care, chronic mental health care, and primary care. The net effect of this expensive reform on access to care is at best modest, and for some patients, negative.

By mandating that uninsured residents purchase private health insurance, the law reinforced the economic and political power of health insurance firms. Thus, the reform augments the already high administrative costs of health care. Moreover, the agency that administers the new law (the “Connector”) adds an extra 4 to 5 percentage points to the already high overhead of private health insurance policies.

The reform failed to reduce overreliance on expensive, high-technology services. Indeed, some of its provisions such as changes in Medicaid rates and cuts to safety-net providers (who do more primary care) have further tilted health spending toward expensive, high-technology care.

A single-payer system of non-profit national health insurance could save about $8-$10 billion annually in the state through reduced administrative costs. This money could be used to cover all of the state’s uninsured residents and to improve coverage for those who now have insurance, without any increase in total health care costs.

The Massachusetts reform law is not providing universal access to care, even in a state with highly favorable circumstances, including previously high levels of spending on health care for the poor, high personal incomes, and low rates of uninsurance. It is not a model for the nation.

Report: Massachusetts’ Plan: A Failed Model for Health Care Reform
https://pnhp.org/mass_report/mass_report_Final.pdf

Press release: Massachusetts Is No Model for National Health Care Reform
https://pnhp.org/news/2009/february/massachusetts_is_no_.php

Comment:

By Don McCanne, MD

Those supporting the leading Democratic model for reform frequently cite the Massachusetts plan as an example of how building on our current system of health care financing is the best path to success. Unfortunately, they use selected positive numbers to define success, while ignoring the fact that Massachusetts has failed in its efforts to achieve the real goals of reform. You can understand how pathological the politics of reform has become when they have to dig into the data of a failed reform effort in order to redefine failure as a success.

Let’s look at some of the goals, and how Massachusetts has fared:

* Everyone should be included – We should quit being dishonest when we say universal, and start demanding that universal means absolutely everyone. The Massachusetts model has left perhaps five percent of individuals without any coverage whatsoever, and there is little likelihood that the numbers of uninsured will be reduced further because of serious flaws in their model.

* The growth in health care costs must be slowed – The Massachusetts model has been ineffective in addressing the primary causes of excess cost escalation.

* Health care must be affordable for each individual – Insurance premiums and cost sharing in private plans have remained unaffordable for many in Massachusetts, impairing access to care. Insurmountable debt or personal bankruptcy from medical bills remains a very real threat in Massachusetts.

* Under-insurance must be eliminated – Massachusetts has expanded the problem of under-insurance in an attempt to make premiums affordable, failing to achieve either goal of adequate plans or affordable premiums.

* Administrative waste must be reduced – Massachusetts has added complexity to an already complex financing system, significantly increasing the administrative waste in their system.

* Coverage should be automatic, portable, and permanent – Massachusetts has provided further confirmation that no model built on our dysfunctional financing system can achieve these goals.

* Health care must be accessible – The Massachusetts model has further exacerbated the deficiencies in the state’s primary care infrastructure, resulting in increased difficulty in accessing their system. Their fragmented financing model has very little capability of realigning resource allocation to improve access.

* Private intermediaries that waste resources and impair access must be eliminated – But isn’t this what the Massachusetts plan is all about? Their view is that we must use our public agencies and tax funds in an all-out effort to protect the private insurance industry, regardless of the harm to patients in the form of physical suffering and financial hardship.

Suppose Congress and the administration accept the message that the Massachusetts plan is the wrong model for reform. Will they then move forward with a single payer national health program – a model that would actually achieve our goals? It is unlikely, based on all signals emitting from Washington. Instead, they will develop a uniquely American plan designed for Americans.

It will be a plan built on our uniquely American, dysfunctional, fragmented system of financing health care. But it won’t be like the Massachusetts plan that was developed in a wealthy state with greater health care resources, and with fewer financing problems than the rest of the nation. No, it won’t be like Massachusetts. It will be much worse… much, much worse.

Single payer: mainstream and 'shovel ready'

The following letter was sent to the editor of The New Yorker on Jan. 22.

In “Getting there from here” (Jan. 26), Atul Gawande suggests that the Massachusetts 2006 mandate plan is a model for national health care reform. He sees his stance as pragmatic, politically feasible, rooted in the particular history of American health care and gifted with the commonsense wisdom that we must start from where we are. Advocates of national health insurance (single payer) are characterized as ideologically driven extremists with “contempt” for pragmatists. I respectfully disagree.

Most Americans, including most physicians, supported national health insurance even before the recent economic collapse, polls show. Endorsers of the single payer bill H.R. 676 (Expanded and Improved Medicare for All) include 93 co-sponsors in the House of Representatives, 450 union organizations in 45 states, and countless others representing a wide range of constituencies. This is not a fringe movement.

High costs are the root cause of Americans’ health insecurity. Gawande’s analysis is flawed by use of a framework centered on insurance coverage rather than the more fundamental issue of health care value. Gawande sees employer-based coverage as the “path-defining” element of our current system because most people are covered by it. Well, it’s all in how you look at it. We need to keep our eyes on the prize, the health care dollar, and follow the money. Government already dominates: tax dollars fund most health care expenditures in the U.S. This is because government covers the sickest and poorest people, tax-favors employer-based private insurance, and covers its own employees. To use Gawande’s metaphor, the lifeboat is already bigger than the “main boat” of American health care. This is where we start.

Gawande asserts that Massachusetts “recently became the first state to adopt a system of universal health coverage for its residents.” As Yogi Berra said, this is like déjà vu all over again. A nearly identical assertion was made twenty years ago by then Gov. Dukakis about Massachusetts’ 1988 reforms. More breathless proclamations heralded reforms in Oregon (1988), Minnesota (1992), Tennessee (1992), Vermont (1992), Washington (1993) and Maine (2003). These plans all had common themes: public spending initiatives, new regulations and mandates, and continued dominance of private insurance in covering low risk populations. None achieved universal coverage. The common denominator of the ultimate failure of all these plans was the absence of effective cost control. Two weeks ago Gov. Deval Patrick of Massachusetts warned that rising costs, “threaten to crush families and businesses and doom Massachusetts groundbreaking experiment with universal insurance.”

In the face of economic collapse and soaring unemployment, with a third of Americans forgoing medical care due to cost, “Job No. 1” is getting value for our health care dollar, not preserving employer-based health insurance. The repetition of failed experiments is not pragmatic, it is part tragedy and part farce. Electronic medical records, chronic disease management and more emphasis on prevention are all important for many reasons but we must admit that short- and long-term cost implications are unknown. Some of these measures may actually increase costs. Medicare is not perfect, but it is demonstrably more cost effective than private insurance and beloved by most Americans. It is “shovel ready.” Single-payer supporters say: everybody in, nobody out. Burned in the fires of the failed Clinton reforms, I believe Gawande misreads the plate tectonics of political possibility at this moment in history, asserting, “No, we can’t” when the opposite is true.

Laura S. Boylan, MD
Clinical Associate Professor of Neurology, New York University School of Medicine
Attending Neurologist, Department of Veteran’s Affairs
Board Member, Physicians for a National Health Program Metro NY

State single-payer bill passes its second test in Senate

BY KIP SULLIVAN Southside Pride, Minneapolis Feb. 16, 2009
If livin’ were a thing that money could buy, You know the rich would live and the poor would die. –“All My Trials,” traditional folk song

SF 118, the Minnesota Health Act, which would guarantee health insurance for all Minnesotans under a program called the Minnesota Health Plan, passed out of the Senate Commerce and Consumer Protection Committee by a party-line vote of 7 to 3 on Feb. 10. The lopsided vote was a sign of the growing support for the single-payer approach. This is the first year since 1991, the year single-payer legislation was first introduced in the Minnesota Legislature, that a single-payer bill has cleared two committees in the Senate. The bill has never been heard in the House. It will get its first hearing in the House on Feb. 25.

The Feb.10 hearing was just one of many battles that remain to be fought over the next several years before the Minnesota Health Act is enacted. But the lopsided vote, the large crowd, the concise and persuasive testimony presented by proponents of the bill, the superficial arguments of the opposing witnesses, and the subdued tone of the Republican senators who voted against it were signs of a change in the way Minnesota talks about health care reform these days. The single-payer approach, long kept off the table by leaders of both parties, is definitely on the table.

The early-afternoon hearing began at 12:40 and ended at 2:45. Sen. Linda Scheid (DFL-Brooklyn Park) began by noting how many people had come (she said people needed tickets to get into the room and others were outside watching on TV monitors). She said she knew people “had strong feelings for this bill” but she wanted the crowd to remain quiet.

Sen. Marty (speaking from the witness table) spoke for 35 minutes, then introduced his three witnesses: Lisa Sherman, the mother of an autistic boy from Stillwater representing Take Action Minnesota; Ann Settgast, a doctor representing Physicians for a National Health Program and the Minnesota Universal Health Care Coalition; and Nancy Breymeier, a financial advisor and president of the Metropolitan Independent Business Alliance which represents over a hundred small businesses. Then opponents of the bill (the insurance industry and three business groups) made brief statements criticizing the bill.

The following five statements illustrate the issues raised by this hearing:

* Sen. Schied’s remarks to Sen. Marty about how helpful he has been in helping her understand the Minnesota Health Plan (MHP);

* Dr. Ann Settgast’s remarks about the insurance industry;

* The remarks by Julie Brunner, the director of the Minnesota Council of Health Plans, implicitly blaming doctors and patients for the health care crisis and deflecting blame from the insurance industry;

* Sen. Mary Olson’s (DFL-Bemidji) reply to Ms. Brunner; and

* Sen. Scheid’s response to a remark by Mike Burress who spoke against SF 118 on behalf of the Minnesota Association of Health Underwriters.

At some point after Sen. Marty had described the bill, Sen. Schied gave him a big smile and said she appreciated all the work he had done to educate her about the bill. “Now I get it,” she said. Sen. Scheid has been in the Legislature since 1976. Single-payer bills have been introduced every year in the Senate and the House since 1991. So for Sen. Scheid to say now, in 2009, she understands why the Minnesota Health Plan is a good plan tells you (a) Sen. Marty is doing a good job as the chief author talking to other senators and (b) change can happen relatively quickly once a single-payer bill begins to move through the Legislature (and of course that happens only if it is backed by a strong movement within and outside the Legislature).

Dr. Ann Settgast’s testimony was effective not only because she’s a doctor, but because she speaks clearly and persuasively while referring to her notes only infrequently. She speaks without notes in part because she speaks about her daily life as a doctor, and in part because she’s a very serious student of health policy and she knows the case for the MHP very well.

The point Dr. Settgast drove home was that she sees mostly insured people, and it’s precisely because she works with mostly insured people that she has come to oppose proposals that leave insurance companies in the mix. Her actual words were something like, “Working daily with a mostly insured population has made me wary of proposals that merely expand coverage.” She made that point again when she reminded the committee that half of all personal bankruptcies are caused by medical bills, and three-fourths of those people had insurance when their medical bills arrived. She said when the MHP becomes law the only thing that will look different will be “the billing department at your clinic.” She cited two surveys that indicate 60 to 65 percent of doctors support single-payer. She closed observing that she didn’t grow up in Minnesota but now wants to stay here, in part because our uninsured rate is low and medicine is done well here, and in part because we’re a state that tends to act before other states do and she looks forward to helping Minnesota lead the nation in health care reform. “I’m thrilled to be here and to be part of this movement,” she said with a smile at the end. “I urge you to support this bill.”

In her comments explaining why the Minnesota Council of Health Plans opposes SF 118, Julie Brunner made two points: That single-payer systems in other countries are not “problem free,” and that the insurance industry is part of the solution, not part of the problem. (SF 118, like all single-payer systems, would give to the MHP nearly all of the functions now carried out by the insurance industry.) Ms. Brunner began her testimony by describing the MHP as a “government-run health care system.” She then quoted a statement she pulled off the internet by some woman who claimed to be an American ex-patriot living in France. This alleged ex-pat said she was paying more now out of pocket than she had been paying in dear old America. It is impossible to know if this was a true anecdote. Brunner was obviously scraping the bottom of the barrel if the best she could do was appear before a state legislative committee and read from some anonymous statement posted on the internet. Brunner went on to say Canada does not cover prescription drugs taken outside a hospital (this is true for some Canadians and not others). She said some cancer treatments are not covered in the United Kingdom. (She must have been referring to a breast cancer drug that extends life by four or five months and has such punishing side effects that it was not approved by the American FDA until just a few months ago. The FDA’s approval was over the objections of many consumer groups in this country and the FDA’s own advisory body. There has been some controversy in the UK in the last year over the UK’s refusal to pay for this drug.) “The MHP won’t be problem-free,” Ms. Brunner concluded.

Sen. Mary Olson, a member of the committee and an active member within the Minnesota Health Reform Caucus (the caucus within the Legislature that represents the single-payer point of view), made a very effective five-minute retort to these comments. She told the committee about a trip she took to Canada with Sen. Sharon Erickson Ropes (DFL-Winona) last summer. Looking at Brunner she said, “I have to tell you, there is no such thing as a perfect system anywhere in the world, but some work better than others. We went to Thunder Bay and then to Winnipeg. We heard an overwhelming message: No one in that country would trade their system for ours. They thought it was outrageous that people in this country can be bankrupted by medical bills. Canadian doctors said they wouldn’t tolerate third parties interfering in their relations with patients the way insurance companies in this country interfere in the doctor-patient relationship. Other countries have problems, but they have better ways of
coping with them than we do.” She closed by criticizing Brunner for referring to the MHP as a “government-run health care system.” She said doctors in Canada are free to practice medicine without interference from the government, whereas in this country we have a system run by health insurance companies.

Brunner’s other point was that Minnesota needs health insurance companies to do the unpleasant work of forcing health care costs down. Even after the MHP is created, Ms. Brunner said, “The work of the health plans must still be done. Health care is not expensive because of health insurance. Health insurance is expensive because of health care.” In other words, we have a health care crisis because doctors and patients are making dumb decisions that lead to overuse of the health care system and we need insurance companies to help doctors and patients figure out how to use less health care. There is a kernel of truth to the claim that doctors and patients overuse the health care system, but it is only a kernel and it is only about one-tenth of the truth. The rest of the truth is that underuse of the health care system is far worse than overuse (thanks in large part to the behavior of the health insurance industry), and the health insurance industry, in its relentless crusade to wipe out the relatively small amount of overuse, harms patients and generates enormous administrative costs that drive up overall costs.

My final highlight: One of the opposition witnesses was a white-haired man named Mike Burress who said he was representing “450 of the state’s brokers, as well as carriers” (which presumably means health insurance companies). He began by saying he approved of the current system in which people who work hard can buy more health care than people who don’t work hard. He said he didn’t approve of the fact that “government has a program for everyone,” regardless of whether they have made any effort to buy health insurance. “People should have the freedom to choose innovative health insuance products,” he said, and SF 118 would take that “freedom” away.

When Mr. Burress was done, Sen. Scheid asked, “I don’t think I heard you correctly. Did you say that wealthier people should be able to have better access to health care?” Burress replied, “Yes, that’s what I said, just like they can buy better cars and housing. This is America.” Sen. Schied replied, “Well, I guess I did hear you correctly.” The audience laughed.

After the vote was taken, Sen. Schied announced the 7 to 3 outcome, and then she thanked the crowd for remaining quiet. They erupted in applause at that. Sen. Schied smiled another big smile, banged the gavel and said, “Meeting adjourned.”

Massachusetts’ plan is the wrong model for the U.S.

Massachusetts’ Plan: A Failed Model for Health Care Reform

Prepared by Dr. Rachel Nardin, Assistant Professor of Neurology, Harvard Medical School, with Drs. David Himmelstein and Steffie Woolhandler (both Associate Professors of Medicine, Harvard Medical School)
February 18, 2009

Executive Summary

The Massachusetts Health Reform Law of 2006 expanded Medicaid coverage for the poor and made available subsidized, Medicaid-like coverage for additional poor and near-poor residents of the state. It also mandated that middle-income uninsured people either purchase private health insurance or pay a substantial fine ($1,068 in 2009). Smaller fines (up to $295 per employee) were also levied on employers who fail to offer insurance benefits.

The reform law has not achieved universal health insurance coverage, although half or more of the previously uninsured now have some type of insurance policy.

The reform has been more expensive than expected, costing $1.1 billion in fiscal 2008 and $1.3 billion in fiscal 2009. In the face of a state budget crisis in fall 2008, Gov. Deval Patrick announced that he will keep the reform afloat by draining money from safety-net providers such as public hospitals and community clinics.

While the number of people lacking health insurance in Massachusetts has been reduced, several recent surveys demonstrate that substantial problems in access to care remain in the state. While the new health insurance improved access to care for some residents, many low-income patients who previously received completely free care under the state’s old free care program now face co-payments, premiums and deductibles that stop them from getting needed care.

In addition, cuts to safety-net providers have reduced health resources available to the state’s remaining uninsured, as well as to others who rely on safety-net providers for services in short supply in the private sector. These safety-net services include emergency room care, chronic mental health care, and primary care. The net effect of this expensive reform on access to care is at best modest, and for some patients, negative.

By mandating that uninsured residents purchase private health insurance, the law reinforced the economic and political power of health insurance firms. Thus, the reform augments the already high administrative costs of health care. Moreover, the agency that administers the new law (the “Connector”) adds an extra 4 to 5 percentage points to the already high overhead of private health insurance policies.

The reform failed to reduce overreliance on expensive, high-technology services. Indeed, some of its provisions such as changes in Medicaid rates and cuts to safety-net providers (who do more primary care) have further tilted health spending toward expensive, high-technology care.

A single-payer system of non-profit national health insurance could save about $8-$10 billion annually in the state through reduced administrative costs. This money could be used to cover all of the state’s uninsured residents and to improve coverage for those who now have insurance, without any increase in total health care costs.

The Massachusetts reform law is not providing universal access to care, even in a state with highly favorable circumstances, including previously high levels of spending on health care for the poor, high personal incomes, and low rates of uninsurance. It is not a model for the nation.

Report: Massachusetts’ Plan: A Failed Model for Health Care Reform
https://pnhp.org/mass_report/mass_report_Final.pdf

Press release: Massachusetts Is No Model for National Health Care Reform
https://www.pnhp.org/news/2009/february/massachusetts_is_no_.php

Comment:

By Don McCanne, MD

Those supporting the leading Democratic model for reform frequently cite the Massachusetts plan as an example of how building on our current system of health care financing is the best path to success. Unfortunately, they use selected positive numbers to define success, while ignoring the fact that Massachusetts has failed in its efforts to achieve the real goals of reform. You can understand how pathological the politics of reform has become when they have to dig into the data of a failed reform effort in order to redefine failure as a success.

Let’s look at some of the goals, and how Massachusetts has fared:

* Everyone should be included – We should quit being dishonest when we say universal, and start demanding that universal means absolutely everyone. The Massachusetts model has left perhaps five percent of individuals without any coverage whatsoever, and there is little likelihood that the numbers of uninsured will be reduced further because of serious flaws in their model.

* The growth in health care costs must be slowed – The Massachusetts model has been ineffective in addressing the primary causes of excess cost escalation.

* Health care must be affordable for each individual – Insurance premiums and cost sharing in private plans have remained unaffordable for many in Massachusetts, impairing access to care. Insurmountable debt or personal bankruptcy from medical bills remains a very real threat in Massachusetts.

* Under-insurance must be eliminated – Massachusetts has expanded the problem of under-insurance in an attempt to make premiums affordable, failing to achieve either goal of adequate plans or affordable premiums.

* Administrative waste must be reduced – Massachusetts has added complexity to an already complex financing system, significantly increasing the administrative waste in their system.

* Coverage should be automatic, portable, and permanent – Massachusetts has provided further confirmation that no model built on our dysfunctional financing system can achieve these goals.

* Health care must be accessible – The Massachusetts model has further exacerbated the deficiencies in the state’s primary care infrastructure, resulting in increased difficulty in accessing their system. Their fragmented financing model has very little capability of realigning resource allocation to improve access.

* Private intermediaries that waste resources and impair access must be eliminated – But isn’t this what the Massachusetts plan is all about? Their view is that we must use our public agencies and tax funds in an all-out effort to protect the private insurance industry, regardless of the harm to patients in the form of physical suffering and financial hardship.

Suppose Congress and the administration accept the message that the Massachusetts plan is the wrong model for reform. Will they then move forward with a single payer national health program – a model that would actually achieve our goals? It is unlikely, based on all signals emitting from Washington. Instead, they will develop a uniquely American plan designed for Americans.

It will be a plan built on our uniquely American, dysfunctional, fragmented system of financing health care. But it won’t be like the Massachusetts plan that was developed in a wealthy state with greater health care resources, and with fewer financing problems than the rest of the nation. No, it won’t be like Massachusetts. It will be much worse… much, much worse.

Single payer: mainstream and ‘shovel ready’

The following letter was sent to the editor of The New Yorker on Jan. 22.

In “Getting there from here” (Jan. 26), Atul Gawande suggests that the Massachusetts 2006 mandate plan is a model for national health care reform. He sees his stance as pragmatic, politically feasible, rooted in the particular history of American health care and gifted with the commonsense wisdom that we must start from where we are. Advocates of national health insurance (single payer) are characterized as ideologically driven extremists with “contempt” for pragmatists. I respectfully disagree.

Most Americans, including most physicians, supported national health insurance even before the recent economic collapse, polls show. Endorsers of the single payer bill H.R. 676 (Expanded and Improved Medicare for All) include 93 co-sponsors in the House of Representatives, 450 union organizations in 45 states, and countless others representing a wide range of constituencies. This is not a fringe movement.

High costs are the root cause of Americans’ health insecurity. Gawande’s analysis is flawed by use of a framework centered on insurance coverage rather than the more fundamental issue of health care value. Gawande sees employer-based coverage as the “path-defining” element of our current system because most people are covered by it. Well, it’s all in how you look at it. We need to keep our eyes on the prize, the health care dollar, and follow the money. Government already dominates: tax dollars fund most health care expenditures in the U.S. This is because government covers the sickest and poorest people, tax-favors employer-based private insurance, and covers its own employees. To use Gawande’s metaphor, the lifeboat is already bigger than the “main boat” of American health care. This is where we start.

Gawande asserts that Massachusetts “recently became the first state to adopt a system of universal health coverage for its residents.” As Yogi Berra said, this is like déjà vu all over again. A nearly identical assertion was made twenty years ago by then Gov. Dukakis about Massachusetts’ 1988 reforms. More breathless proclamations heralded reforms in Oregon (1988), Minnesota (1992), Tennessee (1992), Vermont (1992), Washington (1993) and Maine (2003). These plans all had common themes: public spending initiatives, new regulations and mandates, and continued dominance of private insurance in covering low risk populations. None achieved universal coverage. The common denominator of the ultimate failure of all these plans was the absence of effective cost control. Two weeks ago Gov. Deval Patrick of Massachusetts warned that rising costs, “threaten to crush families and businesses and doom Massachusetts groundbreaking experiment with universal insurance.”

In the face of economic collapse and soaring unemployment, with a third of Americans forgoing medical care due to cost, “Job No. 1” is getting value for our health care dollar, not preserving employer-based health insurance. The repetition of failed experiments is not pragmatic, it is part tragedy and part farce. Electronic medical records, chronic disease management and more emphasis on prevention are all important for many reasons but we must admit that short- and long-term cost implications are unknown. Some of these measures may actually increase costs. Medicare is not perfect, but it is demonstrably more cost effective than private insurance and beloved by most Americans. It is “shovel ready.” Single-payer supporters say: everybody in, nobody out. Burned in the fires of the failed Clinton reforms, I believe Gawande misreads the plate tectonics of political possibility at this moment in history, asserting, “No, we can’t” when the opposite is true.

Laura S. Boylan, MD
Clinical Associate Professor of Neurology, New York University School of Medicine
Attending Neurologist, Department of Veteran’s Affairs
Board Member, Physicians for a National Health Program Metro NY

"Divided We Fail" is divided and failing

The Influence Game: Labor and business, joined in health care cause, now at odds on specifics

By Julie Hirschfeld Davis
Chicago Tribune
February 16, 2009
Labor unions and business groups have teamed up in a multimillion-dollar national lobbying campaign to pressure President Barack Obama and Congress for big changes in the nation’s health care system. But as they get down to the specifics, their strange-bedfellows alliance is quietly at odds.
After spending two years and more than $20 million to promote the idea, collaborators in the Divided We Fail coalition — a project of the seniors lobby AARP, the service workers’ union, and groups representing small business and the Fortune 500 — are indeed divided over key elements of how to fix health care.
Its members agree that something should be done to revamp health care in the United States, and there’s consensus on a vague set of general principles that include making coverage more accessible, affordable and efficient. But they differ over important details, including what roles the government and private businesses should play.
The emerging rifts highlight how difficult it will be for Obama and the Democratic-run Congress to deliver what they say they are committed to: a health care overhaul that would guarantee everyone affordable coverage.
They also illustrate the limits of one of lobbyists’ favorite tactics: banding together with partners to try to build support for a top priority. Such alliances are born and die all the time in Washington, often falling victim to internal disputes over policy.
The coalition is led by a handful of Washington’s most influential lobbyists — Bill Novelli of AARP, John J. Castellani of the Business Roundtable and Dan Danner of the National Federation of Independent Business — as well as Andy Stern of the Service Employees International Union, among the most politically active groups in organized labor.
They acknowledge, however, that keeping the coalition together is getting more difficult as Obama and Congress prepare to delve into specifics.
For instance, labor unions and liberal groups are pressing for a universal health coverage system in which the government provides insurance that competes with private plans. SEIU wants to give everyone health benefits similar to those enjoyed by federal employees. It backs Obama’s “pay or play” idea of forcing employers to either offer health insurance to their workers or pay a fee so they can get it elsewhere.
The Business Roundtable and National Federation of Independent Business, on the other hand, want a system based mostly on private health insurance and are against new requirements for employers. The Business Roundtable’s members include health-insurance giants CIGNA, Aetna and Humana, all of which would have to compete with the government if labor got its way.
There’s also a fight brewing between private insurers and consumer groups over how to ensure that everyone is covered. Insurers say they’ll agree to accept any patient regardless of pre-existing health conditions — but only if everyone is required to buy coverage. Consumer groups say that would turn the government into a collection agency for private insurance companies.
http://www.chicagotribune.com/news/nationworld/sns-ap-health-care-strange-bedfellows,0,6877237.story

“Divided We Fail” presented itself as a broad coalition of diverse interests that could come together and agree on health care reform. But it isn’t a broad coalition. It is a coalition that primarily represents business interests – big business through the Business Roundtable, and small business through the National Federation of Independent Business (NFIB).
Also supporting this effort is AARP, which is probably best characterized as a broker for UnitedHealth insurance products – also a business interest with its own concerns about the future of health care financing in the United States.
The other supporter is Service Employees Union (SEIU), a union that broke off from AFL-CIO partly in a dispute over health care benefits. AFL-CIO wants to be sure that the crucial contribution of employer funds for health care continues at least until a well-financed, universal program can be enacted. Our current system of financing health care would collapse without employer contributions. For SEIU, requiring employers to fund comprehensive benefits was a more difficult issue. Service employees are compensated at lower rates than are those in the manufacturing industries, and their more meager benefit programs reflect this. SEIU would prefer to negotiate for higher wages without the necessity of forgoing wage increases in exchange for health benefits. Although a labor union, SEIU’s position is quite convenient for businesses in the service industries.
This coalition was pro-business, but, in the end, they agreed on only one principle – private health plans should be the dominant player in any reform proposal. Even there, their concepts of the specific role of private insurers are quite different.
Business Roundtable members want to maintain control of their health benefit programs, but they also want relief from the costs. They want public subsidies of their fairly comprehensive programs (even though they are already shifting more costs to their employees), but they don’t want any government-managed insurance programs that compete with the private plans.
NFIB wants a market of very cheap, publicly-subsidized under-insurance products, if they are expected to offer coverage at all. They want relief from the regulatory oversight that would make insurance work. But they too are adamantly opposed to any effective government insurance program that might put their own efforts to shame because of the paltry benefits that they would offer. And they definitely do not want to be mandated to provide coverage for all of their employees.
AARP wants to move aggressively into the non-Medicare market with their brokered UnitedHealth plans. They know that they could never compete with a well designed Medicare-like program that would be available to everyone. They are careful in their public statements, mindful of prior credibility issues stemming from prior public positions such as their support of Medicare privatization. But even now, AARP’s Bill Novelli says that “it’s an inside-outside game.” Outside refers to their public marketing through “Divided We Fail,” whereas inside refers to their private lobbying of Congress. What do you suppose goes on behind those closed doors?
SEIU truly does have the welfare of its members at the forefront. Their president, Andy Stern, can and should be faulted for failing to support single payer based on the “lack of political feasibility” argument. Nevertheless, he does support a regulated market of comprehensive private plans, along with a Medicare-like public option that some believe would improve the private sector products through the forces of competition.
So, even though this pro-business coalition agrees on the common denominator of private insurance plans, they cannot agree on an adequate benefit package, on eliminating under-insurance, on individual mandates, on employer-mandates, on cracking down on wasteful middlemen brokers, on equitable tax policies to finance reform, nor on fundamental health policy issues such as community rating and guaranteed issue.
It looks like the pro-business “Divided We Fail” coalition has divided and failed.
To succeed, a coalition must put patients first, and place all others in a secondary position. Although no coalition could possible ever have all interests on board, a patient-oriented coalition should eventually be successful simply because patients are what our health care system is all about.
“Health Care for America NOW!” was such an effort, but they made a mistake. They decided to go for broader support, bringing more varied interests into their coalition, although most are from the progressive community. To do this, they decided that they must agree that single payer is not politically feasible. Consequently, they decided to support a regulated private market with a public insurance option, trading away many of the beneficial features of a single payer system, though with hopes that it could eventually evolve into single payer. SEIU has joined this coalition, whereas AARP, Business Roundtable, and NFIB have not, reflecting the fact that HCAN and SEIU are truly patient oriented. But the outside opposition to a public option and to an adequately regulated and mandated private insurance market is so great that this coalition is already failing.
“Healthcare-NOW!” is an organization that has been around longer, but differs in that they support health care reform that is designed exclusively to benefit patients – without compromise! All other interests benefit when patients fare well (except the private insurers). “Healthcare-NOW!” provides unwavering support for the principles and policies of the single payer model of a national health program. Although “Healthcare-NOW!” still has a long path to travel, “fail” is not a word in their vocabulary.
Healthcare-NOW Position Regarding Health Care for America Now:
http://www.healthcare-now.org/about/regarding-hcan/

"Divided We Fail" is divided and failing

The Influence Game: Labor and business, joined in health care cause, now at odds on specifics

By Julie Hirschfeld Davis
Chicago Tribune
February 16, 2009

Labor unions and business groups have teamed up in a multimillion-dollar national lobbying campaign to pressure President Barack Obama and Congress for big changes in the nation’s health care system. But as they get down to the specifics, their strange-bedfellows alliance is quietly at odds.

After spending two years and more than $20 million to promote the idea, collaborators in the Divided We Fail coalition — a project of the seniors lobby AARP, the service workers’ union, and groups representing small business and the Fortune 500 — are indeed divided over key elements of how to fix health care.

Its members agree that something should be done to revamp health care in the United States, and there’s consensus on a vague set of general principles that include making coverage more accessible, affordable and efficient. But they differ over important details, including what roles the government and private businesses should play.

The emerging rifts highlight how difficult it will be for Obama and the Democratic-run Congress to deliver what they say they are committed to: a health care overhaul that would guarantee everyone affordable coverage.

They also illustrate the limits of one of lobbyists’ favorite tactics: banding together with partners to try to build support for a top priority. Such alliances are born and die all the time in Washington, often falling victim to internal disputes over policy.

The coalition is led by a handful of Washington’s most influential lobbyists — Bill Novelli of AARP, John J. Castellani of the Business Roundtable and Dan Danner of the National Federation of Independent Business — as well as Andy Stern of the Service Employees International Union, among the most politically active groups in organized labor.

They acknowledge, however, that keeping the coalition together is getting more difficult as Obama and Congress prepare to delve into specifics.

For instance, labor unions and liberal groups are pressing for a universal health coverage system in which the government provides insurance that competes with private plans. SEIU wants to give everyone health benefits similar to those enjoyed by federal employees. It backs Obama’s “pay or play” idea of forcing employers to either offer health insurance to their workers or pay a fee so they can get it elsewhere.

The Business Roundtable and National Federation of Independent Business, on the other hand, want a system based mostly on private health insurance and are against new requirements for employers. The Business Roundtable’s members include health-insurance giants CIGNA, Aetna and Humana, all of which would have to compete with the government if labor got its way.

There’s also a fight brewing between private insurers and consumer groups over how to ensure that everyone is covered. Insurers say they’ll agree to accept any patient regardless of pre-existing health conditions — but only if everyone is required to buy coverage. Consumer groups say that would turn the government into a collection agency for private insurance companies.

http://www.chicagotribune.com/news/nationworld/sns-ap-health-care-strange-bedfellows,0,6877237.story

Comment:

By Don McCanne, MD

“Divided We Fail” presented itself as a broad coalition of diverse interests that could come together and agree on health care reform. But it isn’t a broad coalition. It is a coalition that primarily represents business interests – big business through the Business Roundtable, and small business through the National Federation of Independent Business (NFIB).

Also supporting this effort is AARP, which is probably best characterized as a broker for UnitedHealth insurance products – also a business interest with its own concerns about the future of health care financing in the United States.

The other supporter is Service Employees Union (SEIU), a union that broke off from AFL-CIO partly in a dispute over health care benefits. AFL-CIO wants to be sure that the crucial contribution of employer funds for health care continues at least until a well-financed, universal program can be enacted. Our current system of financing health care would collapse without employer contributions. For SEIU, requiring employers to fund comprehensive benefits was a more difficult issue. Service employees are compensated at lower rates than are those in the manufacturing industries, and their more meager benefit programs reflect this. SEIU would prefer to negotiate for higher wages without the necessity of forgoing wage increases in exchange for health benefits. Although a labor union, SEIU’s position is quite convenient for businesses in the service industries.

This coalition was pro-business, but, in the end, they agreed on only one principle – private health plans should be the dominant player in any reform proposal. Even there, their concepts of the specific role of private insurers are quite different.

Business Roundtable members want to maintain control of their health benefit programs, but they also want relief from the costs. They want public subsidies of their fairly comprehensive programs (even though they are already shifting more costs to their employees), but they don’t want any government-managed insurance programs that compete with the private plans.

NFIB wants a market of very cheap, publicly-subsidized under-insurance products, if they are expected to offer coverage at all. They want relief from the regulatory oversight that would make insurance work. But they too are adamantly opposed to any effective government insurance program that might put their own efforts to shame because of the paltry benefits that they would offer. And they definitely do not want to be mandated to provide coverage for all of their employees.

AARP wants to move aggressively into the non-Medicare market with their brokered UnitedHealth plans. They know that they could never compete with a well designed Medicare-like program that would be available to everyone. They are careful in their public statements, mindful of prior credibility issues stemming from prior public positions such as their support of Medicare privatization. But even now, AARP’s Bill Novelli says that “it’s an inside-outside game.” Outside refers to their public marketing through “Divided We Fail,” whereas inside refers to their private lobbying of Congress. What do you suppose goes on behind those closed doors?

SEIU truly does have the welfare of its members at the forefront. Their president, Andy Stern, can and should be faulted for failing to support single payer based on the “lack of political feasibility” argument. Nevertheless, he does support a regulated market of comprehensive private plans, along with a Medicare-like public option that some believe would improve the private sector products through the forces of competition.

So, even though this pro-business coalition agrees on the common denominator of private insurance plans, they cannot agree on an adequate benefit package, on eliminating under-insurance, on individual mandates, on employer-mandates, on cracking down on wasteful middlemen brokers, on equitable tax policies to finance reform, nor on fundamental health policy issues such as community rating and guaranteed issue.

It looks like the pro-business “Divided We Fail” coalition has divided and failed.

To succeed, a coalition must put patients first, and place all others in a secondary position. Although no coalition could possible ever have all interests on board, a patient-oriented coalition should eventually be successful simply because patients are what our health care system is all about.

“Health Care for America NOW!” was such an effort, but they made a mistake. They decided to go for broader support, bringing more varied interests into their coalition, although most are from the progressive community. To do this, they decided that they must agree that single payer is not politically feasible. Consequently, they decided to support a regulated private market with a public insurance option, trading away many of the beneficial features of a single payer system, though with hopes that it could eventually evolve into single payer. SEIU has joined this coalition, whereas AARP, Business Roundtable, and NFIB have not, reflecting the fact that HCAN and SEIU are truly patient oriented. But the outside opposition to a public option and to an adequately regulated and mandated private insurance market is so great that this coalition is already failing.

“Healthcare-NOW!” is an organization that has been around longer, but differs in that they support health care reform that is designed exclusively to benefit patients – without compromise! All other interests benefit when patients fare well (except the private insurers). “Healthcare-NOW!” provides unwavering support for the principles and policies of the single payer model of a national health program. Although “Healthcare-NOW!” still has a long path to travel, “fail” is not a word in their vocabulary.

Healthcare-NOW Position Regarding Health Care for America Now:
http://www.healthcare-now.org/about/regarding-hcan/

“Divided We Fail” is divided and failing

The Influence Game: Labor and business, joined in health care cause, now at odds on specifics

By Julie Hirschfeld Davis
Chicago Tribune
February 16, 2009

Labor unions and business groups have teamed up in a multimillion-dollar national lobbying campaign to pressure President Barack Obama and Congress for big changes in the nation’s health care system. But as they get down to the specifics, their strange-bedfellows alliance is quietly at odds.

After spending two years and more than $20 million to promote the idea, collaborators in the Divided We Fail coalition — a project of the seniors lobby AARP, the service workers’ union, and groups representing small business and the Fortune 500 — are indeed divided over key elements of how to fix health care.

Its members agree that something should be done to revamp health care in the United States, and there’s consensus on a vague set of general principles that include making coverage more accessible, affordable and efficient. But they differ over important details, including what roles the government and private businesses should play.

The emerging rifts highlight how difficult it will be for Obama and the Democratic-run Congress to deliver what they say they are committed to: a health care overhaul that would guarantee everyone affordable coverage.

They also illustrate the limits of one of lobbyists’ favorite tactics: banding together with partners to try to build support for a top priority. Such alliances are born and die all the time in Washington, often falling victim to internal disputes over policy.

The coalition is led by a handful of Washington’s most influential lobbyists — Bill Novelli of AARP, John J. Castellani of the Business Roundtable and Dan Danner of the National Federation of Independent Business — as well as Andy Stern of the Service Employees International Union, among the most politically active groups in organized labor.

They acknowledge, however, that keeping the coalition together is getting more difficult as Obama and Congress prepare to delve into specifics.

For instance, labor unions and liberal groups are pressing for a universal health coverage system in which the government provides insurance that competes with private plans. SEIU wants to give everyone health benefits similar to those enjoyed by federal employees. It backs Obama’s “pay or play” idea of forcing employers to either offer health insurance to their workers or pay a fee so they can get it elsewhere.

The Business Roundtable and National Federation of Independent Business, on the other hand, want a system based mostly on private health insurance and are against new requirements for employers. The Business Roundtable’s members include health-insurance giants CIGNA, Aetna and Humana, all of which would have to compete with the government if labor got its way.

There’s also a fight brewing between private insurers and consumer groups over how to ensure that everyone is covered. Insurers say they’ll agree to accept any patient regardless of pre-existing health conditions — but only if everyone is required to buy coverage. Consumer groups say that would turn the government into a collection agency for private insurance companies.

http://www.chicagotribune.com/news/nationworld/sns-ap-health-care-strange-bedfellows,0,6877237.story

Comment:

By Don McCanne, MD

“Divided We Fail” presented itself as a broad coalition of diverse interests that could come together and agree on health care reform. But it isn’t a broad coalition. It is a coalition that primarily represents business interests – big business through the Business Roundtable, and small business through the National Federation of Independent Business (NFIB).

Also supporting this effort is AARP, which is probably best characterized as a broker for UnitedHealth insurance products – also a business interest with its own concerns about the future of health care financing in the United States.

The other supporter is Service Employees Union (SEIU), a union that broke off from AFL-CIO partly in a dispute over health care benefits. AFL-CIO wants to be sure that the crucial contribution of employer funds for health care continues at least until a well-financed, universal program can be enacted. Our current system of financing health care would collapse without employer contributions. For SEIU, requiring employers to fund comprehensive benefits was a more difficult issue. Service employees are compensated at lower rates than are those in the manufacturing industries, and their more meager benefit programs reflect this. SEIU would prefer to negotiate for higher wages without the necessity of forgoing wage increases in exchange for health benefits. Although a labor union, SEIU’s position is quite convenient for businesses in the service industries.

This coalition was pro-business, but, in the end, they agreed on only one principle – private health plans should be the dominant player in any reform proposal. Even there, their concepts of the specific role of private insurers are quite different.

Business Roundtable members want to maintain control of their health benefit programs, but they also want relief from the costs. They want public subsidies of their fairly comprehensive programs (even though they are already shifting more costs to their employees), but they don’t want any government-managed insurance programs that compete with the private plans.

NFIB wants a market of very cheap, publicly-subsidized under-insurance products, if they are expected to offer coverage at all. They want relief from the regulatory oversight that would make insurance work. But they too are adamantly opposed to any effective government insurance program that might put their own efforts to shame because of the paltry benefits that they would offer. And they definitely do not want to be mandated to provide coverage for all of their employees.

AARP wants to move aggressively into the non-Medicare market with their brokered UnitedHealth plans. They know that they could never compete with a well designed Medicare-like program that would be available to everyone. They are careful in their public statements, mindful of prior credibility issues stemming from prior public positions such as their support of Medicare privatization. But even now, AARP’s Bill Novelli says that “it’s an inside-outside game.” Outside refers to their public marketing through “Divided We Fail,” whereas inside refers to their private lobbying of Congress. What do you suppose goes on behind those closed doors?

SEIU truly does have the welfare of its members at the forefront. Their president, Andy Stern, can and should be faulted for failing to support single payer based on the “lack of political feasibility” argument. Nevertheless, he does support a regulated market of comprehensive private plans, along with a Medicare-like public option that some believe would improve the private sector products through the forces of competition.

So, even though this pro-business coalition agrees on the common denominator of private insurance plans, they cannot agree on an adequate benefit package, on eliminating under-insurance, on individual mandates, on employer-mandates, on cracking down on wasteful middlemen brokers, on equitable tax policies to finance reform, nor on fundamental health policy issues such as community rating and guaranteed issue.

It looks like the pro-business “Divided We Fail” coalition has divided and failed.

To succeed, a coalition must put patients first, and place all others in a secondary position. Although no coalition could possible ever have all interests on board, a patient-oriented coalition should eventually be successful simply because patients are what our health care system is all about.

“Health Care for America NOW!” was such an effort, but they made a mistake. They decided to go for broader support, bringing more varied interests into their coalition, although most are from the progressive community. To do this, they decided that they must agree that single payer is not politically feasible. Consequently, they decided to support a regulated private market with a public insurance option, trading away many of the beneficial features of a single payer system, though with hopes that it could eventually evolve into single payer. SEIU has joined this coalition, whereas AARP, Business Roundtable, and NFIB have not, reflecting the fact that HCAN and SEIU are truly patient oriented. But the outside opposition to a public option and to an adequately regulated and mandated private insurance market is so great that this coalition is already failing.

“Healthcare-NOW!” is an organization that has been around longer, but differs in that they support health care reform that is designed exclusively to benefit patients – without compromise! All other interests benefit when patients fare well (except the private insurers). “Healthcare-NOW!” provides unwavering support for the principles and policies of the single payer model of a national health program. Although “Healthcare-NOW!” still has a long path to travel, “fail” is not a word in their vocabulary.

Healthcare-NOW Position Regarding Health Care for America Now:
http://www.healthcare-now.org/about/regarding-hcan/