By Marie Cocco
Denver Post
Viewpoints
12/03/2008

Here is a number easily understood by even the math-phobic: Every 1 percent increase in the unemployment rate leads to another 1.1 million Americans becoming uninsured — and causes still another million more children and adults to become eligible for state health insurance programs.

This means that over the past 10 months, as the hemorrhage of jobs began to push the national unemployment rate toward its October level of 6.5 percent, about 3 million Americans were thrown off the insurance rolls or had their incomes fall so much that they became eligible for Medicaid or the State Children’s Health Insurance Program.

These estimates by the Kaiser Commission on Medicaid and the Uninsured do not bewilder as much as do the tallies associated with the various federal bailouts and guarantees of banks and other institutions at the core of the financial crisis. Those are in the hundreds of billions — actually, we’re into the trillions when you count up each form of taxpayer backing — to shore up this or that part of the teetering financial system.

But before long, if unemployment climbs as predicted to 8 percent or 9 percent next year, the worsening economic crisis will deepen the health insurance crisis. And the combination of job losses and the loss of insurance that is inevitably connected to them is likely to be an awful lot like the crisis of the early 1990s — the last time the political system tried to fix the confused, costly and crumbling health insurance system.

The recession of the early ’90s led the Clinton administration to attempt universal health care.

Though the Clinton plan is consistently derided as a failure, in truth, President-elect Barack Obama’s campaign pledge to build a universal system based on the current, employer-based method of delivering insurance is in good measure modeled upon it. And that is the problem.

Look only to the Detroit automakers’ current economic straits for the reasons why. The car companies’ unionized workers still count on a model health insurance safety net — but even this has been scaled back repeatedly in successive contracts.

Last year, the United Auto Workers Union and the Big Three entered into a deal to create a separate trust fund to bear the cost of retiree health benefits. The fund is jointly financed by the union and the companies, and a substantial part of the money is coming from current workers’ forgoing promised wage hikes.

Year after year, employers demand health benefit cuts in contract talks, or impose them unilaterally where there is no union.

In a 2008 survey, the Kaiser Family Foundation found that 40 percent of firms that offer insurance said they are “somewhat likely” or “very likely” to increase the amount their workers contribute to insurance in the coming year, a cost shift that includes higher premiums and co-payments.

Yet the average annual worker contribution toward premiums for a family policy already has more than doubled in the past nine years. During the same period, middle-class incomes have been largely stagnant.

With employers quickly shedding workers, is there any doubt that more health benefit cuts are coming for those lucky enough to keep their jobs?

And when recovery comes, does anyone think American business is going to abandon its argument that health costs represent a competitive disadvantage in the global marketplace? They won’t, because it’s accurate. And that’s largely because other countries have universal, taxpayer-funded health care systems.

These are the immutable truths of the health care conundrum. They haven’t changed much in two decades. Costs are driven inexorably higher by continual advances in care as well as an aging population that needs more of it.

Employers can’t cope unless they scale back coverage, shift costs to workers or eliminate benefits altogether.

States have become insurers of last resort — but right now they face crippling budget shortfalls that threaten this safety net.

Using this compromised system as the basis for health insurance revision is folly — more so now than it was in the Clinton era, when more employers still were covering their workers.

Tightening regulation of the insurance industry and creating a new, government-based plan to make coverage available to those who cannot afford to buy it from private insurers — the essence of Obama’s campaign proposal — would only add another layer of complexity and, eventually, cost.

Only a single, government-financed system can eliminate the administrative waste, unfairness and economic burden of our current health insurance scheme.

Timidity is no longer an option.

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Marie Cocco’s e-mail address is mariecocco@washpost.com.

http://www.denverpost.com/opinion/ci_11130276http://www.denverpost.com/opinion/ci_11130276

Editor’s note: This article from May, 1993 is important because it includes a quote from pollster Celinda Lake saying the more working Americans learn about the Canadian (single payer) system, “the higher the support goes.” In contrast, a proposal for a system based on competing private insurers was found “laughable.”

Public Health

by Jeff Cohen and Norman Solomon
May 12,1993
Page 78

When a coalition of groups concerned about health care held a loud public protest in midtown Manhattan on May 12 [1993], they didn’t set up their picket line outside a hospital or W insurance company headquarters or government agency.

Instead, they gathered in front of the New York Times building, and their demand was simple: “Stop rationing health care news!” The protesters are angry over the fact that the newspaper’s reporting routinely downplays a popular proposal-endorsed by 12 of New York City’s 14 members of Congress-to overhaul the American health system: a singlepayer system of publicly-financed health care.

Poll after poll has shown that most Americans favor tax-financed national health insurance. But at the New York Times and other national media, proponents are kept at the periphery of the health care debate. They include 58 members of Congress who, on March 3 [1993], introduced a bill-“The American Health Security Act”-to establish a Canadian-style, single-payer system.

In a single-payer system, private insurance companies are basically removed from health care. Instead, the government pays all health care providers, and controls fees and costs. As in Canada, consumers would choose their own doctors-but almost never receive a hospital or doctor bill. Insurance deductibles and co-payments are also eliminated.

By eliminating administrative waste and insurance company profits, the shift to a single-payer system would cut $67 billion per year from our country’s medical bill, according to the General Accounting Office-and $39 billion yearly in bureaucracy, according to the Congressional Budget Office. Of every health-care dollar spent in the U.S., 22 cents goes to administrators; in Canada, that figure is 10 cents.

A single-payer system has been endorsed by health care activists, seniors groups, labor unions and a number of regional dailies-including the Atlanta Journal-Constitution and St. Louis Post-Dispatch. A recent Times-Mirror poll found 41 percent of U.S. doctors in support.

After conducting extensive focus groups on health care, pollster Celinda Lake discovered that the more people are told about the Canadian system, “the higher the support goes.” In contrast, according to Lake, working Americans found the managed competition idea “laughable.”

But much of the national news coverage in recent weeks has been promoting Bill Clinton’s managed competition plan as the smart, new, “politically viable” option.

News reports trumpet the “consensus” behind managed competition: big insurance companies, most doctors, conservative Republican think tanks, George Bush, conservative Democratic think tanks, Hillary Rodham Clinton-and the wise men from the “Jackson Hole Group” who’ve been meeting in Wyoming for years to discuss “health care reform.”

In national media discourse, managed competition seems easier to tout than explain. Since no other country has ever tried such a system, it remains a complicated, untested theory.

The plan leaves the largest insurance companies in the center of the picture; after the federal government defines a minimum package of benefits, health care partnerships or superHMOs organized by insurance firms would “compete” to offer health packages. Meanwhile, giant “Health Insurance Purchasing Cooperatives” would be formed so that employers and consumers could search for the best deal. Between these behemoths would be the government, “managing the competition,” grading the medical providers and trying to restrain costs.

To the protesters outside the New York Times headquarters, the news tilt toward managed competition is explained by the clout of insurance companies and medical industry firms- which are major media advertisers. And, as it happens, four members of the New York Times board of directors are also directors of major insurance companies; two are directors of pharmaceutical companies.

While it’s far-fetched to hunt for a conspiracy, the imprint of the insurance industry is all over the managed competition idea. The Jackson Hole study group that originated the scheme is made up of big insurance companies like Prudential, Metropolitan Life, Aetna and Cigna, plus hospital and pharmaceutical interests. Insurers were important early contributors to Clinton’s presidential campaign, and donated $850,000 to the Democratic Party (and even more to the Republicans) for the 1992 elections.

Critics dismiss managed competition as a bureaucratic hoax that should be renamed the “Insurance Industry Preservation Act.” They warn that the freedom to choose one’s own doctor would be eroded. They say it’s absurd to leave “reform” to the Jackson Hole group of special interests who profit from the inefficient status quo.
Managed competition was the subject of a lengthy MacNeil-Lehrer NewsHour discussion on May 5 [1993]. The panel was made up of three government officials-a congressman, a governor and a state health commissioner-who said the Clinton approach would lower costs, and a fourth panelist, Dr. Steffie Woolhandler, who argued it would increase costs and bureaucracy. (Woolhandler founded Physicians for a National Health Program, representing thousands of doctors who support a single-payer system.)

Near the end of the discussion, anchor Robert MacNeil offered Woolhandler the last word “since you’re in the minority”-to which she responded: “Robert, I’m not in a minority. Polls are showing two-thirds of the American people support government-funded national health insurance.”

MacNeil then rephrased his question: “If this [managed competition] is the program that has a political consensus and the other one that you advocate [single-payer] is considered impossible politically at the moment, why are you then against the one that is viable?”

Because it won’t “provide Americans with the care they need,” the doctor replied.

But she could have offered another response: If much of the public supports national health insurance, and it’s not debated seriously in Washington or the national media because of the power of special interests like the insurance lobby, what does that say about the health of our democracy?

That is an issue journalists should be exploring.

By Dr. Taro Adachi
Baltimore Sun
Letter to the Editor
Nov. 25, 2008

http://www.baltimoresun.com/news/opinion/letters/bal-ed.le.letters25n10nov25,0,3920952.story

The concept of the health insurance industry guiding the terms for a national health care plan would be worth a laugh if it wasn’t so dangerous (“Insurers propose health care terms,” Nov. 20).

Leaders of America’s Health Insurance Plans have suggested that, in exchange for agreeing to accept all customers regardless of health conditions, they want a federal requirement that everyone buy coverage. But we have already seen such plans consistently fail on a state level.

The Massachusetts health care plan, which was supposed to create universal coverage, has left hundreds of thousands of people uninsured because the premiums and out-of-pocket expenses are too costly for many to afford.

Other states have tried similar plans but have also failed to achieve universal coverage as a result of annual increases in insurance premiums that make the subsidies many people need to afford care prohibitively expensive.

Mandates requiring people to purchase health insurance are unrealistic when the cost makes health insurance unaffordable.

Health insurance premiums have significantly risen every year, hurting both employers and consumers. This trend would not end under the industry’s current proposal. Instead, we would continue to pay profit-seeking insurers more while we get less care.

We must face the fact that the health insurance industry is a market failure and encourage our political leaders to see that a true single-payer national health system is not only politically feasible but necessary.

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The writer is a member of Physicians for a National Health Program.

By All Unions Committee For Single Payer Health Care–HR 676

Self-described as “one of the Democratic Party’s leading political strategists,” Celinda Lake has claimed that single-payer reform lacks meaningful popular support. Lake’s research, done for the Herndon Alliance, has consistently supported reform based upon private health insurance. She and the Herndon Alliance are largely responsible for the notion that a single payer Medicare-for-all healthcare system is ‘not politically feasible.’

Lake’s findings are in sharp contradiction to numerous polls showing that single payer is enormously popular.

* In a New York Times/CBS News poll in February 2007, 64% said that the federal government should guarantee health insurance for all Americans.

* In October 2003, 62% of respondents to a Washington Post/ABC News poll said they preferred “a universal health insurance program, in which everybody is covered under a program like Medicare that’s run by the government and financed by taxpayers.”

* These findings were repeated in a 2007 Associated Press-Yahoo poll in which 65% supported a Medicare-for-all system.

Kip Sullivan, an attorney and health systems analyst, has been at work on a soon-to-be published analysis of the research methods and methodology used by Celinda Lake to conduct her work on behalf of the Herndon Alliance.

Sullivan has written over 100 articles on health policy, many of which appeared in national newspapers, magazines and journals such as American Journal of Public Health, Health Affairs, Los Angeles Times, The Nation, New England Journal of Medicine, New York Times, and Washington Monthly. He is the author of “The Health Care Mess: How We Got Into It and How We’ll Get Out of It” (AuthorHouse, 2006). He has a BA from Pomona College and JD from Harvard Law School.

Below is Sullivan’s executive summary. For the full article, please click here.

An analysis of Celinda Lake’s slide show, “How to talk to voters about health care”

By Kip Sullivan, November 29, 2008

Executive Summary

Celinda Lake is a pollster who has developed a slide show entitled, “How to talk to voters about health care.” Based on research Lake did for the Herndon Alliance, a coalition formed in 2005, Lake offers an explanation of how “Americans” view “health care reform.” According to Lake, “Americans” have surprisingly conservative “values” about this topic. According to Lake, this means advocates for “health care reform” must not only use and avoid certain words, but they must endorse and avoid certain policies.

Examples of Lake’s findings include:

* Americans think Medicare is “frighteningly flawed” and, consequently, Americans oppose a national health insurance program based on Medicare or which resembles Medicare;

* Americans who have private health insurance not only like it, but like it so much they will resist a Medicare-for-all solution to the health care crisis because it does not leave them the option of continuing to receive coverage from a health insurance company;

* Americans don’t want to pay for health insurance for “the undeserving,” a category which includes even the parents of average Americans;

* Americans don’t like the phrase “universal coverage” or “universal health insurance,” and prefer “quality, affordable health care”;

* Similarly, activists should never say “Medicare for all,” and instead say “choice of public and private plans,” which is, of course, equivalent to saying no one should support a Medicare-for-all (or single-payer bill) and should instead only support legislation that allows the health insurance industry to continue to take in tax dollars and premium payments. (Under a Medicare-for-all system, one payer like Medicare would replace the nation’s 1,500 health insurance company as the sole payer of clinics, hospitals and other providers.)

To understand why Lake would depict Americans as Scrooges who like their health insurance company and are afraid of Medicare, it helps to understand why the Herndon Alliance was formed. The Alliance was founded by individuals who have either opposed or refused to support Medicare-for-all legislation and instead supported legislation like President Bill Clinton’s 1993 Health Security Act, a bill that would have pushed all but the wealthiest Americans into HMOs. In 2005, several individuals who would play leading roles in creating the Herndon Alliance met to discuss why they “keep losing,” that is, why none of the bills they had supported in the past were enacted or, if enacted, stayed enacted. These individuals decided that the primary problem was the “values” of the American people. According to this diagnosis of the problem, their failure to achieve universal coverage was not due primarily to the power of the insurance industry or the unattractiveness of the legislation they had supported, but rather to the “values” of the average American.

But this diagnosis conflicts with a large body of research which shows that 65 to 85 percent of Americans support universal health insurance, and 60 to 70 percent support a Medicare-for-all program. For example, a 2007 poll by AP-Yahoo asked respondents whether they agreed or disagreed with this statement: “The United States should adopt a universal health insurance program in which everyone is covered under a program like Medicare that is run by the government and financed by taxpayers.” Sixty-five percent said yes.

If the Herndon Alliance founders had said that a large majority of Americans support universal coverage and Medicare-for-all programs, and this support can be reduced by false propaganda against such programs, that would have been an accurate diagnosis. But they didn’t. Instead, they adopted the much more questionable assumption that most Americans harbor “values” that cause them not support universal coverage. It is reasonable to infer that Lake was hired by the Herndon Alliance to produce research to confirm their armchair diagnosis of the American pyche.

Lake’s research occurred in three stages: a “mapping values” stage, a focus group stage, and a polling stage. There were serious defects in all three stages.

In the first stage, as Lake put it, “[O]ur research … explor[ed] … the core values that shape … views on health care….” The result of this first stage was a report by a firm called American Environics (AE) that claimed to identify 117 “values” held by Americans that allegedly have some influence over how we think about health care reform. These “values” had names like “brand apathy,” “discount consumerism,” “more power for big business,” “meaningful moments,” and “sexual permissiveness.” The “value” known as “meaningful moments,” for example, was defined this way: “The sense of impermanence that accompanies momentary connections with others does not diminish the value of the moment.” Lake and AE refuse to explain where these “values” come from or how any of them relate to “health care reform,” much less deserve to be called “core values that shape … views on health care.”

On the basis of these “values,” AE divided Americans into eight groups or “clusters” with names as fanciful as the “values” AE says we hold. The three largest groups, in order of size, were “Proper Patriots” (34 percent), “Marginalized Middle-Agers” (17 percent), and “Mobile Materialists” (13 percent). AE describes the millions of people in these “clusters” in terms that can only be called psychobabble. Here is how AE stereotypes Mobile Materialists:

This group tries to impress others with their homes, cars, clothes and looks, scoring high on Status via Home, Buying on Impulse, Importance of Brand, Joy of Consumption, Crude Materialism and Ostentatious Consumption. … [T]he new rims for their car or yet more designer handbags are welcome escapes from everyday drudgery. They tune out after work by watching MTV Cribs (Living Virtually) and feel best when they make time for a workout at the gym or a mani-pedi (Look Good Feel Good, Concern for Appearance).

The second and third stages of Lake’s research were based on the bizarre results of the first stage. For her focus groups, Lake selected people who represented the strange “clusters” concocted by AE. Lake does not tell us how she determined that the people she selected fell into one of the “clusters,” or what questions she asked them. All we hear from Lake are her conclusions about what allegedly went on in the focus groups. It was from these focus groups that Lake allegedly learned that Americans don’t support “universal coverage,” fear Medicare, feel good about their health insurance company, and think their own parents are among “the undeserving.”

In the third stage, Lake conducted a poll designed to see how people felt about a health care reform proposal she developed during the second stage (called “guaranteed affordable choice”) compared with single-payer. She wrote the question in a way that ensured the respondents would favor “guaranteed affordable choice” (GAC) over the single-payer proposal. To offer just one example: Lake declined to tell her respondents that patients would continue to have limited choice of doctors and hospitals under the GAC plan while under the single-payer plan patients would have complete freedom to choose their doctors and other providers.

In short, Lake delivered to the Herndon Alliance the results the founders of the Alliance were looking for. She told them, in effect, that they were right all along to support legislation that leaves the insurance industry at the top of the health care food chain and not to support a Medicare-for-all or single-payer proposal. And she gave them the rationale they wanted to hear — that they were justified in abandoning single-payer and supporting a role for the health insurance industry because that’s what Americans want them to do.

But to give the Herndon Alliance the results they wanted, Lake had to rely on secretive and biased methods. Until Lake reveals her methods and offers a reasonable explanation for why her results are so different from those of other researchers, the public should treat Lake’s research as junk science.

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All Unions Committee For Single Payer Health Care–HR 676
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