Letter to the Editor
New York Times
Published: December 22, 2008

To the Editor:

Re “Necessary Medicine?” (Week in Review, Dec. 14):

The problem with President-elect Barack Obama’s supposed emphasis on the costs of health care is that his proposals fail to deal with the biggest source of wasteful expenditures, our dependence upon private health insurance.

Mr. Obama’s plans, by continuing to embrace a role for private health insurance in our system, wed us to the waste, profiteering and venality of an industry that exists only to take our money and spend as little of it as possible on the objective.

The private insurance industry seeks to increase the proportion of its revenue reserved for profits by spending as little as possible on health care, instead directing its expenditures to marketing, underwriting, “product development” and executive compensation.

I’d prefer my health care dollars to be spent — surprise! — on health care. Only a move toward “Medicare for all” can do that.

Aaron M. Roland
San Francisco, Dec.

The writer is a practicing family physician and clinical associate professor of medicine at the University of California San Francisco.

By Hilda Sarkisyan
Los Angeles Daily News
Article Launched: 12/22/2008

One year ago, my beautiful daughter Nataline lost her long struggle with leukemia. Our insurance company, Cigna Healthcare, closed the door on us. Now we need to make sure that other families can have the security that our daughter didn’t.

It was one year ago that the California Nurses Association, bloggers from coast to coast, and our Armenian community mounted a massive national protest that forced the hand of our insurance company to reverse their decision to deny a lifesaving liver transplant for our 17-year-old daughter.

Tragically, Nataline slipped into a coma and died two hours after Cigna Healthcare relented and approved the procedure.

Nataline was first diagnosed with leukemia at age 14. She was in remission for only one short year before her relapse. After her sweet 16 birthday, which was a huge celebration with her friends and family, she had several months of chemotherapy. She then developed complications following a bone-marrow transplant from her brother, Bedig, which led to liver failure.

Cigna refused to pay for treatment, citing policy provisions which didn’t cover “services considered experimental, investigational and/or unproven to be safe and/or effective for the patient.”

Four prominent doctors, including the surgical director of the Pediatric Liver Transplant Program at UCLA, wrote to Cigna urging it to reverse its denial. They said that Nataline “currently meets criteria to be listed as Status 1A” for

a transplant. They also challenged Cigna Healthcare’s denial that the company said occurred because their benefit plan “does not cover experimental, investigational and unproven services,” to which the doctors replied, “Nataline’s case is in fact none of the above.”

Why didn’t they listen to the doctors and nurses at her bedside and approve the transplant the week before, when there were two healthy livers that were a match and could have saved my sweet Nataline?

We were told that the cost of a liver transplant and one year of follow-up care was $450,000 in 2007 and UCLA turned down two livers while waiting for approval from Cigna Healthcare. It took a huge outpouring of protest and Cigna Healthcare’s public humiliation to force their hand.

We agree with President-elect Obama, who is talking about the need to bring down spiraling health-care costs, but it won’t happen as long as the insurance industry is minding the till.

Having insurance is not the same as receiving needed care. We need a fundamental change in our health-care system that takes control away from the insurance companies and places it where it belongs – in the hands of the caregivers, the patients and their families.

We have a rare opening, a historic opportunity, and piecemeal solutions that keep the insurance industry open for business will only stoke the fires of financial hardship and unnecessary heartbreak for America’s working families.

My family’s New Year’s wish is to see an end to the suffering caused by insurance industry greed and misguided priorities.

We believe that the only way to guarantee all Americans health care, and assure that another young life is not sacrificed, is through a single-payer system, which is like improved Medicare for all.

Hilda Sarkisyan, of Northridge, and her husband filed a lawsuit against Cigna Healthcare of California last week.

By ROSE ANN DeMORO
The Tampa Tribune
Sunday, December 21, 2008

The most heartbreaking e-mail alerts that crossed my computer screen this holiday season arrived from an active, progressive union that has set up a fund for medical benefits for widows and orphans of their former members.

Reliance on charity rather than a public safety net symbolizes what has become a perversely unique American solution to social problems, especially in the Bush administration era.

In “Critical Condition,” a searing 2006 indictment of the collapse of our medical system, Donald Bartlett and James Steele described how pervasive this dependence has become. Garage sales, spaghetti feeds, livestock auctions, pancake breakfasts, walkathons, bingo tournaments, pie socials, carwashes, church suppers, raffles, barbecues, basketball shootouts, even hot-air balloon rides, all to help families drowning with un-payable medical bills.

Rather than a coordinated national system, as every other industrialized country has established, our “you’re on your own” society has hit rock bottom in the most basic area of all, the care of our community.

No wonder the United States ranks last among comparable nations in preventable deaths and first in out-of-pocket costs, despite spending twice as much as anyone else on per capita health care.

Much has been said recently about Franklin Roosevelt’s first 100 days, a period that inaugurated a new standard of social action and set the stage for some of the most important reforms in American history.

But it’s also worth remembering FDR’s 1944 call for a second Bill of Rights that included the right for all Americans to quality health care and other basics in jobs, education, housing and food that he said “spell security.” In other words, a collective response to protect and defend everyone, not just the fortunate few.

Counting on personal check writers or online donors certainly relieves others of their responsibility, most notably the insurance companies that are not about to jeopardize that by starting to actually pay for medical care.

And it circumvents the vision of those who think our government should guarantee health care for all of us, much as government assumes responsibility for police, fire, armed services, schools, libraries, mail service, parks, environmental protections, airport security, national museums and prisons.

And even though the government is already in the game, financing or providing medical care for seniors, veterans, the disabled and low-income families, it should operate with less administrative waste, less bureaucracy and without rejecting people based on pre-existing conditions or dumping them when they get sick.

But somehow, a whole lineup of liberal advocacy groups, policy wonks, media pundits and politicians have concluded there is a national “consensus” to fix this broken and dysfunctional health care system by expanding the private insurance system that created the disaster.

That approach, however, would not curtail skyrocketing premiums, deductibles, co-pays or bills for care denied by the insurance companies. In recent testimony to the Senate Finance Committee, Princeton Professor Uwe Reinhardt noted that the current cost of medical services for a typical family of four consumes 26 percent of that family’s gross wages. At the present rate that will soar to 44 percent by 2018.

Perhaps those “consensus” builders are counting on the pancake breakfasts and orphan funds to make up for their policy failures. Or they could channel that giving spirit into joining a broad grass-roots campaign to demand real reform.

Registered nurses will be in the forefront of this movement. It is RNs who every day look patients in the eye and directly experience the pain and degradation of an all-too-often inhumane system. They know that every life counts and are not willing to leave anyone behind.

And they know what it would take to guarantee high quality care for everyone, a streamlined, more effective system than our current nightmare; one based on care, not insurance, by extending Medicare to cover everyone.

In an era when our government has intervened on behalf of Citigroup and AIG and Freddy and Fannie and all those financial wizards on Wall Street, maybe we can bail out the tens of millions of Americans without having to count on auctions or widows’ funds to pay for medical care.

By Bill Roy
Topeka Capital-Journal
Dec. 20, 2008

As December began, President-elect Barack Obama invited our nation’s governors to meet with him in Philadelphia. I am told 48 governors showed up on 48 hours notice to discuss with him state budget problems.

The good news was Obama indicated some of the promised stimulus package will be channeled through the states to help them fund basic services, most particularly education and health, which claim well over half of every state budget.

That meeting was good for Obama, good for our states and good for our governors, who want to provide the best educational and health care services they can.

America is a great nation. Much of its reputation for good government is derived from good state governments.

In my most fertile imagination, about March 1, President Obama and new secretary of Health and Human Services, Tom Daschle, would call the governors to whatever site they choose and tell them they have a plan to turn health care administration and delivery over to them, along with adequate funds to implement the best system they possibly can.

Daschle could say, “The principles of this plan are so simple that we believe that after careful study you will quickly call upon your members of Congress to go to work and pass the enabling legislation.”

When I was a once-upon-a-time congressman, unprejudiced by previous public service, I realized, and repeatedly stated in Washington and on the stump, that if we didn’t have states we would have to discover them.

State governments are both physically and culturally closest to the people they serve. If people of a state don’t get decent government, it’s usually their own darn fault. States also differ greatly in a multitude of ways, enough so to nearly always guarantee one federal law or one federal program does not fit all.

Many eager states have had a lot of sad experiences trying to have universal health care for their citizens and trying to pay for it. Without exception, they have failed. Oh, they have done some good things, such as marginally decrease the number of uninsured, provide public hospitals and support education and training of health professionals. But they have always fallen short on coverage and money.

But with this proposal, the federal government will share costs if states meet a handful of requirements. Yes, other countries have been successful with similar programs, although admittedly all nations are having difficulty keeping up financially with the rapid advance of biomedical sciences. But the other 29 nation-members of the Organization for Economic Cooperation and Development have been successful in covering nearly everyone for about two-thirds of what we are spending. Our problem isn’t money, it’s trying to deliver care through scores of money-making private health insurance companies.

This country has talked about universal health care too long for anyone to try to be cute, so I won’t. Yes, these are Canadian principles, and it could be called a Canadian plan — and that water was poisoned long ago. If it needs a foreign name, it might be best to call it the Taiwan plan, because that nation implemented a similar single-payer program in 1995 after studying the health systems of industrial nations to find out what works.

The Taiwanese have a smart card that includes all medical information of the holder, and is used for automatic billing that reduced their administrative costs to 2 percent, about one-tenth of our average administrative costs.

The requirements for states to receive federal money would be straight-forward: universality, comprehensiveness, accessibility, portability, and public administration. Yes, it could also be called state-administered Medicare for All.

The privilege of buying private health insurance to cover uncovered services or amenities distinguishes this proposal from the Canadian system, which absolutely forbids private insurance. It makes the system less egalitarian, but infinitely less discriminatory than our current system where health depends on income.

Bill Roy is a retired physician and former member of Congress. He has a law degree and lives in Topeka. He may be reached at wirroy@aol.com.

Robert Wood Johnson Foundation
News Digest
Dec 14, 2008

The rising numbers of unemployed and uninsured mean that “affordable health care has never been more urgently needed,” and “at this critical juncture, a single-payer plan is the only medically, morally and fiscally responsible path to take,” writes Oliver Fein, M.D., associate dean and professor of clinical medicine and public health at Weill Cornell Medical College and president of Physicians for a National Health Program, in an Atlanta Journal-Constitution guest commentary.

The health care reform proposals offered by President-elect Barack Obama, Sen. Edward Kennedy (D-Mass.) and Sen. Max Baucus (D-Mont.) all “share a fatal flaw: they preserve a central role for the private health insurance industry.” Fein points to the mandates in some of the proposed plans as problematic because they require people to purchase “the private health insurance that is failing us today.” And, while some offer a public option modeled on Medicare, private plans continue to “refuse to compete on a level playing field” and instead “cherry-pick healthier patients and insist on more than their share of payment.” Fein argues that private health insurance companies have high overhead costs and “force doctors and hospitals to spend heavily on billing and paperwork.”

Fein proposes getting rid of the private insurance industry, which would save $400 billion a year in administrative costs–“enough to ensure that everyone is covered and to eliminate all co-pays and deductibles.” In its place he suggests implementing a single-payer system that works like Medicare, which “has been a leader in keeping costs down, at least until Washington politicians decided to pay private insurance plans to enroll seniors at a cost 12- to 19-percent higher than traditional Medicare.” A single-payer system would allow patients to choose their preferred doctor and hospital; make it easier for doctors to get paid and allow them to concentrate on providing care; “enhance cost containment through global budgeting”; and emphasize primary care and prevention.

According to Fein, 59 percent of physicians and 62 percent of Americans support the idea of national health insurance. Even opponents of a single-payer plan “often admit it’s the best, most efficient and equitable way to provide quality care” but fear it is not “politically feasible” so prefer to keep it off the table. He concludes, “Medicare for All is within reach, but only if we are prepared to take on the private health insurance industry.” (Fein, Atlanta Journal-Constitution, 12/14/08)