PNHP

On the Single Payer Road Again: It’ll Be a Tough Lobby to Beat

On the Single Payer Road Again: It’ll Be a Tough Lobby to Beat

Doctors, Nurses, Med Students and Patients Join Government and Business Leaders

Calling for Single Payer Reform in Pennsylvania and the Nation

By Donna Smith, community organizer

LANCASTER, PA — I haven’t seen Dr. Walter Tsou of PNHP (Physicians for a National Health Program) as much as I would like to since a sweltering June day last year when he welcomed the huge SiCKO bus into Philadelphia. It isn’t that both he and I haven’t been out talking about single payer healthcare reform, but we don’t often get the opportunity to be in the same place at the same time — until tonight.

We both were panelists for a forum entitled: Single-Payer, Guaranteed Healthcare for All, A Mainstream Solution. We were at the historic Franklin and Marshall College in Lancaster, and we were joined by medical students, doctors, nurses, business leaders and legislators.

This was a powerful bunch of people — each told a piece of the picture of a broken system and of the single payer solution. And this is one lobby group I’d match against any in tenacity, intelligence and just plain humanity. As each spoke, it was clear that respect and passion are hallmarks of this movement. You cannot buy that sort of lobby effort — it rises up from the heart and soul of decent Americans fed up with what we know can be so much better.

Talk about family values… with young women like Mary Carol Jennings, medical student and leigislative director for the 67,000 member American Medical Student Association, working on publicly funded, privately delivered, single payer health care, we clearly have strong, purposeful young women who know how to be political powerhouses and stay grounded in compassion and justice for all. I’d sure choose her to be my doc and she’ll be a fine one in the future… but she’ll be working on single payer in the coming year for AMSA.

Then there was Alan Jacobs, president of the 20-restaurant Isaac’s Deli corp, who shared his objections to hearing John McCain say he didn’t want bureaucrats involved in healthcare. Alan said as an employer under the current healthcare system in the U.S. he becomes the first-line bureaucrat for his employees as he decides which coverage the company will offer with what scope of benefits and at what price. Then he noted that the private insurance company itself becomes the next bureaucrat injected into the patient’s healthcare or lack thereof.

But then Alan finished by talking about his frustration and pain in watching an employee who suffers the onset of a health issue struggle to keep working then ultimately lose his or her job due to illness followed by a lack of income making the former employee unable to afford the insurance once held through employment. “So it is in this final brutality I am forced to participate,” he said.

Dr. Tsou gave a lively talk about the failures of various incremental programs in individual states over the years — Oregon, Tennessee, Massachusetts, Maine — and his prediction that other plans like the one currently being touted by Pennsylvania’s Governor Ed Rendell would not enjoy any different results.

Dawn Ali, RN, of the Pennsylvania Association of Staff Nurses and Allied Professions, told the crowd about how many nurses she knows who just cannot stand the physical and emotional strain of being nurses at the bedside under current conditions. She talked about the medical errors that follow — like night follows day — the pressures placed on nurses to handle unworkable patient loads and work mandatory overtime shifts. All this, she said, the result of a system gone mad on profit.

From one speaker to the next, the case for single payer grew ever sharper and more contrasted with the status quo. Audience questions revealed strong support for making the right sorts of political pressures heard in the right places. And this is one lobby with motivations so focused and strong that it was energizing just to be in the room.

Single payer history tonight. Onward.

William Brody on risk pooling

Health care reform must art with a plan to simplify

By William R. Brody, MD, PhD, president of the Johns Hopkins University
San Francisco Chronicle
September 18, 2008
I favor community-rated health insurance – that is, one big pool to spread and share risk with no cherry picking allowed.
http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2008/09/17/EDA112VONV.DTL

There could not be a more explicit endorsement of social insurance, especially significant since it comes from one of the nation’s more important health care leaders. Once we all agree that we need one big risk pool to spread and share risk, the remaining efforts in health care reform would be limited to working out the details of the mechanics of funding and administering that pool.
That is not to say that it will be easy. We will still be debating whether or not we will dismiss the private insurance industry and replace it with a single payer universal health program. If we continue to use the private insurance industry, it will require massive transformation into a model similar to the European plans using non-profit private insurers, a change that investor-owned insurers surely will resist to the death of their corporations (what a pleasant fantasy). Instead of trying to totally change the mission and structure of U.S.-style insurers, it would be easier to replace them with our own public Medicare-like model.
Once we accept the concept of a single, equitable risk pool for everyone, then we can all move forward with the comparatively simple task of crafting the mechanics of the financing system. We really can do it.

William Brody on risk pooling

Health care reform must art with a plan to simplify

By William R. Brody, MD, PhD, president of the Johns Hopkins University
San Francisco Chronicle
September 18, 2008

I favor community-rated health insurance – that is, one big pool to spread and share risk with no cherry picking allowed.

http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2008/09/17/EDA112VONV.DTL

Comment:

By Don McCanne, MD

There could not be a more explicit endorsement of social insurance, especially significant since it comes from one of the nation’s more important health care leaders. Once we all agree that we need one big risk pool to spread and share risk, the remaining efforts in health care reform would be limited to working out the details of the mechanics of funding and administering that pool.

That is not to say that it will be easy. We will still be debating whether or not we will dismiss the private insurance industry and replace it with a single payer universal health program. If we continue to use the private insurance industry, it will require massive transformation into a model similar to the European plans using non-profit private insurers, a change that investor-owned insurers surely will resist to the death of their corporations (what a pleasant fantasy). Instead of trying to totally change the mission and structure of U.S.-style insurers, it would be easier to replace them with our own public Medicare-like model.

Once we accept the concept of a single, equitable risk pool for everyone, then we can all move forward with the comparatively simple task of crafting the mechanics of the financing system. We really can do it.

KFF's three options includes single payer

Covering the Uninsured: Options for Reform

Kaiser Family Foundation
September 17, 2008
Options for Covering the Uninsured
1. Build on the current system:
Strengthen the employer-based system
Expand public coverage by building on Medicaid and SCHIP
Create new group insurance options for individuals and businesses
2. Revise the sponsorship and financing of health coverage through the tax system
3. Adopt a single-payer plan
http://www.kff.org/uninsured/h08_7813.cfm

Listening to the national dialogue on health financing reform, you would think that we have only two options: 1) Don’t start from scratch with a better program, but build on the current system (Obama), or 2) Reform the tax code to shift incentives for purchasing insurance from employers to individuals (McCain). Replacing our dysfunctional financing system with a single payer national health program, if even mentioned, is immediately dismissed from the dialogue.
As an example, yesterday Health Affairs released three new articles commenting on the reform proposals. An excellent article by Buchmueller et al explained why the McCain proposal would be relatively ineffective in expanding coverage to more individuals and would likely result in a deterioration of the effectiveness of health plans. An article by Antos et al explained why the Obama proposal will fail to slow the escalation in health care costs, besides falling short on universal coverage.
The third Health Affairs article should have been on how single payer would control costs while providing comprehensive coverage for everyone. It wasn’t. Instead it was an article by Mark “Moral Hazard” Pauly describing a compromise model incorporating features of the McCain and Obama plans. Although the Buchmueller and Antos articles were covered extensively by the media, I couldn’t help but notice that the Pauly article was ignored, and quite appropriately so.
Kaiser Family Foundation is precisely right. There are three options for reform. We know that only one of them will work: single payer. A discussion of the McCain and Obama plans is not complete without including an explanation of the effectiveness of single payer. It’s our job to be sure that it is included.

KFF's three options includes single payer

Covering the Uninsured: Options for Reform

Kaiser Family Foundation
September 17, 2008

Options for Covering the Uninsured

1. Build on the current system:
Strengthen the employer-based system
Expand public coverage by building on Medicaid and SCHIP
Create new group insurance options for individuals and businesses

2. Revise the sponsorship and financing of health coverage through the tax system

3. Adopt a single-payer plan

http://www.kff.org/uninsured/h08_7813.cfm

Comment:

By Don McCanne, MD

Listening to the national dialogue on health financing reform, you would think that we have only two options: 1) Don’t start from scratch with a better program, but build on the current system (Obama), or 2) Reform the tax code to shift incentives for purchasing insurance from employers to individuals (McCain). Replacing our dysfunctional financing system with a single payer national health program, if even mentioned, is immediately dismissed from the dialogue.

As an example, yesterday Health Affairs released three new articles commenting on the reform proposals. An excellent article by Buchmueller et al explained why the McCain proposal would be relatively ineffective in expanding coverage to more individuals and would likely result in a deterioration of the effectiveness of health plans. An article by Antos et al explained why the Obama proposal will fail to slow the escalation in health care costs, besides falling short on universal coverage.

The third Health Affairs article should have been on how single payer would control costs while providing comprehensive coverage for everyone. It wasn’t. Instead it was an article by Mark “Moral Hazard” Pauly describing a compromise model incorporating features of the McCain and Obama plans. Although the Buchmueller and Antos articles were covered extensively by the media, I couldn’t help but notice that the Pauly article was ignored, and quite appropriately so.

Kaiser Family Foundation is precisely right. There are three options for reform. We know that only one of them will work: single payer. A discussion of the McCain and Obama plans is not complete without including an explanation of the effectiveness of single payer. It’s our job to be sure that it is included.

KFF’s three options includes single payer

Covering the Uninsured: Options for Reform

Kaiser Family Foundation
September 17, 2008

Options for Covering the Uninsured

1. Build on the current system:
Strengthen the employer-based system
Expand public coverage by building on Medicaid and SCHIP
Create new group insurance options for individuals and businesses

2. Revise the sponsorship and financing of health coverage through the tax system

3. Adopt a single-payer plan

http://www.kff.org/uninsured/h08_7813.cfm

Comment:

By Don McCanne, MD

Listening to the national dialogue on health financing reform, you would think that we have only two options: 1) Don’t start from scratch with a better program, but build on the current system (Obama), or 2) Reform the tax code to shift incentives for purchasing insurance from employers to individuals (McCain). Replacing our dysfunctional financing system with a single payer national health program, if even mentioned, is immediately dismissed from the dialogue.

As an example, yesterday Health Affairs released three new articles commenting on the reform proposals. An excellent article by Buchmueller et al explained why the McCain proposal would be relatively ineffective in expanding coverage to more individuals and would likely result in a deterioration of the effectiveness of health plans. An article by Antos et al explained why the Obama proposal will fail to slow the escalation in health care costs, besides falling short on universal coverage.

The third Health Affairs article should have been on how single payer would control costs while providing comprehensive coverage for everyone. It wasn’t. Instead it was an article by Mark “Moral Hazard” Pauly describing a compromise model incorporating features of the McCain and Obama plans. Although the Buchmueller and Antos articles were covered extensively by the media, I couldn’t help but notice that the Pauly article was ignored, and quite appropriately so.

Kaiser Family Foundation is precisely right. There are three options for reform. We know that only one of them will work: single payer. A discussion of the McCain and Obama plans is not complete without including an explanation of the effectiveness of single payer. It’s our job to be sure that it is included.

BC Calif creates dual networks to cheat patients and physicians

Physicians Urged to Carefully Review Blue Cross Contract Amendment

California Physician
September 15, 2008
Physicians contracted with Blue Cross of California were recently notified of the insurer’s intent to amend its Prudent Buyer contract to include Anthem’s Select PPO product, effective January 1, 2009.
The addendum in question requires contracted physicians to always refer Anthem Select PPO Members to other participating Select PPO providers, unless they have obtained authorization to refer out of network. Physicians should be aware that the underlying Prudent Buyer contract authorizes Blue Cross to unilaterally lower the physicians’ fee schedule as a penalty for referring to out of network providers. For this reason, it is important for physicians to determine if colleagues you frequently refer to and those who refer to you participate in the Select PPO network.
http://www.calphys.org/html/cc763.asp
Addendum:
http://www.calphys.org/assets/applets/bc_addendum_091508.pdf

Those supporting health care reform based on the model of private health plans competing in the marketplace have looked to Blue Cross of California (BCC) as the nation’s leader in innovative market solutions. BCC has been very effective in providing insurance products with competitive premiums by using these innovations to limit what is paid for health care benefits, in an environment of ever-increasing health care costs.
By far the most important innovation was to establish preferred provider lists of physicians and hospitals that agreed to accept contracted reimbursement rates. The providers accepted lower rates, and patients were financially penalized if they used providers outside of the contracted networks. No attempt will be made to address here the many other innovations that allowed BCC to reduce what it pays for health care, but more does need to be said about this new innovation in its preferred provider networks.
Largely because of its competitive premiums made possible by its leverage in being able to sign up physicians and hospitals in its Prudent Buyer PPO plans, BCC has been one of the most successful programs in California, success being defined from a business perspective. Its success has been so great that it is now in a position to be able to make itself its own competitor, but, as we’ll see this is not competition that is designed to benefit the patient/consumer, but rather to benefit the Anthem/WellPoint shareholders of which BCC is a subsidiary.
In addition to its well established Prudent Buyer PPO, it now also has established Anthem Select PPO, a product designed to be more competitive by offering even lower premiums. The Anthem Select PPO has established a separate contract with a much smaller number of physicians and hospitals who have agree to even lower reimbursement rates (presumably lower, though that is proprietary information). Besides lower rates, BCC also benefits by making access more difficult for patients by sharply limiting the number of Select providers available.
Patients may not realize it, but they are penalized when they continue to use their Blue Cross Prudent Buyer providers if those providers have not also signed up to be part of Anthem Select PPO. They may think they have access to the Prudent Buyer PPO list, but if the corner of their card says “A Select Network Product,” they are restricted to a much more limited choice if they expect to receive the full benefits of their plan (that is, full underinsurance benefits).
The new BCC innovation spelled out in the addendum and in the underlying Prudent Buyer contract establishes financial penalties for physicians who continue to refer to their established Prudent Buyer colleagues and hospitals without first checking to be certain that they are on the much more exclusive Anthem Select PPO list.
BCC has provided a potential out. Physicians can obtain prior authorization to refer Select patients to the Prudent Buyer providers. But talk about abusive administrative excesses! BCC is requiring the burdensome prior authorization process merely to cross refer within its own two artificially segregated networks!
The process is hardly transparent. Most physicians and their staff members will not notice “A Select Network Product” on the corner of the card. They will make the Prudent Buyer referrals as usual. When the claim is paid, the disallowed amount will be adjusted off, without the staff realizing that the adjustment is greater than it would have been had a referral been made within the more restricted Select list. The patient will receive a statement of benefits with a larger amount listed as their own responsibility, not realizing that they are being penalized for using a Prudent Buyer provider who did not also have a Select contract.
Thus Blue Cross of California has set up within its own Prudent Buyer program two separate PPO lists that it uses to play against each other for the purpose of cheating the patient, cheating the physician, and cheating the hospital. Only the shareholders benefit.
Some may feel that “cheat” is too strong of a word, but cheating is depriving by trickery, and that is exactly what BCC is doing.
For those who still believe that we can patch together reform by using private insurance plans, please read John Geyman’s “Do Not Resuscitate: Why the Health Insurance Industry Is Dying, and How We Must Replace It” (Common Courage Press).

BC Calif creates dual networks to cheat patients and physicians

Physicians Urged to Carefully Review Blue Cross Contract Amendment

California Physician
September 15, 2008

Physicians contracted with Blue Cross of California were recently notified of the insurer’s intent to amend its Prudent Buyer contract to include Anthem’s Select PPO product, effective January 1, 2009.

The addendum in question requires contracted physicians to always refer Anthem Select PPO Members to other participating Select PPO providers, unless they have obtained authorization to refer out of network. Physicians should be aware that the underlying Prudent Buyer contract authorizes Blue Cross to unilaterally lower the physicians’ fee schedule as a penalty for referring to out of network providers. For this reason, it is important for physicians to determine if colleagues you frequently refer to and those who refer to you participate in the Select PPO network.

http://www.calphys.org/html/cc763.asp

Addendum:
http://www.calphys.org/assets/applets/bc_addendum_091508.pdf

Comment:

By Don McCanne, MD

Those supporting health care reform based on the model of private health plans competing in the marketplace have looked to Blue Cross of California (BCC) as the nation’s leader in innovative market solutions. BCC has been very effective in providing insurance products with competitive premiums by using these innovations to limit what is paid for health care benefits, in an environment of ever-increasing health care costs.

By far the most important innovation was to establish preferred provider lists of physicians and hospitals that agreed to accept contracted reimbursement rates. The providers accepted lower rates, and patients were financially penalized if they used providers outside of the contracted networks. No attempt will be made to address here the many other innovations that allowed BCC to reduce what it pays for health care, but more does need to be said about this new innovation in its preferred provider networks.

Largely because of its competitive premiums made possible by its leverage in being able to sign up physicians and hospitals in its Prudent Buyer PPO plans, BCC has been one of the most successful programs in California, success being defined from a business perspective. Its success has been so great that it is now in a position to be able to make itself its own competitor, but, as we’ll see this is not competition that is designed to benefit the patient/consumer, but rather to benefit the Anthem/WellPoint shareholders of which BCC is a subsidiary.

In addition to its well established Prudent Buyer PPO, it now also has established Anthem Select PPO, a product designed to be more competitive by offering even lower premiums. The Anthem Select PPO has established a separate contract with a much smaller number of physicians and hospitals who have agree to even lower reimbursement rates (presumably lower, though that is proprietary information). Besides lower rates, BCC also benefits by making access more difficult for patients by sharply limiting the number of Select providers available.

Patients may not realize it, but they are penalized when they continue to use their Blue Cross Prudent Buyer providers if those providers have not also signed up to be part of Anthem Select PPO. They may think they have access to the Prudent Buyer PPO list, but if the corner of their card says “A Select Network Product,” they are restricted to a much more limited choice if they expect to receive the full benefits of their plan (that is, full underinsurance benefits).

The new BCC innovation spelled out in the addendum and in the underlying Prudent Buyer contract establishes financial penalties for physicians who continue to refer to their established Prudent Buyer colleagues and hospitals without first checking to be certain that they are on the much more exclusive Anthem Select PPO list.

BCC has provided a potential out. Physicians can obtain prior authorization to refer Select patients to the Prudent Buyer providers. But talk about abusive administrative excesses! BCC is requiring the burdensome prior authorization process merely to cross refer within its own two artificially segregated networks!

The process is hardly transparent. Most physicians and their staff members will not notice “A Select Network Product” on the corner of the card. They will make the Prudent Buyer referrals as usual. When the claim is paid, the disallowed amount will be adjusted off, without the staff realizing that the adjustment is greater than it would have been had a referral been made within the more restricted Select list. The patient will receive a statement of benefits with a larger amount listed as their own responsibility, not realizing that they are being penalized for using a Prudent Buyer provider who did not also have a Select contract.

Thus Blue Cross of California has set up within its own Prudent Buyer program two separate PPO lists that it uses to play against each other for the purpose of cheating the patient, cheating the physician, and cheating the hospital. Only the shareholders benefit.

Some may feel that “cheat” is too strong of a word, but cheating is depriving by trickery, and that is exactly what BCC is doing.

For those who still believe that we can patch together reform by using private insurance plans, please read John Geyman’s “Do Not Resuscitate: Why the Health Insurance Industry Is Dying, and How We Must Replace It” (Common Courage Press).

McCain's Radical Agenda

By BOB HERBERT
New York Times
Published: September 16, 2008

Talk about a shock to the system. Has anyone bothered to notice the radical changes that John McCain and Sarah Palin are planning for the nation’s health insurance system?

These are changes that will set in motion nothing less than the dismantling of the employer-based coverage that protects most American families.

A study coming out Tuesday from scholars at Columbia, Harvard, Purdue and Michigan projects that 20 million Americans who have employment-based health insurance would lose it under the McCain plan.

There is nothing secret about Senator McCain’s far-reaching proposals, but they haven’t gotten much attention because the chatter in this campaign has mostly been about nonsense — lipstick, celebrities and “Drill, baby, drill!”

For starters, the McCain health plan would treat employer-paid health benefits as income that employees would have to pay taxes on.

“It means your employer is going to have to make an estimate on how much the employer is paying for health insurance on your behalf, and you are going to have to pay taxes on that money,” said Sherry Glied, an economist who chairs the Department of Health Policy and Management at Columbia University’s Mailman School of Public Health.

Ms. Glied is one of the four scholars who have just completed an independent joint study of the plan. Their findings are being published on the Web site of the policy journal, Health Affairs.

According to the study: “The McCain plan will force millions of Americans into the weakest segment of the private insurance system — the nongroup market — where cost-sharing is high, covered services are limited and people will lose access to benefits they have now.”

The net effect of the plan, the study said, “almost certainly will be to increase family costs for medical care.”

Under the McCain plan (now the McCain-Palin plan) employees who continue to receive employer-paid health benefits would look at their pay stubs each week or each month and find that additional money had been withheld to cover the taxes on the value of their benefits.

While there might be less money in the paycheck, that would not be anything to worry about, according to Senator McCain. That’s because the government would be offering all taxpayers a refundable tax credit — $2,500 for a single worker and $5,000 per family — to be used “to help pay for your health care.”

You may think this is a good move or a bad one — but it’s a monumental change in the way health coverage would be provided to scores of millions of Americans. Why not more attention?

The whole idea of the McCain plan is to get families out of employer-paid health coverage and into the health insurance marketplace, where naked competition is supposed to take care of all ills. (We’re seeing in the Bear Stearns, Fannie Mae, Freddie Mac, Lehman Brothers and Merrill Lynch fiascos just how well the unfettered marketplace has been working.)

Taxing employer-paid health benefits is the first step in this transition, the equivalent of injecting poison into the system. It’s the beginning of the end.

When younger, healthier workers start seeing additional taxes taken out of their paychecks, some (perhaps many) will opt out of the employer-based plans — either to buy cheaper insurance on their own or to go without coverage.

That will leave employers with a pool of older, less healthy workers to cover. That coverage will necessarily be more expensive, which will encourage more and more employers to give up on the idea of providing coverage at all.

The upshot is that many more Americans — millions more — will find themselves on their own in the bewildering and often treacherous health insurance marketplace. As Senator McCain has said: “I believe the key to real reform is to restore control over our health care system to the patients themselves.”

Yet another radical element of McCain’s plan is his proposal to undermine state health insurance regulations by allowing consumers to buy insurance from sellers anywhere in the country. So a requirement in one state that insurers cover, for example, vaccinations, or annual physicals, or breast examinations, would essentially be meaningless.

In a refrain we’ve heard many times in recent years, Mr. McCain said he is committed to ridding the market of these “needless and costly” insurance regulations.

This entire McCain health insurance transformation is right out of the right-wing Republicans’ ideological playbook: fewer regulations; let the market decide; and send unsophisticated consumers into the crucible alone.

You would think that with some of the most venerable houses on Wall Street crumbling like sand castles right before our eyes, we’d be a little wary about spreading this toxic formula even further into the health care system.

But we’re not even paying much attention.

Small book on 'single payer' packs surprising wallop

FOR IMMEDIATE RELEASE
Sept. 16, 2008

Contact:
Mark Almberg, (312) 782-6006, mark@pnhp.org

10 Excellent Reasons for National Health Care

Edited by Mary E. O’Brien, M.D., and Martha Livingston, Ph.D.
Foreward by Rep. John Conyers Jr.
The New Press, August 2008
Paperback, 176 pp., $13.95

While the public is accustomed to seeing a fresh crop of books by presidential candidates during each election cycle — autobiographies, collections of platitudes or sometimes more visionary musings — it’s less common for them to come across popular and well-researched policy books on the burning issues of the day.

Even rarer are election-year policy books that are well-written, widely accessible and likely to have staying power long after the last vote is cast.

“10 Excellent Reasons for National Health Care,” however, is just such a book. Edited by Mary O’Brien, M.D., and Martha Livingston, Ph.D. — both health policy experts and leaders of Physicians for a National Health Program (PNHP) — this new offering from The New Press delivers exactly what it promises: 10 persuasive, evidence-based arguments for a single-payer national health insurance program in the United States.

Sixteen contributors, including Rep. John Conyers (D-Mich.), United Methodist Church leader James Winkler, California Nurses Association leader Rose Ann DeMoro and Steelworkers President Leo Gerard, make the case for single payer in a compact, pocket-sized paperback.

National health insurance is good for our health, they say. It’s cost effective and will save money. It will assure high-quality care for all, rich or poor. It’s the moral thing to do. It will let doctors and nurses focus on patients, not paperwork. It will diminish racial disparities. It will reduce medical debt. It will benefit both labor and business.

And, as Joanne Landy and Dr. Oliver Fein of PNHP argue, single payer is what nearly two-thirds of Americans want.

In each case, the argument is fleshed out with facts and statistics, sometimes accompanied by charts and even the occasional cartoon. Several contain dramatic patient stories. Dr. Claudia Fegan, for example, relates her frustration with trying to get an insurance company to approve an urgently needed detox treatment for a patient, ultimately finding herself pleading with an emergency room physician to administer a time-critical injection.

Drs. Olveen Carrasquillo and Jaime Torres vividly describe what they call “medical apartheid” in our present setup, a multi-tiered “system of segregated care and unequal access faced by poor and predominantly minority patients,” including undocumented immigrants.

All of these problems would be effectively resolved under an expanded and improved Medicare for all, the contributors argue. The main obstacle to achieving this goal, however, is the influence of the for-profit, private health insurance industry.

Despite the obstacles to reform, “10 Excellent Reasons” is pervaded by a spirit of confidence that national health insurance can be won, an optimism that most readers will find contagious. It’s a powerful tool for single-payer advocacy. It also includes a valuable list of additional resources at the end.

In his foreword, Rep. Conyers sums it up: “This insightful book will provide you with the information you need to be an informed participant in the public debate about how to achieve health care for all, [and] work toward the only sensible solution to our health care crisis: a single-payer national health insurance program.”

* * * *

Mary O’Brien, M.D., is a board-certified attending physician at Columbia University Health Services and a faculty member at the Columbia College of Physicians and Surgeons. She is on the board of directors of the New York Metro chapter of Physicians for a National Health Program.

Martha Livingston, Ph.D., is associate professor of health and society at the State University of New York College at Old Westbury. She is vice-chair of the board of directors of the New York Metro chapter of PNHP.

“10 Excellent Reasons for National Health Care” can be ordered from your local bookseller or from Amazon.com, among other places. In searching for the book on Amazon, use the numeric 10 as the first word in the title or search under the names of Mary O’Brien, Martha Livingston or John Conyers.

To inquire about ordering multiple copies, call Physicians for a National Health Program at (312) 782-6006.

McCain’s Radical Agenda

By BOB HERBERT
New York Times
Published: September 16, 2008

Talk about a shock to the system. Has anyone bothered to notice the radical changes that John McCain and Sarah Palin are planning for the nation’s health insurance system?

These are changes that will set in motion nothing less than the dismantling of the employer-based coverage that protects most American families.

A study coming out Tuesday from scholars at Columbia, Harvard, Purdue and Michigan projects that 20 million Americans who have employment-based health insurance would lose it under the McCain plan.

There is nothing secret about Senator McCain’s far-reaching proposals, but they haven’t gotten much attention because the chatter in this campaign has mostly been about nonsense — lipstick, celebrities and “Drill, baby, drill!”

For starters, the McCain health plan would treat employer-paid health benefits as income that employees would have to pay taxes on.

“It means your employer is going to have to make an estimate on how much the employer is paying for health insurance on your behalf, and you are going to have to pay taxes on that money,” said Sherry Glied, an economist who chairs the Department of Health Policy and Management at Columbia University’s Mailman School of Public Health.

Ms. Glied is one of the four scholars who have just completed an independent joint study of the plan. Their findings are being published on the Web site of the policy journal, Health Affairs.

According to the study: “The McCain plan will force millions of Americans into the weakest segment of the private insurance system — the nongroup market — where cost-sharing is high, covered services are limited and people will lose access to benefits they have now.”

The net effect of the plan, the study said, “almost certainly will be to increase family costs for medical care.”

Under the McCain plan (now the McCain-Palin plan) employees who continue to receive employer-paid health benefits would look at their pay stubs each week or each month and find that additional money had been withheld to cover the taxes on the value of their benefits.

While there might be less money in the paycheck, that would not be anything to worry about, according to Senator McCain. That’s because the government would be offering all taxpayers a refundable tax credit — $2,500 for a single worker and $5,000 per family — to be used “to help pay for your health care.”

You may think this is a good move or a bad one — but it’s a monumental change in the way health coverage would be provided to scores of millions of Americans. Why not more attention?

The whole idea of the McCain plan is to get families out of employer-paid health coverage and into the health insurance marketplace, where naked competition is supposed to take care of all ills. (We’re seeing in the Bear Stearns, Fannie Mae, Freddie Mac, Lehman Brothers and Merrill Lynch fiascos just how well the unfettered marketplace has been working.)

Taxing employer-paid health benefits is the first step in this transition, the equivalent of injecting poison into the system. It’s the beginning of the end.

When younger, healthier workers start seeing additional taxes taken out of their paychecks, some (perhaps many) will opt out of the employer-based plans — either to buy cheaper insurance on their own or to go without coverage.

That will leave employers with a pool of older, less healthy workers to cover. That coverage will necessarily be more expensive, which will encourage more and more employers to give up on the idea of providing coverage at all.

The upshot is that many more Americans — millions more — will find themselves on their own in the bewildering and often treacherous health insurance marketplace. As Senator McCain has said: “I believe the key to real reform is to restore control over our health care system to the patients themselves.”

Yet another radical element of McCain’s plan is his proposal to undermine state health insurance regulations by allowing consumers to buy insurance from sellers anywhere in the country. So a requirement in one state that insurers cover, for example, vaccinations, or annual physicals, or breast examinations, would essentially be meaningless.

In a refrain we’ve heard many times in recent years, Mr. McCain said he is committed to ridding the market of these “needless and costly” insurance regulations.

This entire McCain health insurance transformation is right out of the right-wing Republicans’ ideological playbook: fewer regulations; let the market decide; and send unsophisticated consumers into the crucible alone.

You would think that with some of the most venerable houses on Wall Street crumbling like sand castles right before our eyes, we’d be a little wary about spreading this toxic formula even further into the health care system.

But we’re not even paying much attention.