PNHP

Pariah Diplomacy

Pariah Diplomacy

by JOEL ALBERS
Southside Pride

Proposed solutions to the health care crisis have reached a crossroads, with essentially two paths that Minnesota and the U.S. can follow. One path views health care as a market commodity, in which health care is for sale. Patients are also consumers who must shop around, compare prices and quality of care, and buy insurance. That is if you can afford it. If you cannot, you are uninsured. And therein lies the crisis.

The other path views health care as a public good: government-funded through taxes, like education, social security, Medicare and roads. With everybody in one big pool (creating economies and efficiencies of scale), represented by a single-payer, health care would be universal, comprehensive, a human right, based on need, and free at the household level. As in the rest of the world, cost is essentially out of the picture.

In this legislative session, like in others before it, the Minnesota Senate and House have each passed major health care bills based on the market commodity model described above. The bills are now in conference committee where their differences will be worked out. The House bill, HF 3391, is sponsored by Rep. Tom Huntley (DFL-Duluth) and the Senate bill, SF 3099, is sponsored by Senator Linda Berglin (DFL-Mpls). As may be expected, these bills were fully backed by HMO health insurers and big business.

The Minnesota Health Plan, bill SF 2324, (a Single-Payer bill–a government-funded approach, and, according to surveys, backed by most Minnesotans), was scuttled shortly after the legislative session began, only passing through one committee. Year after year this scenario is replayed resulting in a worsening of the health care crisis.

What’s behind this contradictory trend in which insurance companies and big business circumvent democracy, and what can be done about it? A major factor is rigged, handpicked Task Forces, currently, the “Health Care Transformation Task Force,” whose recommendations became the basis for the aforementioned Huntley and Berglin bills.

Here’s the mechanism of how it works. The so-called Health Care Transformation Task Force was intentionally created by the 2007 Legislature and signed by Governor Pawlenty last May. This allowed the governor to appoint (handpick) all members of the Task Force, including its co-chairs, Rep. Tom Huntley (DFL-Duluth) and Human Services Commissioner Cal Ludeman who also serves as the chair of Governor Pawlenty’s Health Cabinet (also handpicked). Rep. Huntley, in turn became a chief author of the aforementioned bill.

Examining the composition of the 13-member Health Care Transformation Task Force reveals most members represent, not you and me, but corporate health insurance companies and big business: Medica HMO, Park Nicollet, Mayo Clinic, Definity (HSA, Health Savings Accounts), Minute Clinic, General Mills and the Carlson Companies. Only two Task Force members are health care practitioners, both physicians, yet with potential business conflicts of interest; one is former medical director of HealthPartners HMO; the other is a fellow for the Center for the American Experiment (conservative “free market” think tank).

The two remaining Task Force members appear to be more community-based, representing the Citizens League and a major labor union, yet are far from it. In fact, last year the Citizens League convened its own 26 member “Citizens League Medical Facilities Study Committee” charged with examining the expansion of medical facilities such as hospitals in Minnesota. Again, very few citizens or health practitioners. As for the labor union representative from AFSCME Council 6, he sat on the 1992 Minnesota Health Care Commission, and helped it pave the way for the takeover of Minnesota health care by “managed care” HMOs, a market-based approach that called for universal coverage in Minnesota by July 1, 1997.

Previous commissions similarly handpicked and unrepresentative of Minnesotans include: the MN Medical Association Health Care Task Force of 2005, the MN Mental Health Action Group of 2005, the MN Citizens Forum on Health Care Costs (also known as the Pawlenty-Durenberger Commission) 2004, and the MN Health Care Access Commission of 1989.

It would be naive to think these Task Forces are simply oblivious of the gold standard solution to the health care crisis: the Single-Payer, government-funded approach. Many of us have explicitly presented the evidence, including exhaustive studies, public surveys and focus groups in Minnesota, nationally, and internationally. The data are quickly dismissed.

So what can we do to reverse this disturbing state-of-affairs in which rigged Task Forces and Commissions essentially undermine democracy?

A more democratic participatory alternative would be to hold open public hearings. Although this occurred in 2004, the hearings lacked openness with permission to speak only about the problem, not the solution, and with major time limits to testimony.

Another solution is to demand that the composition of Task Forces represent Minnesotans, including people of color, community-based health care reform organizations, and especially health care practitioners and patients. And most importantly, the prohibition of business or financial conflict of interest, as is clearly the case with all previous Minnesota Health Care Commissions, since 1989.

Our community-based organization, Universal Health Care Action Network of Minnesota, is responding by coordinating the formation of a Multidisciplinary Health Practitioner Work Group. The task will be to counter the usual ” official” Minnesota Health Care Commissions by drafting public policy statements, which advance a progressive framework for fundamental health care reform.

Similarly, communities can form their own parallel “Peoples Health Care Commission.”

And finally, when our elected or appointed officials are unaccountable to the public, the public has a right to hold demonstrations, pickets and other important and respected forms of protest, such as civil disobedience. As was said during the civil rights movement (and the right to health care has indeed been called the civil rights issue of the 21st century), “We are the ones we’ve been waiting for”.

Joel Albers is a member of the Universal Health Care Action Network of MN, a grassroots health care reform resource center and action network.

Video: Who will fix America's broken health care system?

Dr. Don McCanne: All candidates' flaw is they support private health insurance, an obsolete model

The Real News Network
Thursday May 8th, 2008

More than 47 million Americans are uninsured, and the New York Times reports that even those who are insured are facing more out-of-pocket expenses for health care. Health-related costs eat up a fifth of American household spending.

All three presidential hopefuls claim to offer the solution.

Democratic candidates Clinton and Obama would increase government regulation of health insurance to improve quality. Clinton would mandate coverage, while Obama would not, arguing that he would instead make health care affordable for the average consumer, thereby improving uptake. Senator McCain would decrease government oversight. He says that insurers will raise the quality of their benefits and lower costs in order to appear attractive to buyers. He offers tax rebates to individuals to offset partial health care costs.

Author Regina Herzlinger and PNHP Senior Health Policy Fellow Don McCanne each take a look at how effective the proposals will be in increasing quality of health care and the number of insured.

Prof. Regina E. Herzlinger is the Nancy R. McPherson Professor of Business Administration Chair at the Harvard Business School. She is the author of bestselling books “Who Killed Health Care?” and “Consumer-Driven Health Care: Implications for Providers, Payers, and Policymakers”.

Dr. Don McCanne is a Senior Health Policy Fellow with Physicians for a National Health Program, a widely recognized organization that represents over 15,000 doctors across the US that advocate for a single-payer national health insurance plan.

Transcript:

VOICEOVER: More than 47 million Americans live without health coverage. With the economy in a downturn, even those who are covered are spending more on health care these days. According to The New York Times, health care eats up almost one-fifth of American household spending. All three presidential hopefuls are touting the merits of their health care plans and rejecting the others.

(CLIPS BEGIN)

SEN. HILLARY CLINTON, PRESIDENTIAL CANDIDATE (D): My plan will cover everyone, and it will be affordable. Senator Obama’s plan does not cover everyone. It would leave, give or take, 15 million people out.

SEN. BARACK OBAMA, PRESIDENTIAL CANDIDATE (D): She would force in some fashion individuals to purchase health care. If it was not affordable, she would still presumably force them to have it, unless there is a hardship exemption, as they’ve done in Massachusetts.

SEN. JOHN MCCAIN, PRESIDENTIAL CANDIDATE (R): They urge universal coverage with all the tax increases, new mandates, and government regulation that come along with that idea.

(CLIPS END)

Professor Regina Herzlinger of the Harvard School of Business and Dr. Don McCanne of Physicians for a National Health Program each evaluated the health care platforms of all three candidates.

PROF. REGINA HERZLINGER, HARVARD SCHOOL OF BUSINESS: I like all three platforms that the presidential candidates are offering. All three of them offer choice to the American consumer, although Senator McCain has put that much more front and center. Choice is very important. It is very important not to be at the mercy of a single payer, whether that single payer for your health insurance is your employer or your government, because they may not give you what you want.

DR. DON MCCANNE, PHYSICIANS FOR A NATIONAL HEALTH PROGRAM: The three proposals of the presidential candidates all fall short of what we think needs to be done. They all build on the private health insurance model. That’s a highly defective model, which is wasting a tremendous amount of resources and failing to provide the coverage that we need. Private plans compete based on the premium they charge. What we really want is competition between health care providers, physicians and hospitals competing based on quality. And that requires that patients have freedom to choose their doctors. Private plans take away that freedom.

VOICEOVER: Both experts took a look at how close Obama and Clinton’s proposals will get to achieving universal coverage.

MCCANNE: The Clinton model mandates individuals to purchase health insurance, whereas Obama does not. He says that we need to make plans affordable so people can purchase them. Neither approach is going to get everyone insured. Obama’s approach is flawed because the private health plans are not going to be able to have enough benefits if they’re going to have affordable premiums. So people will still go without health care in his model. In Hillary Clinton’s model, the plans will not be affordable. So requiring individuals to purchase a plan they can’t pay for is unrealistic. The flaw of their proposal is that the private health insurance plan has become an obsolete model of financing health care.

DISCLAIMER:

Please note that TRNN transcripts are typed from a recording of the program; The Real News Network cannot guarantee their complete accuracy.

AHIP on Medigap’s Impact On Medicare Costs

Taking A Fresh Look At Medigap’s Impact On Medicare Costs

New Health Affairs Study Shows That Medigap Coverage May Have A Much Smaller Impact on Medicare Spending Than Previously Estimated.

America’s Health Insurance Plans (AHIP)
Policy Brief

Previous studies, including those conducted by the Congressional Budget Office (CBO), have reported that Medigap policyholders incur as much as 25 percent more Medicare expenditures than beneficiaries with FFS-only coverage. Thus CBO periodically estimates that restrictions on Medigap’s first-dollar coverage would significantly reduce Medicare outlays.

A recent report from America’s Health Insurance Plans (AHIP) presents new information that explains why past conclusions on this topic should be reconsidered.

Besides controlling for age, gender, and geography as done in prior analyses, the AHIP study broke new ground by analyzing two new factors that turned out to be critical: 1) use of services provided through the Veterans Administration (VA) or at military facilities, and 2) Medicare beneficiaries’ diagnoses (in lieu of self-reported health status or health conditions).

Key Findings

* Nearly half of the increase in Medicare spending that prior studies have reported among beneficiaries with Medigap disappeared when AHIP controlled for use of services received through the VA or at military facilities.

* Detailed analyses of beneficiaries’ health status based on actual diagnosis rather than on the self-reported data used in previous studies found that beneficiaries with Medigap are more likely than those with FFS-only coverage to have high-cost chronic conditions. Therefore, much of the difference in health costs between the two groups may stem from differences in health status rather than differences in insurance coverage.

In short, these results call into question past assumptions about the impact of Medigap coverage on Medicare claims costs. Before taking any action that would affect the Medigap program, policymakers should demand a thorough reexamination of previous research on the health status, service use, and health spending among Medigap policyholders.

http://www.ahipresearch.org/pdfs/MedigapFreshLook2008.pdf#http://www.ahipresearch.org/pdfs/MedigapFreshLook2008.pdf

Health Affairs: “Medigap Coverage And Medicare Spending: A Second Look”
by Jeff Lemieux, Teresa Chovan and Karen Heath (AHIP staff)
http://content.healthaffairs.org/cgi/content/abstract/27/2/469

Comment:

By Don McCanne, MD

Medigap plans are standardized supplemental private insurance plans that fill in some of the gaps in Medicare coverage. Medigap plans, as a group, have amongst the lowest medical loss ratios of all private insurance plans; that is, they pay out the least for health care benefits. Thus the plans are very lucrative for the private insurers, but they are amongst the worst values in private health care coverage.

Previous studies have indicated that individuals with Medigap coverage use more health care services than those covered by Medicare alone. The theory is that patients insulated from out-of-pocket costs will use less discretion in accessing health care, resulting in greater use of health care resources. In fact this does occur to a limited extent, but the recent work by John Nyman and others on the moral hazard theory demonstrates that much of that health care is beneficial (welfare gain rather than a welfare loss). It is particularly important to understand whether those with Medigap coverage actually do have greater health care needs that would result in greater use of services.

This study done by AHIP staff members demonstrates that when the numbers are corrected for those using the VA and military systems and corrected for health status, then much of increased spending for Medigap patients is very appropriate.

This result is quite convenient for the insurance industry. Those supporting an increase in cost-sensitivity for patients (consumer-directed health care) have been advocating for paring back the financial insulation that Medigap policies provide. Obviously the insurance industry does not want to reduce their market for these highly profitable products, and so they are able to use this study to counter this argument.

The result of this study also is quite convenient for those of us who support reasonably comprehensive health care for everyone. The Medigap plans do improve access to health care.

However, our conclusion is the opposite of AHIP’s. AHIP members would continue to market these lucrative plans even though they represent a terrible value for the patient/consumer. In sharp contrast, we would fold the very modest benefits of the Medigap plans into the traditional Medicare program. Based on the results of this study and on newer theories of moral hazard, the increase in Medicare spending would likely be mostly (if not completely) offset by the savings gained by the elimination of the profound administrative waste of the Medigap plans.

Video: Who will fix America’s broken health care system?

Dr. Don McCanne: All candidates’ flaw is they support private health insurance, an obsolete model

The Real News Network
Thursday May 8th, 2008

More than 47 million Americans are uninsured, and the New York Times reports that even those who are insured are facing more out-of-pocket expenses for health care. Health-related costs eat up a fifth of American household spending.

All three presidential hopefuls claim to offer the solution.

Democratic candidates Clinton and Obama would increase government regulation of health insurance to improve quality. Clinton would mandate coverage, while Obama would not, arguing that he would instead make health care affordable for the average consumer, thereby improving uptake. Senator McCain would decrease government oversight. He says that insurers will raise the quality of their benefits and lower costs in order to appear attractive to buyers. He offers tax rebates to individuals to offset partial health care costs.

Author Regina Herzlinger and PNHP Senior Health Policy Fellow Don McCanne each take a look at how effective the proposals will be in increasing quality of health care and the number of insured.

Prof. Regina E. Herzlinger is the Nancy R. McPherson Professor of Business Administration Chair at the Harvard Business School. She is the author of bestselling books “Who Killed Health Care?” and “Consumer-Driven Health Care: Implications for Providers, Payers, and Policymakers”.

Dr. Don McCanne is a Senior Health Policy Fellow with Physicians for a National Health Program, a widely recognized organization that represents over 15,000 doctors across the US that advocate for a single-payer national health insurance plan.

Transcript:

VOICEOVER: More than 47 million Americans live without health coverage. With the economy in a downturn, even those who are covered are spending more on health care these days. According to The New York Times, health care eats up almost one-fifth of American household spending. All three presidential hopefuls are touting the merits of their health care plans and rejecting the others.

(CLIPS BEGIN)

SEN. HILLARY CLINTON, PRESIDENTIAL CANDIDATE (D): My plan will cover everyone, and it will be affordable. Senator Obama’s plan does not cover everyone. It would leave, give or take, 15 million people out.

SEN. BARACK OBAMA, PRESIDENTIAL CANDIDATE (D): She would force in some fashion individuals to purchase health care. If it was not affordable, she would still presumably force them to have it, unless there is a hardship exemption, as they’ve done in Massachusetts.

SEN. JOHN MCCAIN, PRESIDENTIAL CANDIDATE (R): They urge universal coverage with all the tax increases, new mandates, and government regulation that come along with that idea.

(CLIPS END)

Professor Regina Herzlinger of the Harvard School of Business and Dr. Don McCanne of Physicians for a National Health Program each evaluated the health care platforms of all three candidates.

PROF. REGINA HERZLINGER, HARVARD SCHOOL OF BUSINESS: I like all three platforms that the presidential candidates are offering. All three of them offer choice to the American consumer, although Senator McCain has put that much more front and center. Choice is very important. It is very important not to be at the mercy of a single payer, whether that single payer for your health insurance is your employer or your government, because they may not give you what you want.

DR. DON MCCANNE, PHYSICIANS FOR A NATIONAL HEALTH PROGRAM: The three proposals of the presidential candidates all fall short of what we think needs to be done. They all build on the private health insurance model. That’s a highly defective model, which is wasting a tremendous amount of resources and failing to provide the coverage that we need. Private plans compete based on the premium they charge. What we really want is competition between health care providers, physicians and hospitals competing based on quality. And that requires that patients have freedom to choose their doctors. Private plans take away that freedom.

VOICEOVER: Both experts took a look at how close Obama and Clinton’s proposals will get to achieving universal coverage.

MCCANNE: The Clinton model mandates individuals to purchase health insurance, whereas Obama does not. He says that we need to make plans affordable so people can purchase them. Neither approach is going to get everyone insured. Obama’s approach is flawed because the private health plans are not going to be able to have enough benefits if they’re going to have affordable premiums. So people will still go without health care in his model. In Hillary Clinton’s model, the plans will not be affordable. So requiring individuals to purchase a plan they can’t pay for is unrealistic. The flaw of their proposal is that the private health insurance plan has become an obsolete model of financing health care.

DISCLAIMER:

Please note that TRNN transcripts are typed from a recording of the program; The Real News Network cannot guarantee their complete accuracy.

Millennials support a government health insurance plan

The Progressive Generation: How Young Adults Think About the Economy

By David Madland, Amanda Logan
Center for American Progress
May 6, 2008

Young adults today–often known as the Millennial Generation–have decidedly progressive views on economic issues, possibly more so than any previous generation. According to the results of our first-of-a-kind analysis of Millennials’ views on the economy, a majority of 18- to 29-year-olds (our definition of this generation) believe that the government can be a force for good in the economy, and that increased investments in healthcare, education, and other areas are necessary to ensure strong and sustainable economic growth.

Our analysis also shows that Millennials mostly reject the conservative viewpoint that government is the problem, and that free markets always produce the best results for society. Indeed, Millennials’ views are more progressive than those of other age groups today, and are more progressive than previous generations when they were younger. This is especially true when compared to the conservative views of Generation X–men and women who are now in their 30s and early 40s.

* Millennials are more likely to support universal health coverage than any age group in the 30 previous years the question has been asked, with 57 percent of 18- to 29-year-olds saying that health insurance should come from a government insurance plan.

* Eighty-seven percent of Millennials think the government should spend more money on health care even if a tax increase is required to pay for it, the highest level of support in the question’s 20-year history.

Millennials are already the largest generation in size, weighing in today at between 80 and 95 million people, depending on exactly how the generations are defined. This exceeds the number of baby boomers.

What’s more, Millennials are a large, politically active generation that cares deeply about economic issues. Studies have found that they are, for example, more likely to express interest in politics and elections, care a good deal who wins, try to influence others’ votes, and attend political meetings.

Research suggests that the political opinions and voting patterns of young adults are likely to carry forward throughout their lives. Political attachments attitudes formed in early adulthood often continue to be held later in life.

This study did not attempt to pinpoint the source of progressive opinions of Millennials, but our research points to a number of possible reasons why in time they may well become known in the future as the Progressive Generation. Young adults today face more significant economic challenges than have other recent generations, among them lower rates of healthcare coverage, worsening job prospects, and higher levels of student loan debt–all legacies of the conservative policies that have dominated in recent years.

The upshot: This Progressive Generation could well be poised to transform the American political landscape in 2008 and beyond due to their embrace of decidedly progressive positions on economic issues and the role of government in economy.

http://www.americanprogress.org/issues/2008/05/progressive_generation.html

Full report:
http://www.americanprogress.org/issues/2008/05/pdf/progressive_generation.pdf

Comment:

By Don McCanne, MD

The bad news is that Millennials face “lower rates of healthcare coverage, worsening job prospects, and higher levels of student loan debt.” The good news is that they now “reject the conservative viewpoint that government is the problem, and that free markets always produce the best results for society.”

The Millennials recognize that free market dynamics should be relegated to the role where they work well. More importantly, the Millennials clearly understand that working together, through our public institutions, we can use our great resources to make this nation a far better place for everyone.

There really is hope for the future.

Pushing the Single-Payer Solution

By Amy Goodman
Alternet
April 24, 2008

It’s time for the candidates to stop dancing around real health-care reform and get behind a single-payer system.

As the media coverage of the Democratic presidential race continues to focus on lapel pins and pastors, America is ailing. As I travel around the country, I find people are angry and motivated. Like Dr. Rocky White, a physician from a conservative, evangelical background who practices in rural Alamosa, Colo. A tall, gray-haired Westerner in black jeans, a crisp white shirt and a bolo tie, Dr. White is a leading advocate for single-payer health care. He wasn’t always.

He told me in a recent interview: “Here I am, a Republican, thinking about nationalizing health care. It just went against the grain of everything that I stood for. But you have to remember: I didn’t come to those conclusions with lofty ideals of social justice.”

In the early 1990s, his medical group started falling apart. White, a keen student of economics and the business of medicine, determined that it wasn’t just his practice but the system that was broken.

“You’re seeing an ever-increasing number of people starting to support a national health program. In fact, 59 percent of practicing physicians today believe that we need to have a national health program. I mean, that’s unheard of, even 10 years ago. It’s amazing to see a new generation of physicians coming up who are disgusted with our current health-care system. You know, we’re trained to be advocates of patients, we’re trained to save lives, we’re trained to practice medicine. And instead, what we’re doing is we’re practicing Wall Street economics.”

Single-payer is not to be confused with universal coverage, which Hillary Clinton and Barack Obama both support. In fact, in a recent debate, when Clinton raised the issue of single-payer, the audience interrupted with applause. She immediately countered, “I know a lot of people favor [it], but for many reasons [it] is difficult to achieve.”

Why? One of the most powerful industries in the country opposes it — the insurance industry. Under universal coverage, insurance profits are preserved. Under single-payer, they are not. Dr. Rocky White, who now sits on the board of the nonprofit Health Care for All Colorado, has switched his political affiliation. He also has updated and reissued Dr. Robert LeBow’s book on single-payer called Health Care Meltdown: Confronting the Myths and Fixing Our Failing System.

He described possible solutions: “There are a lot of different types of single-payer systems — you could have purely socialized medicine. That’s kind of like what England has. The government owns the hospitals, the government owns the clinics, the government finances all the health care, and all the doctors work for the government. That is truly socialized medicine, as opposed to the Canadian system, where the financing comes through their Medicare program, but all the doctors are in private practice.”

The economics are complex, but this plain-spoken country doctor explains it clearly:

“You know, this industry is a $2-trillion industry, and the profits in the for-profit insurance industry are so huge and it’s so deeply entrenched into Wall Street … but until we move to a single-payer system and get rid of the profit motive in financing of health care, we will not be able to fix the problems that we have.”

What would it take? Dr. White has spent his life dealing with the high winds on the high plains, from Nebraska to Colorado, and describes the challenge the country faces in familiar terms:

“I think that our current presidential candidates understand that ideally single-payer would be the best, but they don’t have the political will to move that forward. Their job is to feel which way the wind is blowing. Our job is to turn that wind.”

Amy Goodman is the host of the nationally syndicated radio news program, Democracy Now!

Dr. Rocky White is a member of Physicians for a National Health Program, headquartered in Chicago, www.pnhp.org.

Labor, Faith, Seniors, Consumer Groups Rally at New York State Capitol in Support of Single Payer Universal Health Care

News Release: Single Payer rally at the state Capitol

Studies Show Single Payer would cut health care costs will giving consumers choice of doctors and hospitals

Capital District Alliance for Universal Healthcare
New Yorkers for Single Payer Universal Healthcare
Hunger Action Network of New York State

Media Release

For Release: May 6, 2008
For More Information: Dr. Richard Propp, 518-482-0420
Mark Dunlea 518 434-7371 xt 1#

Single payer universal health care advocates rallied today at the State Capitol in support of action at both the national and state level.

Representatives of unions, nurses, doctors, seniors, consumer and faith groups urged the state legislature to pass a resolution urging Congress to pass HR 676, known as Medicare for All. As. Felix Ortiz sponsors the Assembly resolution. HR 676 has 90 cosponsors, including NY Congressional representatives Engel, Hinchey, Maloney, McNulty, Nader, Owens, Rangel, Serrano, Towns, Weiner and Velazquez.

The groups are also urging the state to adopt a single payer system as soon as possible. Single payer legislation (A7354 Gottfried / S3107 Schneiderman) is pending in both the Assembly and Senate. A majority of Assembly members (85) are co-sponsors of the single payer bill.

Speakers included Rabbi Donald Cashman, B’nai Sholom Reform Congregation of Albany; Priscilla Bassett, Pres. Sullivan County Senior Legislative Action Committee and V-P StateWide Senior Action Council; Deborah Elliott, MBA, RN, Deputy Executive Officer of the NYS Nurses Association; Mike Keenan, President, Troy Area Labor Council; Matt Funiciello, owner of Rock Hill Bakehouse; Rebecca Elgie of the Tompkins Health Care Task Force; Cheryl Gelder-Kogan of Capital District Alliance for Universal Health Care (CDAUH); Mary Wojtyk, student at Albany Medical College, Patti Young, a nurse and a concerned health care consumer and musician Ruth Pelham. The rally was sponsored by CDAUH, New Yorkers for Single Payer Universal Health Care and The Hunger Action Network of New York State

“The cost and coverage of health insurance has become problematic for many working Americans and a major stumbling block in settling union contract negotiations. HR 676 would save billions of dollars annually by eliminating high overhead and profits of the private health insurance industry and HMOs. The transition to single-payer national health care would apply these savings to expanded and improved coverage for all. That is why the 2007 annual meeting of the Capital District Area Labor Federation unanimously endorsed HR676, and the National AFL-CIO is supporting a universal health care system based upon the successful Medicare program for seniors.” stated Mike Keenan, President, Troy Area Labor Council and a Vice President of the Capital District Area Labor Federation, AFL-CIO.

The Troy Area Labor Council, AFL-CIO represents 10,000 union members and their families in Rensselaer County. The Capital District Area Labor Federation, AFL-CIO represents 100,000 union members throughout the Capital District Region.

The State Legislature last year appropriated funds for the state to study how it could most cost-effectively provide health care to all New Yorkers. The legislature required that one of the systems to be studied be a single payer system. Most doctors now support a single payer system as to most health care advocacy groups. Advocates are concerned however that the organization hired by the state to do the studies, Urban Institute, has repeatedly spoken out against single payer health care. Every other state that has done the study process so far has concluded the a single payer system would do the best job of providing quality health care to all residents while controlling costs and maximizing freedom of choice for consumers.

The groups are particularly critical of the role of private health insurance in the American health care system. As much as a third of every health care dollar going through private health insurance goes to pay for their overhead, profits, marketing costs and excessive CEO salaries. Doctors on average have to hire 2.5 staff people just to deal with the conflicting paperwork, rules and bureaucracy of private health insurance. No other industrial country allows private health insurance to play a dominant role in the health care system. The groups oppose mandates for consumers to purchase private health insurance such as the Massachusetts plan.

“New York nurses pick up the pieces of our broken healthcare system every day. We see uninsured New Yorkers who rely on the emergency room as their main source of health care, as well as those who delay necessary treatment until they are so sick they must be hospitalized. The sad truth is that todayĆ¢ā‚¬ā„¢s for-profit, private healthcare insurers have failed, and a universal, single-payer healthcare system is the only true solution.,” said Deborah Elliott, MBA, RN, Deputy Executive Officer of the NYS Nurses Association.

A recent national survey shows a solid majority of doctors, almost 60 percent, supporting government legislation to establish national health insurance (NHI) — a 10 percent increase in support since 2002. (32% oppose it, 9% are neutral) Support for NHI is particularly strong among psychiatrists (83 percent), pediatric sub-specialists (71 percent), emergency medicine physicians (69 percent), general pediatricians (65 percent), general internists (64 percent) and family physicians (60 percent). The survey of 2,193 doctors was done by Indiana University.

Matt Funiciello, owner of Rock Hill Bakehouse in Moreau, NY said, “Access to health care is a necessity, not a luxury and we, as a country, are failing miserably at providing an affordable option for the American worker who simply cannot afford to pay the exorbitant amounts charged by the HMO’s. We are already spending $7100 per person on health care (twice what other industrialized nations pay), yet we somehow manage to leave more than 40 million people without coverage and another 70 million “underinsured”. Its time for us all to do the math. We ALREADY pay out far more than enough in premiums and subsidies and taxes to fully fund adequate coverage for every American right now! It is simply being denied to us by the powers that be and the corporate interests that get them re-elected. I can only ask that those on the Hill stop worrying about their campaign coffers for a minute and do what’s right for America. From doctors to workers to teachers to unions to business groups everywhere, single payer health care is a rational answer to the health care crisis.”

“As I travel across the state I hear that people don’t want to lose what they have that they want CHOICE, however, the choice they want is not a choice of many different insurance plans which is what they are being offered but the freedom to choose WHO will deliver their health CARE or WHAT facility best fits their particular need . A Single payer plan which allows access to any doctor or facility will provide us with MORE CHOICE than we currently have and WE will be making the decision not the insurance co,” added Rebecca Elgie of the Tompkins Co. Health Care Task Force.

Among the hundreds of groups in NY supporting HR 676 include the Physicians for a National Health Program, New York State Nurses Association, NYS Academy of Family Physicians, Healthcare Now, Tompkins County Health Care Task Force, Hunger Action Network of NYS, Healthcare Work Group (Otsego, Delaware & Chenango Counties). Presbyterian Church USA. United Auto Workers, Albany Central Federation of Labor, AFSMCE District Council 37, Professional Staff Congress-CUNY, CWA Local 1180, United University Professions (Local 2190 AFT); Latinos for National Health Insurance.

Single Payer is defined as financing health care expenditures for the entire population through a single source, presumably the government, with funds collected through progressive taxation of citizens and businesses

“The US spends more than twice as much on health care as the average of other developed nations, all of which boast universal coverage. Yet close to 50 million Americans have no health insurance whatsoever, and most others are underinsured, in the sense that they lack adequate coverage for all contingencies (e.g., long-term care and prescription drug costs). Why is the U. S. so different? The short answer is that we alone treat health care as a commodity distributed according to the ability to pay, rather than as a social service to be distributed according to medical need,” said Mark Dunlea, Executive Director of Hunger Action Network of NYS.

While the United States has very skilled health providers, our health care system performs poorly, with its overall quality only ranked 37th by the World Health Organization. US spending on health care is now over 2.1 trillion dollars — nearly $7,000 per person. This is more the double the world average of $2,571. This amounts to a whopping 15.5% of our GNP on health care — far more than any other country — which puts our businesses at a competitive disadvantage in the international marketplace.

“A prime benefit of a national single payer system is that it would save several hundred billion dollars annually by eliminating the high overhead and profits of the private, investor-owned insurance industry and reducing spending for marketing and other satellite services. Doctors and hospitals would be freed from the burdens and expenses of paperwork created by having to deal with multiple insurers with different rules – often rules designed to avoid payment,” added Dunlea.

A recent study of a single payer system for California showed that it would save $38 billion annually. The legislature passed a single payer system but Governor Schwarzenegger vetoed it.

Public opinion polls have consistently shown strong public support for a universal health care system. For instance, a March 2007 poll by CBS/ NY Times found that 64 percent of the respondents said the government should guarantee health insurance for all; 27 percent said it should not. An overwhelming majority in the poll said the health care system needed fundamental change or total reorganization.

Who determines whether we have coverage?

Offer Rates for Smaller Establishments by Business Age

Kaiser Family Foundation
May 6, 2008

Employer-provided health insurance is the primary source of insurance coverage in the United States, covering almost 160 million people or more than 90 percent of the non-elderly privately-insured population. In recent years, the percentage of firms who offer such benefits has been falling; 69 percent offered health coverage benefits in 2000, whereas 60 percent did the same in 2007. Since employers are not required to offer health benefits to their employees, changes in the rate at which they offer such benefits are important for understanding the number of people covered by private insurance. Having access to work-place health insurance is a key determinant of whether or not a person has private coverage.

Researchers looking at the reasons why employers offer coverage have identified a variety of factors. These include both employee characteristics, such as earnings, occupation, part-time versus full-time status, union status, gender, and age, and employer characteristics, such as geographic region, industry, and firm and establishment size.

This issue brief looks at a less well-understood factor that may also affect an employer’s decision to offer health benefits: how long a business has been operating.

The analysis shows that, for smaller establishments, those with younger business ages are less likely to offer health benefits than establishments with older business ages.

http://www.kff.org/insurance/snapshot/chcm050608oth.cfm

And…

How Risky Is Individual Health Insurance?

by Mark V. Pauly and Robert D. Lieberthal
Health Affairs
May 6, 2008

This paper describes the relationship between type of insurance coverage in one period and the likelihood of becoming uninsured in the next. We find that for people at the median health status, becoming uninsured is most likely for those with individual insurance, less likely for those with small-group insurance, and least likely for those with large-group insurance. However, for people in poor or fair health, the chances of losing coverage are much greater for people who had small-group insurance than for those who had individual insurance.

These results are consistent with a complex characterization of the effect of high risk on individual insurance premiums: high risks pay more if they seek individual coverage after they have become high risks, but individual coverage provides better protection (compared to group insurance) against high premiums for already individually insured people who become high risk. Specifically for an initially insured person of average or better risk, dropping or losing health insurance coverage is more likely if the coverage was expensive individual insurance than if it was cheaper and tax-subsidized group insurance. But group insurance has a tear in its net of protection: it leaves a person who becomes a high risk more vulnerable to dropping or losing any and all coverage than does individual insurance.

http://content.healthaffairs.org/cgi/content/full/hlthaff.27.3.w242/DC1

Comment:

By Don McCanne, MD

These two studies released today add to the great body of policy literature that demonstrates that the decision to have health insurance is often removed from the individual and is under the control of extraneous factors.

One study shows that the age of a small business is a factor in whether or not an employee will obtain insurance. The other demonstrates that the individual’s health status while employed by a small business is a factor in whether or not the individual will be able to continue to have coverage.

The consensus today is that everyone should have coverage that ensures affordable access to essential health care. Yet the private insurance model defeats that goal. The insurance industry continues to manipulate access to their products by individuals and employers with the goal of actively avoiding those with high health care costs and passively avoiding those who are unable to pay the premiums for their low-risk pools.

A single payer national health program would automatically include everyone for life. Yet our politicians insist that we continue to try to patch together private plans even though that will always leave us with “tears in the net of protection.” Policies to repair the rents we already have are only resulting in greater rents elsewhere, thanks to the ingenuity and innovation of the private insurance industry.

Health Care for Latinos

Dodd: Nation desires universal health

By Ryan J. Phelan
Record-Journal
May 3, 2008

The American people are desperate for a universal health care plan, said U.S. Sen. Christopher J. Dodd, D-Conn., during his keynote address at the regional action summit of Latino Voices in Universal Healthcare on Saturday.

All three presidential candidates’ health plans promise to make health insurance available to all, but none of the plans address all of the concerns expressed by the summit’s panel of speakers. Dr. Olveen Carrasquillo, the principal investigator and director of the Columbia Center for the Health of Urban Minorities, examined the three plans and found that none were explicit enough in how they were going to make health care affordable for Latinos, and said that none included coverage for undocumented residents.

Key to the summit’s discussion was the issue of racial and ethnic disparities in health care, in what some speakers called a “health care apartheid” and “enforced poverty.”

In July 2007, the nation’s Hispanic population was recorded at 45.5 million, more than 15 percent of the U.S. population of 301.6 million. However, Latinos make up more than 40 percent of the nation’s uninsured, with the highest numbers existing in undocumented immigrants from Mexico.

Many Latinos are covered under Medicaid, which Carrasquillo said was considered by many to be second-rate coverage with respect to Medicare. Speaking from his position as a doctor, Carrasquillo related how Latinos were waiting months for operations that with better coverage would have been taken care of in days.

Many at the summit expressed frustration with the fragmentation of the current health care system, which is split into 1,500 separate health plans and lags behind other industrialized countries in terms of efficient spending, according to Dr. Jaime Torres, president of Latinos for National Health Insurance.

“The middle man is killing us,” Torres said. “One health insurance for all, for life. This will be the first step for a mechanism where the money will be distributed in a way that makes sense.”

Carrasquillo said research done in 2003 had shown that a national health care plan that awarded insurance to all residents, documented or not, would save between $200 billion and $250 billion, but feels that despite studies and statistics that there are those who would rather pay more in order to exclude the undocumented rather than save on an inclusive plan.

“I think the most glaring issue is that most of the leading politicians are not willing to take on this issue,” Carrasquillo said. “It’s obvious that there’s widespread public support. Over half the U.S. population supports this, and yet they don’t want to talk about it, simply put, because they don’t have the backbones to stand up to the insurance and pharmaceutical industry.”

“Obviously, the universality of covering everybody is important,” Dodd said.

Dr. Torres asked those assembled to think about the reality of the issues facing Latinos in health care, and said the message must change if the outcry for national health care was going to be heard.

“In the past it has been a political and economic issue,” Torres said. “We need to make it a moral issue.”

http://www.myrecordjournal.com/site/tab1.cfm?newsid=19659124&BRD=2755&PAG=461&dept_id=592709&rfi=6

Comment:

By Don McCanne, MD

Dr. Torres is absolutely correct, except that we don’t need to make it a moral issue. It already is.

Canadian health care is better for the consumer

By Anita Watkins
Guest Column
The Ithaca Journal
May 2, 2008

As a dual United States and Canadian citizen who has experienced health care in both countries, I’d like to add some perspective to warnings against government health care modeled after the Canadian system.

The Canadian system is publicly financed, but doctors and clinics practice privately while hospitals are independently governed. The government is the single payer for services using federal tax dollars controlled by the individual provinces. In the U.S., in contrast, providers must deal with hundreds of different insurance companies and HMOs. The single-payer system is efficient, and administrative costs are about half those in the United States. More money goes into health care; less goes into paperwork. Canada spends about half what the United States spends per person on health care and achieves better outcomes in terms of life expectancy. The United States also runs a widely-used, effective and popular publicly financed, single-payer health care system — Medicare.

The Canadian provincial governments manage health care dollars so that the vast majority of people receive the care they need in a timely fashion. Critical care is immediately available. In the United States, the majority of people receive health care, but insurance companies and HMOs ration and deny treatments to save costs, and one out of seven Americans are not assured of health care at all, and may avoid checkups and preventative treatments they can’t afford to pay for. Canadians don’t hold bake sales and chicken barbecues to pay for a child’s cancer treatment.

Wait times, a concern in Canada, are largely the result of attempts to keep health care costs under control, particularly by conservative governments. This could be remedied with more money to provide capacity in the system and by removing caps limiting the number of doctors trained or certified to practice.

There are also wait times in the United States To make a realistic comparison of the two systems, we would need to factor in the people who effectively wait forever in the United States because they can’t afford access to the system. The United States rations health care by ability to pay. Canada manages health care by need. The bottom line is that the vast majority of Canadians get the health care they need with no problems.

I have personal experiences with both systems. I have found no faster or better service here than what I received in Canada. Last summer my son Tom, an Ontario resident, developed an infection in a bite on his leg while he was in Algonquin Park. We were seen at a walk-in clinic in Huntsville and treated within 10 minutes on arrival. Two days later, he visited the same clinic for fast, efficient, follow-up treatment. In Toronto, he followed up with visits to change dressings. All of this was covered by the Ontario Health Insurance Plan. The clinics filed the claims electronically and there was no paperwork to deal with. Tom, who was starting his first full-time job, couldn’t have afforded health insurance nor the cost of the treatment had he been in the United States In contrast, for a trip here to a clinic with a tick bite, I spent several hours, mostly waiting to be seen. The visit generated paperwork for co-pays and health savings reimbursement.

Do Canadians pay higher taxes to cover health care services? On average Canadians pay a higher rate of income tax, but it’s hard to make comparisons on the total tax bill because Americans often pay more local and Social Security taxes. What Canadians (individuals or companies) don’t pay are high insurance premiums, co-pays and deductibles, essentially another layer of tax that Americans have to ante-up. Think how much you pay for health care premiums and add that to your tax bill! What Canadians don’t finance is an inefficient bureaucracy to process payments and produce a profit for shareholders.

Would Canadians like to change their system to American-style health care? Resoundingly no. Canadians like to complain about health care and hockey, but I’ve never met any Canadian who would trade. In fact, when asked to name the Greatest Canadian in history, a broad national consensus in Canada chose Tommy Douglas, who was the father of the Canadian health care system.

The Fraser Institute quoted in a letter in March is a conservative, libertarian think tank, with an ideology opposed to taxation and government control (“Canadian health care,” March 7). It advocates more freedom to choose and pay within the Canadian system but keeping the public system intact, modeled after schemes in countries such as Austria, Belgium, France, Germany and Japan. The Fraser Institute is quick to reassure readers that the changes suggested will not lead to the “Americanization” of health care.

Is Canadian health care perfect? No. But it’s the exceptional anecdotes of problems that make the news, not the excellent care that the vast majority of people receive quickly and efficiently. Before people criticize the Canadian model, I think they should talk directly to Canadians — a lot of Canadians — and get a broad picture of the Canadian experience. Despite grumbling, Canadian dissatisfaction with their health care system remains in the single digits. Can the United States say the same thing about its health care system?

Anita Watkins lives in Cayuga Heights.

Understanding your own insurance

J.D. Power and Associates Reports: Satisfaction with Health Plans Varies Dramatically From Region To Region, Largely Due to Poor Communication From Insurance Providers

J.D. Power and Associates
April 30, 2008

Nearly 50 Percent of Members Say They Don’t Fully Understand the Details of Their Health Insurance Plan

The study finds that the majority of health plan members rate their insurer lowest for the communications and information that are provided to help them understand their plan. Only 45 percent of members reported they fully understand how to use their health insurance coverage and member services. Enhancing member understanding with critical plan details–such as prescription coverage, co-pays, how to locate physicians and how to appeal coverage denials–can lead to higher satisfaction ratings for insurers.

http://www.jdpower.com/corporate/news/releases/pressrelease.aspx?ID=2008045

Comment:

By Don McCanne, MD

Although this was a J.D. Power study of consumer satisfaction, it does reveal a very important point. Only 45 percent of health plan members self-reported that they understood their health insurance coverage. The other half didn’t, and that was correlated with lower satisfaction ratings.

Although the politicians are proposing that “you can keep the insurance you have,” it is difficult to see why someone would want to continue with a plan that they can’t even understand.

Also, those that report that they do understand their plans are mostly healthy individuals who have little need to use their coverage. Yet we are inundated daily with anecdotes of individuals who thought that they had excellent insurance, only to discover that when they needed to use it, what they really had was underinsurance. What they thought was good coverage left them exposed to financial hardships.

When so many don’t understand their insurance plans, and many others fail to realize that they don’t have insurance but instead have underinsurance, it makes you wonder why the politicians continue to imply that private insurance is better than what you would receive through a public insurance program. Do you think that the politicians really understand their own health care plans?