PNHP

George Lakoff: Don't Think of a Sick Child

George Lakoff: Don't Think of a Sick Child

The Logic of the Health Care Debate

By George Lakoff, Eric Haas, Glenn W. Smith and Scott Parkinson
Rockridge Institute
October 18, 2007

Introduction

Most health care reports advocate a policy, describe it, and argue for it. We take a different approach. In this paper, we describe the logic of the overall debate over the U.S. health care system — the assumptions, the arguments, who makes them, and why. We do come out of this process with recommendations, but not of the usual sort.

This analysis presents something new and important: a distinction among three modes of thought — progressive, conservative, and neoliberal. What’s new here is a deeper understanding of neoliberal thought, as it affects the discourse on health care. Briefly, it accepts the progressive ethic of care, insisting on maximizing coverage. Meanwhile, neoliberal thought accepts a conservative version of market principles that guarantees profits to insurance and drug companies. Often, this is done in the name of political pragmatism, as a way to mute expected conservative opposition. This creates an inherent tension between the moral mission of government to provide for the protection — in this case the health security — of all of its people and the profit-maximizing insurance marketplace, which works only by denying care.

The neoliberal mode of thought is at the center of the health care debate. It can also be found in issues across the board.

In the health care debate, positions based on the progressive values of empathy and responsibility for oneself and others are focused on the well-being of human beings. The current health care system is focused on insurance company profits, which insurance companies maximize through denying health care to millions of Americans. Neoliberal plans that sincerely seek market solutions or simply appease conservative opposition and protect insurance profits are unlikely to remedy our current health care tragedy. We conclude that progressives who adopt a neoliberal mode of thought, or align themselves with others who do, could inadvertently undermine progressive values and policy goals, surrendering them in advance — anticipating conservative resistance even before negotiations occur — and before the public has a chance to even consider such values.

The other sections of this report:

A Bit of History

A Basic Fact

Your Interests? Or Theirs?

The Conservative Mode of Thought

The Progressive Mode of Thought

The Neoliberal Mode of Thought

Analysis Of The Arguments

What We Can Do

http://www.rockridgeinstitute.org/health (For the 18 page PDF version of this report, under Campaign Resources: The Logic of the Health Care Debate, click on PDF.)

Comment:

By Don McCanne, MD

Most of us have greatly appreciated the guidance on framing the debate that George Lakoff has given us through his publications such as “Don’t Think of an Elephant!”

Professor Lakoff and his colleagues at the Rockridge Institute now provide us with important guidance for understanding and framing the health care debate.

Don’t just sit there and think of a Sick Child. Download the report now! We’ve got work to do!

Same health care program that covers Congress

Health Plan Used by U.S. Is Debated as a Model

By Reed Abelson
The New York Times
October 20, 2007

It makes for a compelling stump speech. And the leading Democratic candidates for president are all saying pretty much the same thing: adapt the health care program that covers Congress and offer it to the 47 million Americans currently without insurance.

The (Federal Employees Health Benefits Program) gives members of Congress, along with about four million other active and retired government workers, a wide array of private insurance offerings with fairly generous benefits.

While health policy experts acknowledge that the federal employees’ program could be a workable way to reach some of the uninsured, they also say there is nothing about it that would help address what they see as an underlying reason for the growing numbers of uninsured: the nation’s runaway medical costs. And without major changes, they say, the model would be sharply limited in achieving the goal of universal coverage for all Americans.

To begin with, not everyone makes the $165,000 a year or so that members of Congress do. In fact, at least 100,000 federal workers — at least 5 percent of the active work force — do not have health insurance. In many cases, according to the union that represents the workers, they consider even the cheapest options within the federal plan unaffordable.

And despite the program’s federal imprimatur, the government currently plays only a limited role, preferring to let commercial insurers take the lead.

“This is a private-based solution, with all of its foibles,” said Jonathan Gruber, a professor of economics at Massachusetts Institute of Technology who is advising various Democrats about the federal program as a possible model. It would probably have higher administrative costs and pose more of a risk of private insurers trying to enroll only the healthiest people, Mr. Gruber said, than if the government were to provide the insurance directly.

And the officials running the federal program emphasize that theirs is not a government-run plan like Medicare, in which the government is the main buyer of health care and can effect broad changes in public health.

In order to make insurance affordable to a greater number of the 47 million who currently have none, experts say, the coverage might have to be much more limited than even the most basic federal employees option, and be designed to protect mainly against catastrophically high doctor or hospital bills.

“You don’t want to take them from nothing to a Cadillac,” said Professor Gruber.

http://www.nytimes.com/2007/10/20/business/20fedhealth.html?ref=health&pagewanted=all

Comment:

By Don McCanne, MD

So the health insurance program that covers members of Congress is the program that we should all have – except for those of us like the 100,000 federal workers who are not covered by their own program. What?

So to make federal coverage more affordable we would convert it into catastrophic coverage that still wouldn’t be affordable for most average-income individuals, and would expose many of those who are covered to financial hardship? And to do that we would sacrifice efficiency, equity, and the ability to effect positive changes in public health?

In this day and age, when it is difficult to tell the difference between a Cadillac and a Chevrolet, no one would propose ensuring a mode of transportation by offering a Chevrolet with its engine and transmission removed. Except maybe the leading Democratic candidates. After all, the shell of a Chevrolet is politically feasible, even if their owners are not able to show up at work.

Why the United States lacks full health care

By Peter Phillips and Bridget Thornton
MinutemanMedia.org
Published Friday, October 19, 2007

Health and disability insurance companies are systematically cheating the American public. Michael Moore’s top-grossing movie Sicko is one example of the growing concern surrounding health care in the US.

The number of Americans without health insurance reached forty-seven million at last count, or sixteen percent of the population. The cost is rising two to three times faster than inflation and is the number one cause of personal bankruptcy in the country. We pay more and get less medical care than the rest of the industrialized world. The total per capita health care cost in the US exceeds the expense per person in all other full care countries.

The Institute of Medicine estimates that as many as eighteen thousand Americans die prematurely each year because they do not have health insurance. This figure does not include those who die prematurely each year because their insurers delay, diminish, or deny payment for promised benefits. Reports about people who die unnecessarily from withheld services seldom receive broad coverage in the corporate media. Lack of media coverage has led to a nation of people uninformed about how national health and disability policies are controlled by the private insurance industry and how government regulators are powerless to do anything about it.

If industrialized countries around the world offer health care as a basic right, why is it not happening in the US? Private insurance companies are motivated to make as much money as possible and do so by systematically delaying, diminishing, and denying payment for promised services, and blaming individuals for their own misfortune.

On the boards of directors of the nine largest insurance companies are one hundred thirteen people. These directors are some of the richest in the world. They hold one hundred fifty past and/or present positions with major financial or investment institutions in the US, including such major firms as J.P. Morgan, Citigroup, Lord Abbett, Bank of America, and Merrill-Lynch. Additionally, these board members have connections to some of the largest corporations in the world including General Motors, IBM, Ford, Microsoft, and Coca Cola. The combined affiliations among the one hundred thirteen health insurance directors represent revenue of over 2.5 trillion dollars 2006.

As some of the richest most powerful citizens in America, health care executives dominate health policy with their campaign donations and active lobbying. They spend millions to keep themselves in the insurance business despite overwhelming evidence that we would all be better off without them. They use these profits to propagandize the American public and influence voters through scare tactics of “socialized medicine” and long delays of service that supposedly occur in single-payer systems.

The single-payer advocacy group, Physicians for a National Health Program, reports that private insurance corporations spend an enormous amount of money on business-oriented expenses rather than health-related investments. A 2003 study in the New England Journal of Medicine estimates that spending for administrative costs associated with health care amount to over $320 billion per year or about thirty-one percent of health care costs in the US overall. The administrative costs in the Canadian national healthcare system amount to 16.7 percent, or about half of the overhead in the US.

Countries with common pool or single-payer systems provide similar levels of service to every person. In such countries, it is the responsibility of society as a whole to provide health care for each individual.

Americans have a choice. We can continue with a high-cost profit-driven private insurance system leaving millions to languish without care, and millions more to face the frustrations of systematic delays, diminished care, and denials of promised benefits. Alternatively, we can build a common pool health care system that provides necessary care to everyone — for less than what we are now paying.

Let’s find and support politicians who will provide universal health care outside of corporate fat-cat control.

Read Practices in Health Care and Disability Insurance: Delay, Diminish, Deny, and Blame by Peter Phillips and Bridget Thornton

Peter Phillips is a Professor of Sociology at Sonoma State University and Director of Project Censored. Bridget Thornton is a graduate student in the Interdisciplinary Studies Program. All statements above are fully documented in their new study “Practices in Health Care and Disability Insurance: Delay, Diminish Deny and Blame — www.projectcensored.org.

National Nurses Movement Lauds Al Gore For Leadership on Single-Payer Healthcare

Gore’s New Statement Is Clear: It’s Time for Universal, Single-Payer Healthcare

The California Nurses Association/National Nurses Organizing Committee thanks Al Gore for his forceful new words in support of the kind of universal, non-profit, single-payer healthcare that this country desperately needs–and that is succeeding in nearly every other industrialized democracy.

The statement reflects a growing national consensus that a national, non-profit insurance system would clearly out-perform the private insurance corporations that spend up to one-third of their overhead on overhead and profits…and that it is long past time to put an end to the nation’s healthcare crisis.

On this issue, however, the public is far ahead of most of the political class. A March New York Times/CBS poll found that the vast majority of Americans want a total restructuring of the healthcare system, and preferred a single-payer system to the current private insurance system 47% to 38%. Unfortunately, many politicians continue to accept money from health insurance corporations, and push plans that mandate Americans to purchase expensive and inefficient private insurance products.

“Al Gore has long been a champion of the environment–and now he’s a champion of America’s patients. There is only one solution to our healthcare crisis, and that is the kind of guaranteed, non-profit, single-payer health insurance that we know works,” said Zenei Cortez, RN, a member of CNA/NNOC’s Council of Presidents.

Called “Healthcare Is A Right,” Gore released the following statement on his Current television channel:

I strongly support universal, single-payer, government-provided–or, government-funded–healthcare. It doesn’t mean the government runs it, it has competition among the different providers. But I just think that we’ve long since reached the stage that its immoral to put people in a situation where they cannot get the medical care they need because their incomes aren’t high enough. I think it ought to be a matter of right and our current system just doesn’t work, its way too expensive. The quality of healthcare is excellent for those who have enough money to buy the very best, but lower-income and low middle-income Americans are not getting good healthcare and so many now can’t afford the private health insurance that they’re going without insurance, millions and millions of people. And I think that to eliminate the incredibly ridiculous cost of all this unnecessary paperwork and different standards for different companies, it is time to have universal health insurance.

George Lakoff: Don’t Think of a Sick Child

The Logic of the Health Care Debate

By George Lakoff, Eric Haas, Glenn W. Smith and Scott Parkinson
Rockridge Institute
October 18, 2007

Introduction

Most health care reports advocate a policy, describe it, and argue for it. We take a different approach. In this paper, we describe the logic of the overall debate over the U.S. health care system — the assumptions, the arguments, who makes them, and why. We do come out of this process with recommendations, but not of the usual sort.

This analysis presents something new and important: a distinction among three modes of thought — progressive, conservative, and neoliberal. What’s new here is a deeper understanding of neoliberal thought, as it affects the discourse on health care. Briefly, it accepts the progressive ethic of care, insisting on maximizing coverage. Meanwhile, neoliberal thought accepts a conservative version of market principles that guarantees profits to insurance and drug companies. Often, this is done in the name of political pragmatism, as a way to mute expected conservative opposition. This creates an inherent tension between the moral mission of government to provide for the protection — in this case the health security — of all of its people and the profit-maximizing insurance marketplace, which works only by denying care.

The neoliberal mode of thought is at the center of the health care debate. It can also be found in issues across the board.

In the health care debate, positions based on the progressive values of empathy and responsibility for oneself and others are focused on the well-being of human beings. The current health care system is focused on insurance company profits, which insurance companies maximize through denying health care to millions of Americans. Neoliberal plans that sincerely seek market solutions or simply appease conservative opposition and protect insurance profits are unlikely to remedy our current health care tragedy. We conclude that progressives who adopt a neoliberal mode of thought, or align themselves with others who do, could inadvertently undermine progressive values and policy goals, surrendering them in advance — anticipating conservative resistance even before negotiations occur — and before the public has a chance to even consider such values.

The other sections of this report:

A Bit of History

A Basic Fact

Your Interests? Or Theirs?

The Conservative Mode of Thought

The Progressive Mode of Thought

The Neoliberal Mode of Thought

Analysis Of The Arguments

What We Can Do

http://www.rockridgeinstitute.org/health (For the 18 page PDF version of this report, under Campaign Resources: The Logic of the Health Care Debate, click on PDF.)

Comment:

By Don McCanne, MD

Most of us have greatly appreciated the guidance on framing the debate that George Lakoff has given us through his publications such as “Don’t Think of an Elephant!”

Professor Lakoff and his colleagues at the Rockridge Institute now provide us with important guidance for understanding and framing the health care debate.

Don’t just sit there and think of a Sick Child. Download the report now! We’ve got work to do!

Don't Think of a Sick Child

George Bush doesn’t want you to think about sick children. He wants you thinking about the fine print of health insurance policies. He wants us to debate types of coverage, premiums and the size of networks, and whether we can afford catastrophic, comprehensive, limited, mini-med or scheduled health insurance. But George Bush doesn’t want you thinking about all the sick children left behind in America. And insurance companies don’t want you thinking about all the children they will bar from care, just so they can maximize profits.

Senior fellows at the Rockridge Institute, including cognitive linguistGeorge Lakoff, author of the best-selling “Don’t Think of an Elephant,” have joined together to examine the hidden truths in our raging national debate over health care. And to bring their new report, “The Logic of the Health Care Debate” to life, the Rockridge Institute has produced a video spot that dramatizes the way in which our current health care system is based on excluding nearly half of the American family — concluding with the provocative question: “Which one of your children would you leave unprotected?”

The video, written by Rockridge senior fellow Glenn W. Smith and produced by Margie Becker of Austin, TX, can be viewed online at

www.RockridgeInstitute.org/health

SCHIP Vote Not Bipartisan: Relative Risk Republicans Hate Children

by DrSteveB
DailyKos
Fri Oct 19, 2007 at 04:47:52 AM PDT

As an epidemiologist I am trained to analyze risk. One of the types of analysis we use in studying a cohort, such as the House of Representatives, is Relative Risk.

Statistics proves that the vote was not bipartisan as some Repuglican apologists in the media are trying to claim.

Relative Risk is:

The proportion of diseased people amongst those exposed to the relevant risk factor divided by the proportion of diseased people amongst those not exposed to the risk factor. This should be used in those cohort studies where those with and without disease are followed to observe which individuals become diseased.

In this case, the cohort is the House of Representatives. The Relative Risk (RR) is the risk of an event (developing a disease; voting against SCHIP) relative to exposure (being a Repuglican). Relative risk is a ratio of the probability of the event occurring in the exposed group versus the control (non-exposed) group, or in this case the probability of the voting against SCHIP for Repuglicans compared to Democrats.

In epidemiology we typically try to reduce the analysis to what is called a “2 by 2 table”

OUTCOME
EXPOSURE Disease+ NonDisease-
Exposure + A B
NonExposure – C D
Relative Risk (or Risk Ratio) = (a / (a+b)) / (c / (c+d))

Therefore:

 
Against SCHIP
For SCHIP
Republican
154
44
Democrat
2
229

Running the statistical calculations, we find that the Relative Risk = 89.8, with a 95% confidence interval from 22.6 to 357.8; P-value < 0.0001.

What this means is that the probability of voting against SCHIP is about 90 times greater if the Representative is a Repuglican then if they are a Democrat.

Got that?

The probability of a Republican voting against SCHIP are 90 times greater than the probability of a Democrat voting against SCHIP. That is NOT bipartisan!

And yes, it is highly statistically significant, with the chance that this would occur by random chance is less than 1 in 10,000. If we were to re-run the experiment 100 times, 95 times the relative risk would be between 22 and 357.

Just how bad is this? Well the relative risk of lung cancer and smoking is 11, and is often cited as one of the highest we see in medicine.

The vote was not bipartisan.

Republicans are a very toxic exposure.

The way to prevent this (the cure) is elect a lot more Democrats.

Health care is a right

Physicians join the ranks of those working toward 'Medicare for everyone'

By Bryce Benson
Chico News Review

At a routine checkup last December, a local doctor advised Sandra Goulart to wait a year before having necessary blood work done.

Ten and a half months later, Goulart is counting the days until she turns 65. Dec. 7, she’ll finally be eligible for Medicare, and she’ll be able to stop living in fear of getting sick, and even have the mammograms she said she has skipped.

She has insurance, but like many Americans she is underinsured, something Dr. Don McCanne, speaking at a health care forum last Thursday (Oct. 11) in the Chico City Council chambers, said 28 percent of privately insured Americans experience.

McCanne is a senior health policy fellow for and past president of the group Physicians for a National Health Program. The event was sponsored by the California Nurses Association and the League of Women Voters. OneCareNow, a grassroots campaign supporting single-payer health insurance, and the Butte County Healthcare Coalition, which has long advocated for the same, were there in force.

Even before her doctor visit last year, Goulart felt the burden of being underinsured. When she had a skin cancer removed from her nose, her insurer paid roughly $150 of the $3,000 to $4,000 bill.

“Oh, this is one of the worst companies out there,” McCanne told Goulart after the forum, when she showed him a letter from MEGA Life and Health Co., informing her that her monthly payment would increase to $619 beginning Nov. 1, 2007.

The only reason she has a policy with what she called a “junk insurance” company is that no other insurance company would take her, she said. Twenty-five years ago she had the virulent form of skin cancer, melanoma, and since then it has been nearly impossible to obtain health insurance.

She couldn’t believe her insurer “had the nerve” to raise her premium for her last month in the private health insurance world but said that out of fear she’s keeping the plan so that at least she’ll have “something to fight” if her health goes south and MEGA won’t pay.

“It’s scary that people are waiting to turn 65 so they’ll be eligible to receive adequate health insurance,” Goulart said.

If the underinsured are scared, McCanne said, think how the roughly 47 million Americans with no insurance at all must feel. They live every day with a feeling of insecurity.

“Who wants to see Medicare totally abolished?” McCanne asked his audience of around 100.

When everyone kept their hands in their laps, he asked sarcastically, “What, are you a bunch of socialists?”

He did that to prove a point. In any discussion of single-payer health insurance, it inevitably is equated with socialism. In reality, McCanne said, the plan is “Medicare for everyone.”

In a week (meaning today, Oct. 18), McCanne said, the House of Representatives will vote on whether to override President Bush’s veto of an expanded State Children’s Health Insurance Plan, the highly successful program that is equivalent to Medicare for children of low-income families. The battle over SCHIP represents the increasingly more prevalent debate over whether private or government-run programs are more efficient and affordable.

Even though most Americans support government health-care programs such as SCHIP, Medicare and Medicaid, President Bush, who enjoys government-funded health insurance himself, is steadfast in his efforts to privatize not only SCHIP but most social programs, like Social Security, McCanne said.

In California, 6.5 million people are uninsured, and Gov. Arnold Schwarzenegger wants to implement universal health care, too. However, his approach is much different.

There are two options for health care reform, McCanne said. The current privatized system can be expanded, or a single-payer system can be organized.

Schwarzenegger’s plan expands on the current system by requiring all Californians to buy health insurance, much like the law requiring drivers to have auto insurance. But, just as with auto insurance, McCanne said, not everyone will buy health insurance; thus not everyone will be covered.

Schwarzenegger’s answer is to fine those who don’t comply.

This is a backward approach, McCanne said. If people can’t afford insurance, how will they pay the fine?

A similar program isn’t working in Massachusetts, despite the fact many politicians have labeled it the model for health care reform, McCanne said. In fact, the level of uninsured actually increased in 2006 to more than 10 percent of the state’s population.

“We can no longer afford the waste and inefficiency, the high overhead and outrageous executive salaries of the private insurance industry,” McCanne said. “Only reforms that end our reliance on defective private coverage and assure guaranteed coverage for all will work.”

¡SÍ, SE PUEDE!

Universal Health Care Foundation Newsletter
Get educated. Get talking. Get active.

“Un seguro médico, para todos, de por vida. One health insurance, for all, for life. That is our goal.”

So declared Jaime Torres, a podiatrist and hospital administrator in New York City. “Latinos in the U.S. are three times as likely as non-Hispanic Whites to lack health insurance,” explained Dr. Torres. “We must close the gap so that affordable and accessible health care is available to all living in the U.S.”


The photo includes, from left to right: Juan A. Figueroa, Universal
Health Care Foundation President and LNHI Vice-President;
Dr. Olveen Carrasquillo, LNHI Vice-President; Richard N. Gottfried,
New York State Assemblyman; Dr. Jaime Torres, LNHI President;
and David Galarza, LNHI Treasurer

That’s why Dr. Torres and a coalition of Latino leaders have joined forces as Latinos for National Health Insurance (LNHI): to educates policymakers, the media and the public about how health inequities and lack of coverage affects all U.S. residents, particularly Latinos.

At a recent reception in New York City, LNHI board members – including Universal Health Care Foundation President Juan A. Figueroa – outlined LNHI’s plans to continue taking its message around the country. Latino leaders and supporters, including New York State Assemblyman Richard Gottfried, who is spearheading health care reform efforts in the state, attended the event.

Latinos are least likely to have insurance of any racial or ethnic group. Here in Connecticut, Latino’s comprise 10% of the state’s population but 40% of our uninsured.

“What we can’t forget is that universal health care is not only an economical solution, it is an ethical solution to our nation’s health care crisis,” explained Dr. Torres. “We can’t leave anyone behind.”

Email here for more information about Latinos for National Health Insurance.

Don’t Think of a Sick Child

George Bush doesn’t want you to think about sick children. He wants you thinking about the fine print of health insurance policies. He wants us to debate types of coverage, premiums and the size of networks, and whether we can afford catastrophic, comprehensive, limited, mini-med or scheduled health insurance. But George Bush doesn’t want you thinking about all the sick children left behind in America. And insurance companies don’t want you thinking about all the children they will bar from care, just so they can maximize profits.

Senior fellows at the Rockridge Institute, including cognitive linguistGeorge Lakoff, author of the best-selling “Don’t Think of an Elephant,” have joined together to examine the hidden truths in our raging national debate over health care. And to bring their new report, “The Logic of the Health Care Debate” to life, the Rockridge Institute has produced a video spot that dramatizes the way in which our current health care system is based on excluding nearly half of the American family — concluding with the provocative question: “Which one of your children would you leave unprotected?”

The video, written by Rockridge senior fellow Glenn W. Smith and produced by Margie Becker of Austin, TX, can be viewed online at

www.RockridgeInstitute.org/health

¡SÍ, SE PUEDE!

Universal Health Care Foundation Newsletter
Get educated. Get talking. Get active.

“Un seguro médico, para todos, de por vida. One health insurance, for all, for life. That is our goal.”

So declared Jaime Torres, a podiatrist and hospital administrator in New York City. “Latinos in the U.S. are three times as likely as non-Hispanic Whites to lack health insurance,” explained Dr. Torres. “We must close the gap so that affordable and accessible health care is available to all living in the U.S.”


The photo includes, from left to right: Juan A. Figueroa, Universal
Health Care Foundation President and LNHI Vice-President;
Dr. Olveen Carrasquillo, LNHI Vice-President; Richard N. Gottfried,
New York State Assemblyman; Dr. Jaime Torres, LNHI President;
and David Galarza, LNHI Treasurer

That’s why Dr. Torres and a coalition of Latino leaders have joined forces as Latinos for National Health Insurance (LNHI): to educates policymakers, the media and the public about how health inequities and lack of coverage affects all U.S. residents, particularly Latinos.

At a recent reception in New York City, LNHI board members – including Universal Health Care Foundation President Juan A. Figueroa – outlined LNHI’s plans to continue taking its message around the country. Latino leaders and supporters, including New York State Assemblyman Richard Gottfried, who is spearheading health care reform efforts in the state, attended the event.

Latinos are least likely to have insurance of any racial or ethnic group. Here in Connecticut, Latino’s comprise 10% of the state’s population but 40% of our uninsured.

“What we can’t forget is that universal health care is not only an economical solution, it is an ethical solution to our nation’s health care crisis,” explained Dr. Torres. “We can’t leave anyone behind.”

Email here for more information about Latinos for National Health Insurance.

Affordability threshold for family health care

The Cost of Keeping Up

By John Hill
The Sacramento Bee

California families must earn far more than the minimum wage and in some cases as much or more than the median hourly income just to keep up with the bare-bones expenses of living, a report released Tuesday said.

A family of four with two working parents needs a yearly income of $72,343 just to cover such costs as housing, medical care, transportation and food, according to the report, “Making Ends Meet,” by the California Budget Project, a nonprofit public policy research group that advocates for working Californians.

That figure doesn’t even include putting away savings for retirement or college, or extras such as cable television, an Internet connection or vacations, the report said.

The culprits are California’s perennial high cost of housing, even with the recent downturn in the market, and exploding health care costs.

Many Californians who make less than what it takes to pay the bills wouldn’t qualify for government programs, such as tax breaks and health insurance for children, said Jean Ross, executive director of the California Budget Project.

http://www.sacbee.com/111/story/436684.html

California Budget Project, “Making Ends Meet”
http://www.cbp.org/pdfs/2007/0710_mem.pdf

And…

What Does It Take for a Family to Afford to Pay for Health Care?

UCLA Center for Health Policy Research
August 2007

This report provides insight into how much Californians can afford to pay for health care by estimating how much they currently pay for health care — including both insurance premiums and out-of-pocket expenses — and how much they pay for the cost of other basic necessities — including housing, child care, transportation, food, and taxes on the income needed to purchase these necessities.

This research suggests that most Californians with incomes below twice the poverty line — $41,300 for a family of four — may not be able to contribute any resources toward their health care and that partial subsidies are needed for many families with incomes well above three times the poverty line — $61,950 for a family of four.

Proposals to extend health coverage to the uninsured should ensure that families are able to afford what policymakers ask them to pay for health coverage. In addition, policymakers should protect families from the risk of extraordinary health care costs by establishing affordable limits on out-of-pocket costs or through other means. While some families have conditions that require higher levels of health costs on an ongoing basis, families with low health costs most years face the possibility of an accident or illness that could require them to pay substantially higher health costs in a particular year. All families, regardless of health coverage, could face financially devastating medical costs if they are not adequately protected from these risks.

Policymakers should consider… taking into account costs families face, such as housing and child care, when determining how much families can afford to pay for health care. Because families face very different costs… income alone is an imprecise measure of what families can afford to spend on health care.

http://www.cbp.org/pdfs/2007/RevisedCBPUCLAAffordabilityReport.pdf

Comment:

By Don McCanne, MD

A median family income is no longer enough to pay for premiums plus out-of-pocket expenses for a family facing chronic conditions or facing a significant injury or major illness. Furthermore, there is no standard income level above which individuals could be assured that health care would be affordable.

If we are going to continue to insist that private plans serve as the basis for expanding coverage to everyone, look at the task we face. For each individual or family, we would have to craft a benefit package which would not only cover any existing chronic disorders and preventive services, but which also would cover cost surges due to significant acute problems. In addition, that benefit package must be tailored to keep premiums affordable, or must have a flexible system of public subsidies that would vary based not only on income but should also consider other living costs and personal reserves. It is no wonder that we waste so much on administration in our multi-payer system when we are trying to tailor benefits, premiums and subsidies to fit each individual circumstance, especially when those circumstances are changing constantly.

Wouldn’t it be smarter to establish one standard benefit package that included care for all acute and chronic disorders and preventive services? Wouldn’t it also be smarter to establish a single risk pool, include everyone, fund it with equitable progressive taxes, and simply pay for care as required? And what doesn’t seem very smart is that we keep asking the same questions over and over again, when we already know the answers.