Letter to the Editor
Atlanta Journal Constitution
07/08/07

Don’t be fooled by all the politicians claiming to support “universal” health care. If you read the fine print, most of their proposals dictate that everyone should buy a private health care card. What good is your card if it commits you to a $5,000 deductible and 50 percent co-pay before you receive any of your (limited) benefits?

We should reject a mandate that everyone must contribute to the coffers of the big insurance corporations. No, thanks. That sort of “universal” plan could mainly bankrupt the middle class and further enrich the private insurance manipulators.

We need a universal plan that is compassionate and sustainable. The clearest way is to eliminate the role of for-profit insurance companies. Having been practicing medicine for 35 years, after seeing “Sicko” I’m convinced we need — and will eventually demand — a single payer, universal, health insurance system.

Thanks, Michael Moore, for pointing the way.

HENRY S. KAHN
Kahn is emeritus professor of family and preventive medicine at Emory University School of Medicine.

By Jane Bryant Quinn
Newsweek

July 30, 2007 issue – Prepare to be terrorized, shocked, scared out of your wits. No, not by jihadists or dementors (you do read “Harry Potter,” right?), but by the evil threat of … universal health insurance! The more the presidential candidates talk it up, the wilder the warnings against it. Cover everyone? Wreck America? Do you know what care would cost?

But the public knows the American health-care system is breaking up, no matter how much its backers cheer. For starters, there’s the 46 million uninsured (projected to rise to 56 million in five years). There’s the shock of the underinsured when they learn that their policies exclude a costly procedure they need–forcing them to run up an unpayable bill, beg for charity care or go without. And think of the millions who plan their lives around health insurance–where to work, whether to start a business, when to rretire, even whom to marry (there are “benefits” marriages, just as there are “green card” marriages). It shocks the conscience that those who profit from this mess tell us to suck it up.

I do agree that we can’t afford to cover everyone under the crazy health-care system we have now. We can’t even afford all the people we’re covering already, which is why we keep booting them out. But we have an excellent template for universal care right under our noses: good old American Medicare. When you think of reform, think “Medicare for all.”

Medicare is what’s known as a single-payer system. In the U.S. version, the government pays for health care delivered in the private sector. There’s one set of comprehensive benefits, with premiums, co-pays and streamlined paperwork. You can buy private coverage for the extra costs.

Health insurers hate this model, which would end their gravy train. So they’re trying to tar single-payer as a kind of medical Voldemort, ready to destroy. Here are some of their canards, and my replies:

Universal coverage costs too much. No–what costs too much is the system we have now. In 2005, the United States spent 15.3 percent of gross domestic product on health care for only some of us. France spent 10.7 percent and covered everyone. The French comparison is good because its system works very much like Medicare-for-all. The other European countries, all with universal coverage, spent less than France.

Why are U.S. costs off the charts? Partly because we don’t bargain with providers for a universal price. Partly because of the money that health insurers spend on marketing and screening people in or out. Medicare’s overhead is just 1.5 percent, compared with 13 to 16 percent in the private sector. John Sheils of the Lewin Group, a health-care consultant, says that the health insurers’ overhead came to $120 billion last year, of which $40 billion was profit. By comparison, it would cost $54 billion to cover all the uninsured.

Eeeek, your taxes would go up! Maybe not, if Sheils is right. Both the Congressional Budget Office and the General Accounting Office have testified that the United States could insure everyone for the money we’re spending now. But even if taxes did rise, you might still come out ahead. That’s because your Medicare plan would probably cost less than the medical bills and premiums you’re paying now.

We get world-class care; don’t tamper with it. On average, we don’t. International surveys put France in first place. On almost all measures of health care and mortality, we lag behind Canada and Europe. Many individuals do indeed get superior care, but so do people in single-payer countries, and at lower cost.

They have long waiting times. No advanced country has waiting periods for emergency surgery or procedures that are urgently needed. The United States has shorter waits than Canada and England for elective surgery. Still, queues are developing here, at the doctor’s door. In a study of five developed countries, the Commonwealth Fund looked at how many sick adults had to wait six days or more for an appointment. By this measure, only Canada’s record was worse than ours. But waits depend on how well a system is funded, not with the fact that it’s single-payer. Many countries that cover everyone, including France, Belgium, Germany and Japan, report no issue with waits at all.

There’s no problem; people get care even if they’re uninsured. They don’t. They get emergency treatment but little else. As a group, the uninsured are sicker, suffer more from chronic disease and rarely get rehabilitation after an injury or surgery. They also die sooner–knowing that, withh insurance, they might have lived.

Right now, Congress is trying to bring 3.3 million uninsured children into the State Children’s Health Insurance Program. President George W. Bush says he’ll veto the expansion as “the wrong path for our nation.” He objects to “government-run health care” (like Medicare?) and says that SCHIP “deprives Americans of … choice” (like the choice to go uninsured?). Buzzwords like “government run” are supposed to summon up monsters like “socialized medicine” that apparently still lurk under our beds. If these terror tactics work, prepare for another 46 million uninsured.

Sau Friedman
Newsday
July 21, 2007

Beware the front groups that claim they would help save Medicare or promote health care reform. More than likely they’re saving or promoting themselves – at the expense of Medicare and your health.

The “front group,” invented by the late father of public relations, Edward Bernays, is the quintessential tool of deceptive propaganda, says the Center for Media and Democracy, a nonprofit public-interest organization, for it is “an organization that purports to represent one agenda while in reality it serves some other party or interest.”

One prominent example is the Coalition for Medicare Choices, which said in a May press release it enlisted “more than 100,000 seniors … to urge Congress to protect the benefits they receive though Medicare Advantage plans. With the recent surge in membership, the Coalition now totals more than 350,000 members.”

The Coalition’s sponsorship is not hidden, but it may not be well known, among the unions and predominantly African-American organizations it lists as supporters, that it was organized in 1999 and is wholly financed by America’s Health Insurance Plans. That group has opposed the expansion of publicly supported health care and most measures to strengthen Medicare. It, as well as drug lobbies, wrote the 2003 legislation that gave administration of the new Part D drug benefit to insurers instead of Medicare and prohibited the government from negotiating prices with drug manufacturers.

Medicare Advantage (HMOs and PPOs) is private managed care that seeks to take the place of traditional Medicare. And for weeks the Coalition has been bombarding lawmakers and unsuspecting editors with letters, messages and press releases sounding alarms over Democratic proposals to slash the government subsidies paid to insurance companies to offer these plans. Letters to editors have listed how many beneficiaries in various states stand to lose their Medicare Advantage coverage if the proposals pass.

As I’ve reported, the government pays the insurers on average 12 percent more per beneficiary on a Medicare Advantage plan than it pays for an enrollee on traditional Medicare. That’s one reason insurance companies have been able to promise subscribers extra benefits and lure 19 percent of the 43 million Medicare beneficiaries away from traditional Medicare. But, as we reported on March 24, subscribers have complained that the insurers’ salespeople have been using deceptive practices and advertising to sell unwary Medicare beneficiaries on Advantage plans that may not serve them well.

Medicare Advantage insurers may refuse to pay for out-of-network services or deny coverage for some procedures. Drug benefits may be uncertain. Its policies require written referrals for specialists or lab work and frequent co-payments. Last month, America’s Health Insurance Plans president Karen Ignani announced that seven leading insurers have voluntarily suspended selling Medicare Advantage plans. She’s also the spokesperson for the Coalition for Health Care Choices, which has chosen to remain silent on the issue.

The official Medicare Payment Advisory Commission (MedPAC), the American Medical Association and most Medicare advocates have told members of Congress that the subsidies for the Medicare Advantage plans are not needed. The Congressional Budget Office estimated that cutting them would save Medicare more than $50 billion over five years – money that could be spent on the State Children’s Health Insurance Program and Medicare.

But Congressional Budget Office director Peter Orszag told the Senate Budget Committee that, if Medicare Advantage plans grow, they will strain the Medicare budget. Worse, he said, “I think the result would be a fundamental change in the nature of the Medicare system that may be hard to reverse.” The Centers for Medicare and Medicaid Services has acknowledged abuses in the sale of Medicare Advantage plans but has taken no position on the legislation.

The Coalition for Health Care Choices and America’s Health Insurance Plans maintain that, without the subsidy, insurers may have to abandon the Medicare Advantage business, as they did five years ago when they quit offering Medicare Plus Choice (HMO) plans because profits weren’t high enough. These are scare tactics, to be sure, but Medicare Advantage beneficiaries should be warned that they may, indeed, lose their coverage and have to switch to traditional Medicare, if Congress ends the insurers’ gravy train. The good news, however, is that traditional Medicare will be strengthened.

Another couple of front groups have formed to fight against government-sponsored universal health care, including Medicare. Health Care America, based in Washington, D.C., gets support from the drug industry, according to its Web site. More prominent is the recently formed Coalition to Advance Healthcare Reform, which describes itself on its Web site as group of “business leaders, employers and other like-minded leaders committed to healthcare reform” through “meaningful, market-based solutions to our health care crisis.”

Much of the reason for the crisis is the current market-based system. Nevertheless, the new coalition says its “core principles” include “a market-based” system, and “universal coverage with individual responsibility,” meaning requiring individuals and/or employers to buy insurance, perhaps with help from government.

This coalition includes more than 40 of the nation’s largest corporations, many of which helped make the American health care system what it is today, while profiting from it: Aetna, Cigna Health Care, Eli Lilly, CVS Caremark, GlaxoSmithKline, McKesson Corp., Kaiser Permanente, plus General Mills, The Kroger Co., Safeway and PepsiCo.

The coalition’s statement of purpose says business wants a “place at the table,” if and when the nation chooses a health care system, to make sure it’s based on private insurance. In a coming column, I’ll write about whether we need private insurance.

WRITE TO Saul Friedman, Newsday, 235 Pinelawn Rd., Melville, NY, 11747-4250, or by e-mail at saulfriedman@comcast.net

By LEO Weekly

The red that progressive doctors, nurses and other healthcare professionals are seeing over the roughly 47 million uninsured Americans probably looks a lot like the blood-colored, “Sicko”-branded scrubs they wore Friday morning as they shouted, “I get sick!” in unison outside Baxter Avenue Theatres. The boisterous demonstration actually inspired a neighborhood dog to bark its own outrage at the insurance-driven woes of the American healthcare system — or maybe it just had a cough.

The gathering of medical professionals and activists before the premiere of Michael Moore’s new documentary, “Sicko,” was part of a nationwide effort called “Scrubs for Sicko,” using the film as a springboard to cull support for universal healthcare legislation, specifically House Resolution 676, which would establish a national healthcare program by extending Medicare to every U.S. resident — that includes those visiting the United States and its territories.

Many of those same professionals spoke at a press conference before the screening, along with civic and government leaders, including state Rep. Jim Wayne, D-35. Suzy Post, a veteran of multiple social movements, said healthcare rights must be won the way civil rights and womens’ rights have been.

“Civil rights are no damn good if you’re dead,” Post said.

Others extolled the virtues of HR 676, which currently resides in the House Ways and Means, Veterans’ Affairs and Energy and Commerce committees. Third District U.S. Rep. John Yarmuth is a co-sponsor of the bill, one of 74 representatives on that list; Michigan Democrat John Conyers originally floated the resolution in 2003. Marty Meyer, a representative in Yarmuth’s district office, delivered a statement from the Congressman in support of the bill.

Though attendees rallied behind Moore’s latest film, most of the discussion focused on the issues presented in “Sicko” rather than the movie itself.

“Medical care is a necessity rather than a commodity,” Syed Quadri, medical director at a free medical clinic in Elizabethtown, said. “Many people don’t agree with Moore’s politics, but no one disputes the facts coming out of this film. People know about the problems.”

Volunteers handed out literature and “Free Universal Healthcare” cards — like the I.D. cards HR 676 would require — that could only be activated when the legislation passes. –Ryan Real

By USW International President Leo W. Gerard

Michael Moore, the activist author and filmmaker, has given every union member in the United States a great tool of advocacy for our health care agenda with his new movie, “SiCKO.” We should return that favor by attending the premiere of his movie June 29. Wear your USW gold and blue when you go.

With a compelling combination of humor and pathos, “SiCKO” documents how medical insurance companies act like cancer on this country’s health care system. This is what we want to eliminate with a national health care system.

Moore begins “SiCKO” by subjecting his viewers to excruciatingly painful insurance system failure scenes. They include an injured worker suturing up his own lacerated knee because he is one of the 47 million Americans without health insurance; a couple moving into a spare room in their daughter’s home after medical insurance co-payments for the husband’s three heart attacks and the wife’s cancer forced them into bankruptcy, the most common cause for personal bankruptcy today; and a young woman recounting the death of her 18-month-old baby because an ambulance took the critically ill girl to a hospital that refused to treat her because her insurance would not pay for services there.

Those disquieting scenes are thankfully interspersed with Moore’s often-comical antics in four countries with national health care: Canada, Britain, France and Cuba.

In Canada, he tools around in a golf cart with a conservative, who endorses the country’s national system of medicine and describes its creator, Tommy C. Douglas, as a Canadian hero, akin to George Washington or Abe Lincoln.

How could a conservative support socialized medicine, Moore asks the man. The conservative says it’s because not everyone can afford the medical services they need. The conservative, like Michael Moore and most of us, recognizes that health care is a human right, not some kind of privilege bestowed only on the rich or the lucky.

On his trip to Britain to investigate their national health care system, begun after World War II, Michael Moore searches a hospital for some department that will bill a patient. Finally, after numerous workers laugh at him, Moore discovers a cashier’s window. It turns out, however, money is dispensed from the window to patients, reimbursing them for public transit to the hospital.

Moore reports that his research shows that Canadian, British and French citizens live longer, healthier lives than Americans, and their infants are more likely to survive. The overhead costs for these health care systems are far less than America’s. In fact, the overhead for the one, already national system in America, Medicare, is 3 percent. It’s 30 percent for the insurance system. Apparently, Moore says, the government can do something right.

Moore ends up in Cuba after trying to take some American patients, including two 9-11 first responders who suffered lung injuries, to Guantanamo Bay to get some of that free health care American is dispensing to accused al Qaida war criminals imprisoned there.

After being refused entrance to the American portion of the island, Moore takes his patients to a Cuban hospital which provided free treatment to the foreigners, under the same procedures and circumstances that it gives care to Cuban citizens. The idea, again, was that medical treatment is a right of all humans, regardless of nationality, or religion or politics.

A Cuban firehouse conducted a ceremony to honor the first responders before they left because, the firemen said, they were all brothers and sisters. The Cubans said they wished they could have aided with the rescue on 9-11.

This kind of solidarity is essential for us to win a better health care system. The film advocates radical surgery on the American system to excise the insurance companies, which profit by denying coverage, treatments and pharmaceuticals, and by rescinding payments once made.

Michael Moore argues in “SiCKO” that this is not representative of American behavior. We show solidarity in crises. We rush to aid each other when there’s a tornado, a Katrina, a Virginia Tech. We bring food, build houses, give blood and clothes. We are generous. We are not the people of a stingy health care system. We have the right, the power and the opportunity to deliberately plan and build a health care system that would be fair and equitable and cover everyone as a human right. Let’s stand in solidarity for that.

We all know from our bargaining experiences how crucial it is to get health care off the table. That would eliminate much of the contentiousness in negotiations and make it much easier for American companies to compete in the global economy against nations that already provide national health care, including all of those in Western industrialized countries. We should act to radically reform the existing health care system that has resulted in 47 million uninsured Americans.

Make no mistake. Moore’s film advances our cause. It’s to our benefit to advance his film, which will play in only about 1,000 theaters its first weekend. The more people who clamor to get into those doors that first weekend, the more movie screens it will appear on the following week, and so on. The more popular the film, the more clear it will be to politicians that this issue must be addressed.

Again, I encourage you to go see the movie on opening night. Put on your USW cap or shirt when you go. Take your family and friends and neighbors. And take action outside the theatre, too. Stand in solidarity with your union brothers and sisters and Michael Moore to cure our SiCKO health care system.

Supporters hope Michael Moore’s latest movie will sway public opinion. The AMA and others counter that government-run health care isn’t the right solution.

By Doug Trapp
AMNews staff
July 23/30, 2007

Washington — Michael Moore’s latest film, “SiCKO,” has energized single-payer supporters and drawn attention to their cause. But what, if any, long-term effect the movie will have on the national debate on universal health care system reform is up for debate.

Moore created a buzz on Capitol Hill before “SiCKO” opened on June 29. He grabbed headlines with a rally, a crowded June 20 news conference with Democratic supporters, and two special screenings of his movie: one for lawmakers and one for health care lobbyists. Moore bought a full-page newspaper ad inviting 900 lobbyists to the screening, but only 11 showed up. The viewing for lawmakers, however, was better attended.

Organized labor, led largely by nurses unions, and single-payer advocates used the film as a vehicle to try to sway public opinion by “making moviegoers into health care activists.” Their nationwide “Scrubs for SiCKO” campaign on opening night featured nurses in red scrubs designed by Moore, “From SiCKO to Sanity” flyers and an invitation to join the single-payer movement.

The film grossed $11.5 million in its first two weeks, finishing ninth in box office totals. But it opened in only about 10% of the screens occupied by an average summer blockbuster, then expanded to nearly 20% in its second week, according to Rotten Tomatoes, a popular Web site that tracks the film industry. About 91% of media reviews in the site’s unofficial tally were positive.

The film was powerful, said Robert Blendon, ScD, a professor of health policy and political analysis at the Harvard School of Public Health. But with many Americans cynical about their government, “SiCKO” still won’t create a tidal wave of support for a government-run single payer health system, he said.

“What I think it will contribute to is a sense that it’s wrong that we don’t have some way of requiring or guaranteeing that people have some basic insurance coverage,” Dr. Blendon said.

Peter Clarke, PhD, a professor of preventive medicine and communication at the University of Southern California, said the film won’t change the health reform debate in a lasting way, partly because Moore is stereotyped easily by detractors.

In the film, Moore unapologetically targets the profits and influence of the health insurance and drug industries while questioning the profit motive of the American public-private system. He challenges the country’s inability to provide basic, affordable health care to everyone the way other countries do. The movie mentions the American Medical Association as a longstanding opponent to socialized medicine.

The AMA is working to increase access to health care and is worried about corporations putting profits before patients, said AMA Board of Trustees Chair Edward L. Langston, MD.

“We disagree, however, that the only solution is to give up and turn our health care system over to the government under a single-payer system,” Dr. Langston said. The AMA, as a member of the Health Coverage Coalition for the Uninsured, supports tax credits to help low-income families and individuals buy health insurance, among other reforms.

Rep. John Conyers (D, Mich.) hosted Moore at the Capitol Hill news conference for both “SiCKO” and the United States National Health Insurance Act, which would expand Medicare to cover everyone. The measure, which Conyers introduced, has 75 co-sponsors, all Democrats.

Moore was joined by 32 lawmakers, including Conyers, plus a few dozen members of the California Nurses Assn., which backs single-payer legislation in California. It’s the only state where the Legislature passed a single-payer bill, but Gov. Arnold Schwarzenegger vetoed the measure last fall.

With only one presidential candidate supporting single-payer health care — Rep. Dennis Kucinich (D, Ohio) — the odds are against the issue gaining traction. It takes the power of a newly elected president for such legislation to succeed, Dr. Blendon said.

Still, single-payer supporters are in a better position today than several months ago when the subject wasn’t mentioned as an option for health system reform, said Quentin Young, MD, president of Physicians for a National Health Program. “In recent months, before the movie, even, we moved up to the next higher stage. We were no longer irrelevant, we were the less-desirable alternative,” Dr. Young said.
Fairness an issue in “SiCKO”

“SiCKO,” like his previous documentaries, includes Moore’s sense of theatrics. He takes three 9/11 volunteer rescue workers from New York City to Guantanamo Bay, Cuba, in search of treatment for their various illnesses. Moore says they should be eligible for the same health care as terrorism detainees.

“SiCKO” also showcases horror stories, including an insured couple who went bankrupt because of expenses from multiple episodes of cancer and heart attacks.

Many critics pointed out the film’s lack of balance in discussing health care in the U.S. compared with Britain, France and Cuba. Moore solicited through a Web site thousands of complaints from Americans about their health plans but limited his examination of other countries’ nationalized health care to anecdotal encounters, such as a dinner with Americans living in France.

“There’s no question he did not in any way try to talk about the problems that are faced in those systems and the complaints that citizens have. They are major political issues — they have been in Britain and Canada — about waiting times,” Dr. Blendon said.

John Goodman, PhD, president of the National Center for Policy Analysis, a nonprofit research institute that promotes private-sector alternatives to government regulation, didn’t expect Moore to be fair.

“Since the whole purpose of the film is to compare the worst features of American health care with the best features of health care in Britain, Canada, France and even Cuba (!) who can complain about a few errors here and there?” he wrote on his blog.

Moore, at the Capitol Hill news event, said there are many myths about other countries’ health care systems. “Yes, they have their flaws. All human systems do. But ask a Canadian if they would trade their national health care card for your HMO card. You won’t find a Canadian willing to do that. Or a Brit or anyone from Ireland or from France.”