PNHP

Say yes to national health care

Say yes to national health care

By Michael Hochman and David Himmelstein
Baltimore Sun
October 29, 2007

Michael Moore’s film Sicko gave a big boost to the movement for single-payer national health insurance this year. But even those turned off by Mr. Moore’s less-than-subtle style will find many reasons to support a single-payer system. As the number of uninsured and underinsured Americans continues to rise and medical costs spiral out of control, these reasons are increasingly compelling.

As doctors at an urban hospital, we see uninsured patients in the emergency room with serious illnesses that easily could have been prevented with appropriate preventive care. We waste countless hours filling out unnecessary insurance forms. And we listen to patients complain about the complexities and hassles of navigating the health care system.

This is why an increasing number of us on the front lines have started calling for meaningful change in the form of a single-payer system in which the government funds health care.

Next weekend, proponents of single payer will gather in Washington for the annual convention of Physicians for a National Health Program. Our group has proposed giving every U.S. resident a health care card entitling him or her to all medically necessary services. The new program would be funded by an increase in taxes, but that would be fully offset by savings from abolishing insurance premiums and many out-of-pocket health care costs. Those wanting cosmetic and other medically unnecessary services could still pay out of pocket.

Opponents of a single-payer system argue that single payer could be even more inefficient and bureaucratic than the current system. They point to other countries, such as Canada, that have national health insurance and yet have long wait times to see doctors.

But research supports the opposite conclusion. For example, a 2003 study published in The New England Journal of Medicine found that the average overhead of U.S. insurance companies is 11.7 percent, compared with 3.6 percent for Medicare and 1.3 percent for Canada’s national health insurance program. And the waits in Canada are a result of Canada’s low level of health spending – on a per capita basis, about half that in the United States. The efficiency of Canada’s national health insurance program coupled with our current high level of health funding would yield the world’s best health care system.

There is no reason to expect, as some people do, that reckless use of health care resources would increase under a single-payer system. Other countries that offer free health care spend much less than we do, and even now, most Americans don’t “feel” the cost of health care because insurance companies pay many of the bills.

Some also suggest that the quality of health care would decline under a single-payer system. But again, this is unlikely. Life expectancy is shorter and infant mortality rates are higher in the United States compared with most nations with a single-payer system, and a comprehensive analysis has found that Canadians receive care at least as good as most insured Americans. The only difference would be that instead of sending bills to private insurance companies – a difficult and time-intensive process – doctors and hospitals would bill the national health insurance program.

Medical innovation would also continue unfettered. The vast majority of basic science in the United States is publicly funded, and incentives for drug development would remain strong.

Despite the merits of a single-payer system, none of the major 2008 presidential candidates supports it. Instead, they have put forth a creative array of meaningless, incremental reforms that would do little for our failing system.

For example, Mitt Romney’s Massachusetts Health Reform – which requires citizens to purchase health insurance or face a fine – is proving far more complicated and far less comprehensive than many had hoped.

Proposals from Democratic Sens. Barack Obama of Illinois and Hilary Rodham Clinton of New York also fall far short. Under both of their plans, only low-income citizens who qualify for Medicaid or the State Children’s Health Insurance Programs would be guaranteed health care. The rest would be required to buy their own, effectively criminalizing the uninsured.

Although few mainstream politicians endorse single payer, we see reason for optimism. A recent survey of Massachusetts physicians found that almost two-thirds favor single payer, and we believe health care providers are coming around nationwide as well. We hope the political thrust for single payer will come soon. If it doesn’t, we face a future of more wasteful spending, more inefficiency – and ever more Americans struggling to get by without health insurance.

Dr. Michael Hochman is a member of the Massachusetts chapter of Physicians for a National Health Program, and Dr. David Himmelstein is a co-founder of that organization.

AHIP's deceptive release on CDHC

New Study Shows Lower Costs, Increased Consumer Engagement in Account-Based Health Plans

HealthDecisions.org
October 23, 2007

HealthPartners today released results of a study that provide new evidence that members who have health savings accounts and health reimbursement accounts have lower medical costs and are more engaged in seeking out more cost effective care. The analysis shows that even when adjusted for illness burden, health care costs were 4.4 percent lower for HealthPartners members in these consumer directed health plans compared to members in traditional plans.

http://www.healthdecisions.org/HSA/News/default.aspx?doc_id=139052

Consumer Directed Health Plans Analysis

HealthPartners
October 2007

As demand for consumer-directed health care increases, this study adds to evidence from national studies about the impact of consumer-directed health plans. Several studies show that consumer-directed plans are associated with increased consumer engagement and lower costs.

CDHPs are associated with lower costs and more efficient care

The cost of care for members in CDHPs was more than 4.4 percent lower than the cost of care for members in traditional plans after accounting for differences in illness burden.

Cost of Care by Product:

$210 – HSA

$194 – HRA

$216 – Traditional without deductible

http://www.healthpartners.com/files/39058.pdf

Comment:

By Don McCanne

This study released by America’s Health Insurance Plans shows that consumer-directed health plans using health savings accounts are effective in reducing health care costs (confirming the theory that patient-consumers will be more careful in spending funds from their own health savings accounts).

Wait a minute. That’s what the press release would have you believe. But what did this study really show?

Individuals with their own health savings accounts (HSA) spent $6 less than those with traditional plan without a deductible (2.8% less). That’s not very impressive.

But what about those with health reimbursement arrangements (HRA)? The funds in those accounts revert to the employer if they are not spent by the patient-consumers. Under the consumer-directed theory, health care spending should not decrease under HRAs since it is not the patients’ money, and the employees would eventually lose access to the funds if they didn’t spend them. Yet those individuals spent $22 less (10.2% less). Both the HSA and the HRA products combined resulted in 4.4% decrease in costs, but the real savings was with the HRAs and not the HSAs.

So what is the conclusion? Patients who need care will freely spend their own money out of their HSAs, but they will hold back on care if its their employers’ money that they’re spending. This, of course, is the exact opposite of what this press release and the advocates of consumer-directed health care would have you believe.

Of course this is all nonsense. The real issue is that high-deductible health plans are replacing more comprehensive coverage, and these deductibles are making health care access less affordable. Hiding behind the rhetorical diversion over health savings accounts, to which two-thirds of employers don’t even contribute, hardly advances the cause of affordable, comprehensive health care for all.

AHIP’s deceptive release on CDHC

New Study Shows Lower Costs, Increased Consumer Engagement in Account-Based Health Plans

HealthDecisions.org
October 23, 2007

HealthPartners today released results of a study that provide new evidence that members who have health savings accounts and health reimbursement accounts have lower medical costs and are more engaged in seeking out more cost effective care. The analysis shows that even when adjusted for illness burden, health care costs were 4.4 percent lower for HealthPartners members in these consumer directed health plans compared to members in traditional plans.

http://www.healthdecisions.org/HSA/News/default.aspx?doc_id=139052

Consumer Directed Health Plans Analysis

HealthPartners
October 2007

As demand for consumer-directed health care increases, this study adds to evidence from national studies about the impact of consumer-directed health plans. Several studies show that consumer-directed plans are associated with increased consumer engagement and lower costs.

CDHPs are associated with lower costs and more efficient care

The cost of care for members in CDHPs was more than 4.4 percent lower than the cost of care for members in traditional plans after accounting for differences in illness burden.

Cost of Care by Product:

$210 – HSA

$194 – HRA

$216 – Traditional without deductible

http://www.healthpartners.com/files/39058.pdf

Comment:

By Don McCanne

This study released by America’s Health Insurance Plans shows that consumer-directed health plans using health savings accounts are effective in reducing health care costs (confirming the theory that patient-consumers will be more careful in spending funds from their own health savings accounts).

Wait a minute. That’s what the press release would have you believe. But what did this study really show?

Individuals with their own health savings accounts (HSA) spent $6 less than those with traditional plan without a deductible (2.8% less). That’s not very impressive.

But what about those with health reimbursement arrangements (HRA)? The funds in those accounts revert to the employer if they are not spent by the patient-consumers. Under the consumer-directed theory, health care spending should not decrease under HRAs since it is not the patients’ money, and the employees would eventually lose access to the funds if they didn’t spend them. Yet those individuals spent $22 less (10.2% less). Both the HSA and the HRA products combined resulted in 4.4% decrease in costs, but the real savings was with the HRAs and not the HSAs.

So what is the conclusion? Patients who need care will freely spend their own money out of their HSAs, but they will hold back on care if its their employers’ money that they’re spending. This, of course, is the exact opposite of what this press release and the advocates of consumer-directed health care would have you believe.

Of course this is all nonsense. The real issue is that high-deductible health plans are replacing more comprehensive coverage, and these deductibles are making health care access less affordable. Hiding behind the rhetorical diversion over health savings accounts, to which two-thirds of employers don’t even contribute, hardly advances the cause of affordable, comprehensive health care for all.

Oberlander on learning from failure

Learning from Failure in Health Care Reform

By Jonathan Oberlander, Ph.D.
The New England Journal of Medicine
October 25, 2007

The Clinton administration’s misadventure carries several broader lessons about the politics of health care reform. First, no matter how much momentum it seems to have, no matter how many signs point to change, there is nothing inevitable about health care reform in the United States. In U.S. health policy, the status quo is deeply entrenched and, despite all its failings, the system is remarkably resistant to change, in part because many constituencies profit from it. Thus, although everyone decries the amount of money spent on health care, the political reality is that national health care expenditures represent income to health industry stakeholders, whose interests lie in ensuring even greater spending.

Second, many Americans are satisfied with their own health care arrangements, so reforms that threaten to unsettle those arrangements risk running afoul of the voting public. Health care reformers must thread the needle by persuading the anxious insured that reform is in their best interest and that the uninsured can be covered without disturbing (and ideally, while enhancing) their coverage.

Third, expanding government authority over a health care system that accounts for more than $2 trillion and one sixth of the economy in a country that is ambivalent about public power is an inherently controversial exercise. No universal coverage plan, no matter how clever, can evade that ideological debate.

Fourth, paying for health care reform remains a formidable challenge. The Clinton plan collapsed largely because the administration could not secure congressional support for an employer mandate, but no obvious financing alternatives have emerged in the ensuing years, and persistent antitax politics and federal deficits constrain the options for reform.

Fifth, U.S. political institutions limit presidential power, foster divisions in Congress, create opportunities for those with vested interests to block change, and generally complicate the adoption of health care reform.

Finally, the window for enacting a comprehensive plan for health care reform never stays open for long, so failure comes at a high price — namely, the loss of political will to do anything meaningful about the uninsured for some time to come.

NEJM Audio Interview with Jonathan Oberlander:

I really believe that for health reform to pass things have to get worse, and they have to get much worse for the middle class. As long as this is an issue about people on the other side of the tracks, it’s not going to pass. It has to be a case where the president and members of Congress are really hearing that their middle class constituents who, after all are the ones who are voting, are hurting, and I’m afraid actually that’s exactly where we’re headed.

http://content.nejm.org/cgi/content/full/357/17/1677

Comment:

By Don McCanne, MD

It would be a shame to see so much more suffering occur before we could achieve reform. What would the healthy want to hear now, before their personal finances are threatened by medical costs, that would make them want to change to a public program ?

They need to be convinced that the coverage would be superior to what they have, with greater benefits, fewer out-of-pocket costs, and free choice of their health care professionals.

Perhaps even more persuasive would be the assurance of permanent health security. No longer would individuals potentially be one paycheck away from losing their insurance merely because of loss of employment or the desire for early retirement. A public program would be there for them for their entire lives.

So we should ask Americans whether they want to wait for the pain, or prevent the pain. If they want to prevent it, they need to let Congress and the president know.

Competing health insurance plans equally flawed

By Malinda Markowitz
San Jose Mercury News
10/25/2007

It’s time to wave the warning flag on the steamroller demanding action on health care this year – no matter what it is. Rather than resulting in sound policy, the drumbeat could just as easily produce a hastily designed “compromise” that perpetuates our state’s health care crisis while stalling real reform for years to come.

Consider Massachusetts, whose mandatory health insurance law is the model for Gov. Arnold Schwarzenegger’s proposal and which provided much of the inspiration for a similar legislative proposal vetoed by Schwarzenegger earlier this month.

The Massachusetts law was hurriedly rushed through its Legislature last year amid clamor for passage of a law that its advocates could claim solved their health care morass while burnishing the credentials of politicians such as Gov. Mitt Romney, then in the final stages of preparing his candidacy for president.

Today the law remains a mess. Despite tax penalties for failure to buy insurance, only 20 percent of the uninsured have purchased the mandatory plans – and 94 percent of those who have enrolled received full or partial public subsidies.

One reason so many are willing to accept the fines is the law’s failure to control costs.

Even the cheapest plans have high deductibles and co-pays, and huge gaps in coverage have eroded existing benefits for many families with modest incomes.

Massachusetts officials admit 18 percent of the uninsured cannot afford insurance, notes a report by the Santa Monica-based Foundation for Taxpayer and Consumer Rights. As Ben Day, director of Mass-Care, a vocal critic of the law, points out, “many of those who supported it are now saying the law will never work.”

Why does Massachusetts matter? Because both the latest Schwarzenegger proposal, and the alternative favored by Assembly Speaker Fabian Núñez and some of his allies, repeat the mistakes of the Massachusetts law.

Neither approach constrains skyrocketing premiums, deductibles, co-pays, drug costs or hospital charges. That’s a fatal flaw. Millions of Californians are likely to end up with junk insurance that increases their health insecurity with policies that will jeopardize their financial health if they use medical care or encourage them to self-ration and not use the care they still have to pay for.

Proponents of the two versions say they are cracking down on insurers by requiring them to provide coverage to everyone, but massive loopholes make that promise illusory.

The governor’s latest plan, for example, allows health plans to require information on a patient’s health status or history and permits them to raise rates further for “risk adjustment.” The Núñez bill permitted insurers to dump people with “serious medical conditions” into a public pool that would probably be bankrupted by having to pay for the sickest patients.

Two issues, both ominous for California working families, appear to be holding up the final back-room deal.

The first is a Massachusetts-style mandate forcing all uninsured individuals to buy insurance. As in Massachusetts, the price tag for the cheapest plans in the governor’s proposal is enormous deductibles and other high out-of-pocket costs, and a required minimum that a family must spend on its health plan which together could financially devastate many California families.

While Núñez and his allies have opposed the individual mandate, it seems likely a deal will be cut providing financial offsets for some middle-income families. But, as the Massachusetts experience proves, without effective cost controls, any offsets on an individual mandate are meaningless.

A second point of contention is how much tax will be levied on employers who don’t provide health coverage for workers. But both the amount favored by the governor, and the one in the Núñez bill that was vetoed, are substantially less than what the average California business offering health plans now pays, a clear incentive for businesses to reduce coverage or drop benefits entirely and just pay the tax.

Sadly, the main beneficiaries of a rushed “compromise” will be the same insurance companies that created the present crisis. They would harvest millions of new customers, with the government using its power and the public purse to further an insurance industry that will continue to be able to profiteer and deny care.

We don’t have to turn just to Massachusetts to see an example of how this can lead to disastrous public policy. A decade ago, the same “consensus” pushed the hurried passage of energy deregulation. That was followed by blackouts, skyrocketing energy costs for consumers, financial calamity for the state, and open thievery by Enron and other energy corporations.

Californians should demand that legislators pull the plug before we plunge into another disaster.

MALINDA MARKOWITZ is a member of the Council of Presidents of the California Nurses Association/National Nurses Organizing Committee and a registered nurse at Good Samaritan Hospital in San Jose. She wrote this article for the Mercury News.

Rewarding physicians for providing less care

Physicians Cite Reasons Incentives Are Onerous

By Scott Shepard
The Daily News
October 24, 2007

A plan by two insurance companies to reward Memphis doctors based on efficiency and cost effectiveness has doctors upset. And it’s not a problem with working under incentives, which have existed for years in health care, but with rating doctors based on their billing histories.

Representatives from both United HealthCare and Cigna have been making the rounds in West Tennessee explaining their new incentive programs, which will rate doctors who make the grade with higher reimbursements.

In an environment in which costs continue to escalate, carriers are under extreme pressure to rate providers who give the best dollar value, said physician Robert McLaughlin, medical director of Cigna HealthCare of Tennessee.

Insurance companies have mountains of billing information on every doctor, noted Richard Lachiver, an occupational medicine physician and market medical director of Tennessee and Arkansas for United. Billing data may contain some bias, but when aggregated it still shows clear patterns and points out opportunities for improvement.

It’s unfortunate, he said, that this has become known as an incentive plan. Carriers would rather it be treated as an information-sharing project doctors could embrace. Physicians have been too slow to change, and the economics now are driving the system.

http://www.memphisdailynews.com/Editorial/StoryLead.aspx?id=99512

Comment:

By Don McCanne, MD

Since reimbursement rates are already set by contracts between insurers and physicians, this can’t be about the specific fees that are billed since they are automatically adjusted down to contracted rates.

By using “mountains of billing information,” the “best dollar value” will be determined by the frequency and intensity of services. Physicians who see their patients less frequently, do fewer procedures, and provide fewer intensive visits will be paid more for the services that they do deliver. The physicians who are most successful at selecting a larger number of healthy patients and dumping the sick ones will receive the highest compensation.

This is precisely the marketplace mentality that we have come to expect from the private insurance industry. In contrast, a public insurance program would be designed to be certain that those who really need health care would receive it.

The insurers say that this isn’t an “incentive plan,” but rather, in consumer-directed lingo, it is an “information-sharing project.” In more traditional rhetoric, “when they say it isn’t about the money, it’s about the money.”

Big N.Y. Union, Gore Back Government Run Single-Payer Health Care

Press Associates, Inc. (PAI)
10/22/2007

ALBANY, N.Y. (PAI)–A big New York state union, the 58,000-member Public Employees Federation, has joined the growing group that backs government-run single-payer health care. And former Vice President Al Gore does, too.

A 2-sentence endorsement PEF delegates added at their recent convention said it “supports the expansion of Medicare described in bill HR676–the United States National Health Insurance Act. This legislation would provide not-for-profit, single-payer health care to all Americans.”

That adds single-payer health care to a detailed PEF federal agenda that includes preservation of Social Security, transportation funding, and other issues.

Meanwhile, the California Nurses Association, one of at least six AFL-CIO unions that back single-payer, reported Gore’s statement, aired on cable television.

Gore, who won the 2000 presidential election against GOP nominee George W. Bush, but who was deprived of the job by GOP theft, called the present health care system “incredibly ridiculous.” Gore just shared the Nobel Peace Prize for his work on alerting the world to the dangers of global warming. That gives him added credibility.

“I strongly support universal, single-payer, government-provided-for, government-funded health care,” Gore said. “It doesn’t mean the government runs it, it has competition among different providers. But I just think that we’ve long since reached the stage that it’s 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. It’s way too expensive. The quality of health care 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 health care and so many now can’t afford the private health insurance that they’re going without insurance,” Gore explained.

PEF is a joint affiliate of AFT and the Service Employees, neither of which has endorsed the government-run single-payer health care proposal. That legislation, by veteran Rep. John Conyers (D-Mich.) would abolish any role for the private insurance companies, as well as their co-pays, deductibles, denial of care and deaths caused by refusal to pay for patient care.

In other news from the New York unionists’ convention, the delegates endorsed home-state Sen. Hillary Clinton (D) for the Democratic presidential nomination. New York’s primary, like 24 others nationwide, is on Feb. 5. AFT has also endorsed Clinton, but SEIU left endorsement decisions up to its locals.

Schwarzenegger and Clinton plans similar

Politics add irony to health debate

By Aurelio Rojas
The Sacramento Bee
October 22, 2007

Gov. Arnold Schwarzenegger’s and Sen. Hillary Rodham Clinton’s health care plans have a lot in common, but the labor unions that have attacked the governor’s plan have been largely silent about Clinton’s.

“From labor’s viewpoint, the health care plan looks a lot worse when the other side proposes it,” said Jack Pitney, professor of politics at Claremont McKenna College in Southern California.

That irony was underscored last week when the California Federation of Labor announced it has hired Chris Lehane, an ex-aide to former President Clinton, to direct its campaign against Schwarzenegger’s health plan.

During a recent interview, Lehane acknowledged similarities between the Schwarzenegger and Clinton plans but quipped, “You don’t hear many Democrats say that.”

Pitney, meanwhile, predicts that labor will hold off on criticizing Clinton.

“I don’t think they’re going to take many shots at her during the campaign,” Pitney said. “But should she be elected and try to get her proposal through Congress, labor is going to argue it doesn’t do enough.”

A comment posted in response to this article:

Comment:

By Don McCanne, MD

Mandate to purchase unaffordable plans?

The average cost of employer-sponsored family coverage is now over $12,000, and that does not include deductibles, copayments, coinsurance, and out-of-pocket spending for products and services that are not covered. U.S. median household income is $48,000. Those numbers no longer work. Private health plans are a vestige of the last century. We need a 21st century model that pools all risks and funds the pool through equitable tax policies. Gov. Schwarzenegger and Sen. Clinton insist that the solution is to require individuals to purchase private plans that they cannot afford. That might work for the wealthy, and for the poor on welfare programs, but that does not work for the majority of us who are just trying to make ends meet.

http://www.sacbee.com/111/story/446457.html

The Long, Dark Night

By BOB HERBERT
Op-Ed Columnist
The New York Times
October 23, 2007

I was making small talk with Dan and Sharon Brodrick in a waiting area filled with anxious-looking patients on the first floor of St. Thomas Hospital. Mrs. Brodrick seemed tired, but she managed a smile. Her husband, a former truck driver who is now an ordained minister, was the talkative one.

“We found out five days after her 56th birthday,” he said. “How’s that for a happy birthday?”

While maintaining a pleasant facade for the outside world, the Brodricks, married 37 years and still deeply in love, are spinning toward the abyss.

“We’re in big trouble,” said Mr. Brodrick.

Mrs. Brodrick learned last May that she had cancer of the duodenum, and it had already spread to her liver and pancreas. Not only is the prognosis grim, but the medical expenses will soon leave the couple destitute. Mrs. Brodrick has no health insurance.

The emotional toll has been nearly as devastating as the physical. Mrs. Brodrick told her husband that she wasn’t ready to leave him. “I don’t want to die,” she said. When he told her they had to cling to their faith in God, she replied, “I know that God can take care of this. But how’s he going to do it?”

The American Cancer Society has been campaigning to raise awareness of the desperate plight of people trying to deal with cancer without health insurance. I offer Dan and Sharon Brodrick as Exhibit A.

The Brodricks never had much money, but they raised two boys and managed to buy a modest home in Gainesboro, a rural town about 90 miles east of here. Dan Brodrick severely damaged his back in an accident at work several years ago and is disabled. His wife has suffered from a variety of illnesses.

But by carefully managing their meager income, they have lived in reasonable comfort. “With a little bit of savings,” said Mr. Brodrick, “and with what I’ve been drawing in disability, we figured we’d be all right.”

But the absence of health insurance for Mrs. Brodrick left a gaping hole in their financial plan, and they knew it. She had been covered by her husband’s health insurance while he was driving a truck. But that coverage ended when he was forced to retire.

“We tried to buy insurance for her,” said Mr. Brodrick. “We applied to dozens of companies. But they wouldn’t touch her because she already had health problems.”

Without insurance, Mrs. Brodrick received treatment for her various ailments under a special program for uninsured patients at St. Thomas. But the cancer diagnosis was an entirely different story, a step for the Brodricks into a realm of dizzying, unrelieved horror.

First came the biopsy, accompanied by reassuring comments from doctors. Then came word that the tumor was indeed malignant. That was followed by surgery.

“They opened her up, and then they closed her right up again,” said Mr. Brodrick.

Not only had the cancer metastasized, it was moving very aggressively. Various estimates were given, each one shorter than the last, about how long Mrs. Brodrick might live.

While his wife was being prepped for chemo, Mr. Brodrick sat in the corner of another room and spoke about what it was like to have one’s life all but literally blown apart.

“It tears you down,” he said. “You’d like to fight this with your bare hands, but you can’t. We’ve been married 37 years Sept. 2, and when I think about it, it was the quickest 37 years I’ve ever seen go by in my life. It went by in a flash. And we have leaned on each other that whole time.”

The hospital is not billing the Brodricks for its costs. “But,” said Mr. Brodrick, “I’ve still got to pay the doctors’ bills and pay for the drugs. And the drugs are very expensive.”

He reeled off a long list of charges that are coming at him like machine-gun fire, bills that he cannot afford to pay.

“So we’re selling the house,” he said. He sat quiet for a moment, then added in a soft voice, “You shouldn’t have to go live in a tent somewhere just because you don’t have insurance.”

He said he wanted to tell his story publicly because he knew there were millions of others without health insurance, and that there are many families, like his own, facing the long, dark night of devastating illness.

“Something has to be done,” he said.

Mr. Brodrick was able to get his wife into a renowned cancer center in the Midwest to get another opinion on the course of treatment she was receiving.

“They said it was the perfect treatment for her and they wouldn’t change a thing,” he said. “They said the success rate with that treatment was 5 percent or less.”

He looked at me. “We’ve got faith in God,” he said. “Without that you might as well throw yourself off a cliff, because there’s nothing else left.”

Single Payer Health Care works in Italy

by Mikael Rudolph
http://www.opednews.com
October 22, 2007

Last month I helped organize a protest/appeal at a Minneapolis appearance by House Judiciary Committee Chair John Conyers’ Jr. (D-MI) at a Town Hall meeting to drum up support and educate those in attendance about his proposed United States National Health Insurance Act (HR 676) sponsored by my Representative in Minnesota’s 5th District, Keith Ellison.

My perspective, as well as those of my fellow ImpeachforPeace.org members was that as troubled and ineffectual as the American health care system was, the health of our Constitution and our Democratic Republic was of far greater import and in far more urgent need of attention.

While my concern for the future of our nation and passion for defending our nation’s Constitutional form of government against the domestic enemies to it now in power hasn’t lessened, October’s events in my personal life have certainly affected my vantage on health care.

It is with full permission from my sister that I share that she is suddenly in a fight for her life.

Having lost our mother and father in fairly rapid succession in 2001 and 2003, she and I and our brother are middle-aged orphans. We haven’t been getting along all that well in dealing with the estates and all the mess of dealing with two lifetimes of possessions and properties, which is fairly common among siblings dealing together with the loss of parents.

The old adage that blood is thicker than water proves true, however, and I was at her side within days of learning that she was suddenly debilitated by a stroke that had rendered her left side paralyzed. A cancerous tumor in her abdomen that had begun to secrete coagulants into her blood is the likely cause of the stroke.

In just three short weeks, her recovery from the effects of the stroke has been remarkable, her experience as an assistant to a physical therapist and her extensive body awareness learned from years of dance and yoga practice and teaching paying off markedly. A week ago she couldn’t walk and now she takes multiple daily strolls up and down the hospital ward hall, albeit “teetery” in her own word. She employs ‘pranayama’ breathing techniques as well as Reiki and Feldenkrais methods to stimulate both sides of her brain and body. Her face shows no remaining signs of the left-side droop of her first few days following this catastrophic medical affliction.

Her left arm has been slower to wake up; her fingers and wrist not yet reactivated, but her bicep started working again about ten days ago and she does regular curls as well as stirring motions with both arms by interlocking her fingers along with other exercises.

Like approximately 50 million Americans, she is without insurance, having allowed her coverage to expire recently as she traveled from job to job in moving from California back to the Seattle area where we grew up.

Hundreds of thousands of dollars of payments are impending. Without insurance, she will spend the rest of her life indebted to hopitals, doctors, drug companies and the rest of the for-profit network that defines America’s capitalistic Medicine-for-Profit system so well exposed in Michael Moore’s latest documentary film: Sicko.

Except my sister has no bills so far. None. Not one. Everything so far is paid for.

She was visiting Italy when hit by the stroke.

In 1978 Italy changed over to a socialized medicine system. Overnight the governmental medical service SSN (Servicio Sanitaris Nazionale) was introduced on the basis that “Everyone has to be treated with the same dignity, regardless of his social position. Everyone in need has to receive medical treatment.”

Moreover, this system works because Italy has deep roots in the kind of “family values” that Dr. Dobson can only dream about. Nearly every patient at Ospedale Rieti as well as Ospedale Magliano Sabina where I first was greeted with a tearful, one-armed, bedridden hug and a “Welcome to Italy” by my sister has someone visiting as often as needed to support the nursing staff and serve as an advocate in communicating with the medical staff concerning their loved one’s treatment. Those families whose loved one is in need of personal care moment-to-moment hire a personal attendant as an adjunct to the medical professionals in the hospital if a family member cannot break away full-time.

It was in this spirit that Anna, the Italian mother-in-law of an American friend of my sister’s took charge when it came time for me to officially sign my sister in at the hospital. I handed over her passport and answered a short list of questions with the help of the latest in a string of Italian people who have extended themselves to help me out in a nation where I suddenly found myself in need of everything and knowing nothing.

When asked if my sister had insurance, I answered “Non”. The admissions administrator gave me a bit of a stare and a raised eyebrow smirk, as if to say: “Coming over here to get free medical help, are we?”.

Anna stepped forward with all of her four-foot-ten inches of machisma and explained very clearly that my sister had been stricken with illness while visiting Italy and was in need of help. Imagine a female Danny DeVito with a bee in her bonnet and you’re on the right track.

Shortly thereafter, I was handed a small blue folded card, much like the paper trail I would leave my neighborhood bank with as a child after depositing my lawn mowing earnings to my 5.4% interest savings account with the handwritten entry of the transaction faithfully recorded by the teller.

My sister was instantly not just a visitor to Italy, she was an honored, respected and cared for guest of the Italian people. She was not an illegal alien, she was not a suspected terrorist, she was S.T.P. 110 No 000000397.

Her medical expenses and care were suddenly and simply 100% covered anywhere she would need to be taken care of in Italy for six full months.

Single Payer Health Care works. Italy got it in place virtually seamlessly about 45 years after their dance with the fascism that Mussolini himself defined as “Corporatism”.

Let’s hope we don’t have to wait that long after we recover from our dance with Bush

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.