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