Letter to the Editor
New York Times Magazine
April 15, 2007

Is this what our country has come to? Leading C.E.O.’s, despairing of their ability to limit rising health-care costs and unwilling to bear these costs themselves any longer, will now back legislation that would place every individual and family at the mercy of private insurance companies like UnitedHealth, Wellpoint and the other insurance giants. Do they think John and Jane Doe can achieve what Safeway and General Motors cannot, namely, affordable health care for all of us?

Instead of moving backward to the time before there was employer-based or group health insurance, when people were on their own to get health care any way they could, we should be moving forward, recognizing that health care is a necessary public good that should be treated as a public responsibility. We should be expanding and improving the Medicare program, which we know provides reliable, cost-effective coverage and has been doing so for more than 40 years. Public Medicare-for-All, not private for-profit insurance, is the only path to a future that will truly provide access to health care for all Americans.

Oliver Fein, M.D.
New York
Leonard Rodberg
Flushing, N.Y.

(The authors are, respectively, chairman and research director of the New York chapter of Physicians for a National Health Program)

William Whitaker, a professor of social work at Boise State University, has been named Idaho’s Social Worker of the Year by the Idaho chapter of the National Association of Social Workers.

Whitaker came to Boise State in 2002 as the coordinator of the master of social work program. In 2005 he was honored with the Faculty Award for Service by the College of Social Sciences and Public Affairs. During his more than 40 years as a social worker, he has been involved in a variety of community and university programs, including serving two elected terms on the board of the Council on Social Work Education and a two-year term on Boise State’s Faculty Senate. He is also a consulting editor for two professional journals, the Journal of Community Practice and Social Development Issues.

As president of United Vision for Idaho, Whitaker has helped initiate and implement New Voices, New Vision, a statewide effort to develop a progressive agenda for Idaho for the next 15 years. One agenda issue is universal health insurance for Idaho. As part of this, Whitaker has supported the development of Idaho Health Care for All, the rejuvenated chapter of Physicians for a National Health Program. In May, he will complete his two-year term as IHCFA co-chair. Whitaker also is an organizer and convener of the Idaho Interfaith Roundtable Against Hunger.

Note from PNHP: The AFL-CIO endorsed a Medicare for All approach to health reform in March, 2007, but some splinter unions, most prominently SEIU, have kept silent on single payer and instead had high profile press conferences with groups like the pro-market National Business Roundtable. This article sheds some light on SEIU president Andy Stern’s corporate alliances and the internal battle at SEIU that will determine the fate of hundreds of thousands of health care workers – and impact the future of health care reform in the US.

The secret deal worked out between SEIU bosses and nursing home owners denies union members the right to speak out, strike, or protect patients

By Matt Smith
SF Weekly
Published: April 11, 2007

“With time, my loss of Cassie began to transform the way I approached life.”
–Andy Stern, Getting America Back on Track: A Country That Works, Simon & Schuster, 2006

“It is as if he cant help conflating the fate of workers with the fate of his daughter.”
–Matt Bai, New York Times Magazine, Jan. 30, 2005

“When she died it broke my heart,” he says. “It just gave me the strength to say, ‘Speak out; dont be afraid.'”
“One brave thing he’s done is pursue a partnership with corporate America.”
–Leslie Stahl, CBS News, May 14, 2006

In the above excerpted narrative, repeated ad nauseam in Service Employees International Union (SEIU) press materials, union president Andy Stern emerged from a personal catastrophe differently than others who face crisis in middle age.

Stern did not turn to sports cars, young girlfriends, adventure athletics, or otherwise immerse himself in narcissism after his 13-year-old daughter died from surgery complications, his wife later divorced him, and he took to dining alone in bars.

Instead, Stern has said in his book and to newspaper and magazine writers, the 2002 personal tragedy caused him to become something of a combined Steve Jobs and Martin Luther King, a futuristic innovator applying his genius to empowering disenfranchised workers in his 1.8-million-member SEIU, where Stern became president in 1996.

The union left the umbrella of the AFL-CIO in 2005, based on the idea that the old trades federation was a stodgy, backward-looking organization not focused enough on growth.

Key to Stern’s characterization of himself as a new, different type of labor leader is his assertion that the SEIU is leaving behind the old class-struggle-style unionism pitting employees against bosses. In its place is a modern template where workers and employers seek to advance interests they hold in common.

“Employees and employers need organizations that solve problems, not create them,” Stern wrote in A Country That Works. “Nursing home owners and SEIU leaders are formulating a new national labor-management committee and new state-based relationships to promote quality and employer economic stability. In California, the industry and union worked with the legislature on a plan to enhance quality in nursing homes, stabilize the work force, and provide more resources for direct patient care.”

However, there’s another trove of literature describing the recent history of Stern’s SEIU, one that’s quite different than the Cassie-focused genre popular in newsstands and on bookshelves. It’s contained in secret for-top-union-officials-eyes-only contracts, memos, lobbying agreements, and analysis reports obtained from various sources by SF Weekly. They illustrate the details of a sweetheart deal between the SEIU and California nursing home companies that impair, rather than empower, workers and patients, while inflating dues-paying union ranks.

These documents suggest Stern’s post-Cassie leadership of the SEIU shares little in common with Martin Luther King, and doesn’t involve much real innovation. Instead, it’s merely a re-hash of the sort of sweetheart company-union labor deals that have marred the reputation of trade unionism throughout history. It has involved trading away workers’ free-speech rights, selling out their ability to improve working conditions, and relinquishing their capability to improve pay and benefits, in order to expand the SEIU’s and Stern’s own power.

As testament to how little interest Stern’s SEIU has in explaining to the public, or to union workers, the inner workings of its modern, employer-friendly style of leadership, 10 requests for interviews to officials at Stern’s Washington headquarters, and to union officials in Northern and Southern California, went unanswered.

In spite of the official silence, union memos obtained by SF Weekly also point to a serious rift between Stern and Sal Rosselli, president of SEIU United Healthcare Workers West, an Oakland-based 140,000-member local representing workers in California hospitals, nursing homes, and other health facilities. The fight is over whether the union should continue its current, Stern-backed strategy of expanding membership by giving up workers’ rights, and the rights of patients they serve, through “partnerships with corporate America” such as the nursing home pact mentioned in A Country That Works.

Or should the union seek to expand the old-fashioned way, through recruitment, political pressure, picketing and other protests, lawsuits, alliances with advocacy groups, and pointing out corporate abuses to the press?

Officials with Sal Rosselli’s UHW-West have apparently taken a strong stand saying corporate-friendly alliances aren’t the panacea Stern makes them out to be.

And documents I’ve obtained suggest that regardless of the image crafted by his own brilliant public relations, Stern has tread a route common among men who’ve suffered crippling late-life personal setbacks. He’s become ornery in his old age.

Sal Rosselli won’t answer questions when I call him on his cellphone. And judging from the wall of silence I’ve received from some other officials in his local, he’s apparently instructed the rest of his staff to do the same.

Notwithstanding, secret SEIU documents I’ve obtained have made me come to respect Rosselli’s style of union leadership. Leaked SEIU contracts, memos, and reports, as well as off-the-record interviews with some union insiders, suggest Rosselli has been engaged in a showdown with Stern over the rights of unionized health care workers, and of the patients they care for.

According to a recent report prepared by UHW-West, Stern’s brand of corporate collaboration has done little for the SEIU besides inflating the membership rolls with workers who’ve received hardly any benefit from union membership.

At issue is a 2003 agreement between the SEIU and a group of California nursing home chains. According to this pact, its terms would be kept secret, and otherwise “be held in confidence to the full extent allowed by law.” Notwithstanding, I received two copies of the misleadingly named “Agreement to Advance the Future of Nursing Home Care in California,” from different sources last month. I have also obtained a copy of a similar agreement recently negotiated between the SEIU and nursing home chains in Washington state, which involves similar tradeoffs between the SEIU and nursing home chains.

The California agreement was set to expire at the end of last year; the union and the nursing homes are currently negotiating a possible extension. Whether, or how, the agreement will be extended may have been thrown in doubt thanks to complaints about the current agreement coming from Rosselli’s UHW-West.

On the SEIU’s side of the 2003 bargain, the union agreed to use its clout with Democratic legislators in Sacramento to accomplish three goals of interest to nursing home owners:

The SEIU pledged to use its lobbying muscle to pass a 2004 bill increasing MediCal subsidies to nursing homes by more than $2 billion over four years, according to patient advocates. The bill passed, creating a windfall for nursing home owners.

The union also agreed to attempt to pass tort reform legislation that would have limited patients’ right to sue in the event they were neglected, raped, abused, or killed. (The union’s tort reform lobbying efforts were put on hold, however, after a 2004 SF Weekly story led union members and advocacy groups to complain.)

The SEIU also pledged in the 2003 pact to staunch any efforts by patient advocates to push for legislation or regulations requiring nursing homes to provide enough staff to keep patients safe and healthy, unless the nursing home companies agree to such reforms in advance. The SEIU will “oppose any long-term-care-specific staffing and reimbursement legislation or regulation that fails to meet mutually agreed objectives,” the agreement states.

According to lobbyists for nursing home patients, the union has indeed been successful in repressing efforts by nursing home advocates to pass legislation that would have tied increases in state nursing home subsidies to improvements in the quality of care.

In return, the nursing home chain owners agreed to allow the SEIU to recruit workers into their union. Under ordinary circumstances, nursing home owners vigorously resist union organizing drives by occasionally intimidating and firing union-sympathetic workers, and by attempting to convince them that union membership isn’t in their interest. Under the lobbying agreement, however, the nursing home chains would refrain from these tactics in a certain number of facilities if the union helped to pass the 2004 funding bill, and in more facilities if the union got tort reform legislation passed.

So far, workers in some 42 nursing homes have joined the SEIU in this way, according to a union report.

This membership gain has allowed the union to publicly characterize the lobbying deal as a means to improve the quality of care for nursing home patients, while improving wages, benefits, and working conditions for people who care for the aged and infirm.

This is the new era of worker-employer collaboration touted in Stern’s book, and in articles that characterize him as a bold modernizer. Journalists, however, appear to have been so caught up in Stern’s tactic of getting weepy about his deceased daughter during interviews that they’ve failed to find out exactly what it is he’s talking about.

If they had, they would have discovered a monumental catch: workers who joined the union specifically as part of the 2003 agreement with nursing home chains, an agreement that is supposed to be a national model for corporate collaboration, get a severely stripped-down version of union representation. In important ways, the agreement causes workers to lose rights rather than gain them.

Under the 2003 lobbying pact, all nursing home workers entering the union under the auspices of the agreement would work under uniform, employer-friendly labor contracts called “template agreements.”

These agreements specify that the union is not allowed to report health care violations to state regulators, to other public officials, or to journalists, except in cases where the employees are required by law to report egregious cases of neglect and abuse to the state. The agreements also prohibit the unionized workers from picketing, and negotiating improvements in health care or other benefits. They prohibit the workers from having a say in their job conditions.

According to the template contract, employers have the “exclusive right to manage the business.”

This means the owners set pay rates, pay increases, and incentive plans. They hire, lay off, demote, discipline, and determine benefits for workers without union input. The employers may outsource work performed by union members, and speed up, reassign, or eliminate jobs at will. The employer may eliminate vacations, or any other time off, as the employer sees fit.

The agreement also guarantees that workers’ wages will not put an employer at an “economic disadvantage,” either through employee pay, benefits, or through staff-per-patient ratios.

To advocates for health care consumers, contract language guaranteeing the union will refrain from reporting poor nursing home conditions to state regulators is particularly appalling.

“This is a sector where caregivers are the eyes and the ears and the witnesses when there is abuse. To tie their hands and to tie their tongues is to let people die. That’s immoral and a terrible thing for a nursing home worker to have to live with,” says Jamie Court, president of the Foundation for Taxpayer and Consumer Rights, and author of Corporateering: How Corporate Power Steals Your Personal Freedom. “I’ve never seen a labor union except for the SEIU enter into a top-down, industry-friendly agreement that binds the hands of the workers.”

The agreement doesn’t merely prohibit workers from attempting to complain about their lot once they’ve signed a union contract. It also puts a halt on any traditional unionizing drive in other nursing homes owned by a chain that is party to the lobbying agreement — even in cases where workers have expressed interest in joining the SEIU.

“There’s a struggle going on at the SEIU, and the struggle is, what kind of unionism is being advanced? Are these agreements that lay the ground for voluntary recognition? Or are they in fact straightjackets?” said Bill Fletcher, a visiting professor at City University of New York, who formerly held the SEIU position of assistant to the president for the East and South.

It’s from studying that internal SEIU struggle that I’ve discovered new respect for UHW-West under Rosselli’s leadership.

That union local recently issued a report analyzing the 2003 lobbying pact from the workers’ perspective.

The report, titled “The California Alliance Agreement: Lessons Learned in Moving Forward,” suggests that the agreement resulted in subsidies that fattened nursing home profits, and handcuffed workers, while inhibiting the union’s chances at ever negotiating legitimate labor contracts that truly enhanced workers’ lives.

“Alliance-based template agreements do not allow workers to empower themselves,” the UHW-West analysis report says. “Is it any wonder that we have often heard from these workers that ‘the boss brought us the union?'”

The report can be read as a repudiation of Stern’s brave new path, coming out of the biggest health care workers’ union local in the western U.S.

“Clearly this is an internal polemic against the direction coming out of Washington,” Fletcher notes.

Indeed, the UHW-West report comes near calling the 2003 agreement a sellout.

For one thing, the union might have been able to expand, while obtaining greater benefits for workers, without any agreement at all. “Many workers at Alliance nursing homes throughout California were precluded from organizing,” the UHW-West report says.

Those workers who were assimilated into the SEIU through the lobbying deal were introduced to a paltry version of trade unionism, the report says.

“If the nature of the labor agreement defined in the current Alliance templates — which restrict members’ rights and ability to be empowered — is allowed to continue, what effect will this have on the fundamental nature of a union organization? What ultimately happens if we give up the right to strike as the means for workers to level the playing field with employers when needed?” the report says. “We would argue that it would adversely affect our mission and goal to advance and defend the interests of our members, and in fact, may come close to becoming close to what have historically been called ‘company’ unions.”

According to the “Lessons Learned” report, the UHW surveyed 1,600 members who were under these Alliance template contracts. The workers’ No. 1 complaint: Short staffing at these nursing homes hampered their ability to provide quality care for patients.

Indeed, short staffing is cited in news stories, in lawsuit complaints, and by public health advocates as the primary cause behind cases of neglect where patients develop bedsores, are left covered in their own feces, or die needlessly of festering illnesses or injuries.

Ironically, the SEIU’s 2003 MediCal subsidy bill was touted as a way to help nursing homes afford to hire enough caregivers to adequately provide for patients.

Instead, the Lessons Learned report claims, the nursing home chains used an inordinate amount of the increased state subsidies to fatten profits, rather than increase staffing levels.

According to the UHW-West analysis, nursing homes organized under the agreement received $119 million in added MediCal subsidies during the ’06-07 funding year thanks to the 2005 nursing home funding bill the SEIU led the effort to pass. But those same employers will only spend $21 million of that money on personnel in those facilities.

“Did we sell ourselves short?” the UHW-West study asks, leaving the answer implicit: absolutely.

In what some view as payback for UHW-West’s role in speaking up for the rights of nursing home workers and patients, the union’s Washington headquarters has moved to strip the local of its ability to represent nursing home workers.

During a 2006 statewide reorganization of SEIU locals, in which California union locals merged along industry lines, Stern’s representatives recommended that all the state’s nursing home workers be reassigned to a new bargaining unit run out of Los Angeles by a Stern ally named Tyrone Freeman.

Freeman is reportedly more amenable than Rosselli to the “collaborate-with-corporate-America” style of worker organizing alluded to in A Country That Works. Freeman did not return calls requesting comment.

“I would be likely to offer up my Southern California buildings first, because the Southern California union reps are simply more pleasant, more cooperative, and more pragmatic,” said Greg Stapley, spokesman for California’s fifth-largest nursing home chain, the Ensign Group.

Though Ensign is not currently part of the agreement with the SEIU, Stapley has been sitting in on negotiation meetings with a thought to joining.

Indeed, according to a Jan. 13 memo to UHW-West board members from the local’s director for nursing home organizing, Freeman’s local “literally said that the union should have no say on things like what shifts the workers should work.”

This attitude has earned the favor of nursing home owners, the memo said.

“The operators indicated very strongly that they do not want SEIU to ‘run’ their facilities and that their position on any new agreement meant that the current ‘template’ contract would remain intact.”

Rosselli’s UHW, meanwhile, has said in negotiations that “the template must go, that workers as health care providers need a voice and rights on the job,” the memo said.

Rosselli has so far struggled to resist efforts by the national union to dilute his power. A recent Stern memo, however, suggests the possibility exists that nursing home workers currently represented by UHW-West could eventually be moved to the Long Term Care Workers’ local run by Freeman.

Stern’s “corporate collaboration” rhetoric aside, the facts of the California Alliance agreement demonstrate that workers and employers don’t have the same interests.

“You can get a condominium of interests that includes the union, but excludes the union member. He doesn’t get self-determination, doesn’t get the full market value that strong collective bargaining would give him. He doesn’t get the right to be a citizen, and be able to complain about a situation where they aren’t treating clients properly,” says Robert Fitch, author of Solidarity for Sale: How Corruption Destroyed the Labor Movement and Undermined America’s Promise.

Somehow, though, Stern has managed to get journalists to look past possible downsides of his new labor paradigm by offering up a compelling story line, where a labor leader is impelled by the death of his daughter to become courageous, and to make a real stamp on the world.

Though American newspapers, magazines, radio stations, and television stations don’t employ labor reporters anymore, they’ve got plenty of business writers. And if those journalists know anything, it’s that there’s truth in numbers. The union’s membership numbers are up every year — “1.8 million members and growing” is www.seiu.org’s homepage tagline.

Making Stern’s ideas even more attractive, the man is constantly doing things that are just plain newsy. In February he appeared with the head of Wal-Mart giving lip service to the idea of universal health care. Before that, he was meeting with leaders of China’s government-controlled national labor union — the one with the reputation for worker suppression. And in 2004 he was quoted saying that his union might be better off if George Bush beat John Kerry. And then there’s the intriguing underlying story line: the anti-intuitive idea that workers and the boss are actually on the same team. For story-hungry hacks, what’s not to like about all that?

Stern “does things that are very provocative. Unless you dig into it, you say, hey, the guy is full of good ideas,” says Fletcher, the former SEIU organizer who teaches at CUNY. “The fact is, workers and employers are going to clash. And they have contradictory interests. Andy obscures that question, and that helps explain the attraction he has for Fortune, for Business Week. ”

Buoyed by a cushion of flattering press, the SEIU and nursing home owners are now in talks to extend the cynically named “Agreement to Advance the Future of Nursing Home Care in California.”

If the pact is extended as a result of current negotiations, the SEIU would lobby for a new piece of California legislation adding hundreds of millions of dollars of enhanced state Medical subsidies to nursing home companies. In return, the SEIU would be allowed to gain members in additional nursing homes, according to a version of the agreement currently under discussion.

However, a Bay Area union local that’s party to those negotiations has pointed out that the reality behind SEIU’s policy of joining hands with corporate America is far worse than the hype.

I urge UHW-West leader Sal Rosselli, along with any other SEIU members with a conscience, to work toward the next logical step. It’s time to scuttle this pact before it causes the waste of more tax dollars, diminishes the rights of more workers, and helps endanger the lives of more elderly and disabled nursing home patients.

Somehow, I believe Cassie might have wanted it that way.

To read the report from the United Healthcare Workers West on the agreement between nursing home owners and the SEIU, click here.

Michael Ozer
Special to the San Antonio Express-News
04/07/2007

When one examines the state of the U.S. health care system today, three things are obvious.

First is access. Forty-seven million people are uninsured, and demand for medical care has never been greater. Waiting lines are longer and emergency rooms are overflowing.

Second, our system of employer-financed insurance cannot meet the escalating crisis. Premiums and costs are higher than ever while coverage is increasingly skimpier.

Third, Americans have a growing desire to fix the system, and the majority seem to want a national fix. In a recent New York Times/CBS poll, nearly two-thirds of those surveyed said the government should guarantee coverage for all Americans. Half said they would be willing to pay up to $500 a year more in taxes for universal coverage.

So where does all this leave us? For one thing, it means the 2008 presidential candidates will be talking more about health care as their campaigns unfold, and, as consumers, we should try to better understand the underlying issues.

At this point, none of the major contenders has made bold proposals that would threaten the dominant role the private insurers have in our system. Most would create mandates for employers to purchase health insurance for their employees and provide tax credits for those too rich to qualify for Medicaid or the Children’s Health Insurance Program.

Unfortunately, such approaches won’t adequately address the problem. Decent coverage would increasingly become more unaffordable for more and more Americans as medical costs continue to rise.

In Massachusetts, the pioneer of the state-mandated plans, a 56-year-old making $30,000 annually will have to spend $7,164 in premium and deductible payments before insurance kicks in and still pony up 20 percent of hospital costs after that, according to Physicians for A National Health Program, or PNHP.

Such coverage is health insurance in name only. It leaves patients unable to access care and subject to financial ruin. PNHP studies show that more than a quarter of insured Americans go without needed care because of cost, and 75 percent of those bankrupted by medical bills had coverage when they got sick.

Forcing or enticing Americans to buy stripped-down health insurance may decrease the number labeled “uninsured,” but it won’t protect the physical or financial health of beleaguered families. And as costs continue to rise, employers will push more middle-class families from comprehensive plans into ones with scaled-down benefits and higher deductibles.

The only way to simultaneously expand coverage and lower costs is through single-payer national health insurance, or NHI — a plan similar to Canada’s or Britain’s, but distinctly American in its approach.

There’s already federal legislation before Congress — the United States National Health Insurance Act (HR 676). It has 78 sponsors and would expand and improve the existing Medicare system, creating a sort of “Medicare for All.” Unfortunately, none of our local legislators have signed on yet.

Arguments that NHI would hurt medical research or lessen the quality of medical care are unfounded in this nation, with the existing personnel, resources and infrastructure devoted to health care. But we could achieve tremendous savings from overhead and duplication in our system, possibly as much as $350 billion a year, according to the New England Journal of Medicine.

In fact, PNHP estimates, U.S. insurance companies spend more than a third of U.S. health care dollars on administration and marketing as they try to enroll healthier, more profitable patients and sustain their profits. This diverts money that could be devoted to patient care. In addition, a national system would facilitate long-term cost controls on the pharmaceutical industry and in other areas, thus ensuring that the new benefits are sustainable.

And while a uniquely American single-payer system is the way to go, look for the insurance and pharmaceutical industries to fight intensely to stop it.

Health care affects every American, and all of us should educate ourselves on health care reforms. Inform your congressman where you stand on the issue.

---

Dr. Michael Ozer is a San Antonio pediatrician and a member of Physicians for A National Health Program.

DAVE PARKS
The Birmingham News
News staff writer
Monday, April 09, 2007

A newly reinvigorated chapter of Physicians for a National Health Program – an organization that has been pushing since the 1980s for universal health care – has formed in the Birmingham area.

Dr. J. Walden Retan, a practicing internist in the Birmingham area for the past 40 years, is president of the local chapter called Health Care for Everyone.

Retan said a local chapter of Physicians for National Health Program had existed in the past, but had been inactive in recent years. The group has reformed locally as part of an effort to influence the health care debate in the presidential campaign leading up to the 2008 election.

The group wants to extend a coverage like Medicare to everyone in the country from birth to death and eliminate premiums, co-pays and other out-of-pocket costs for health care.

“It could be paid for with an employer tax of about 5.8 percent, which is much less than what employers now pay for the insurance they provide for their employees, coupled with an income tax of 2.9 percent, which is much less than most people spend on out-of-pocket expenses … for insurance that’s available today,” Retan said.

Retan’s organization also wants to cut administrative costs of health care by eliminating private insurance companies.

“What’s unique about the proposal that our organization has been backing is that it proposes to eliminate private insurance carriers who generate on an average between 17 and 20 percent of their premium dollars being taken up in administrative costs and replacing them with a single-payer plan much as is present in Canada,” Retan said.

Health Care for Everyone is open to all interested people. For more information email healthcareforeveryone@charter.net or call 205-262-2001.

E-mail: dparks@bhamnews.com

© 2007 The Birmingham News
© 2007 al.com All Rights Reserved.

Charting a Course for Health Care Reform: Moving Toward Universal Coverage

March 14, 2007

Contact:
Sarah K. Weinberg, MD
3304 81st Pl. SE
Mercer Island, WA 98040
206-236-0668
weinbergsk@msn.com

Senator Max Baucus, Chair, and Members of the Senate Finance Committee including our own Washington Senator Maria Cantwell:

Introduction

We are individuals and members of several different Washington State organizations that are committed to the creation of a high quality American health care system that is affordable and accessible to all. We came together over a year ago as an Ad Hoc Coalition in support of the Citizens Health Care Working Group (CHCWG) and its public hearing held in Seattle in February 2006. We submitted a critique and recommendations for improvement of the Interim Report last summer. We now testify before the Senate Finance Committee about the CHCWG report “Health Care That Works for All Americans”, and make further comments about implementation of reform of the American health care system.

First of all, we second the comments made by Sen. Baucus in his opening remarks. We agree that health is the first of all liberties, and that it is a responsibility of society to provide health care for all its residents. We think it is helpful to view health care as part of the essential infrastructure of our nation. Further, the use of tax dollars to guarantee the health care of American citizens is an appropriate investment in America’s future. We share Sen. Baucus’ belief that a nation-wide consensus is forming around five principles for our health care system:
1. Universal coverage – indeed an essential first step enabling the others
2. Sharing the burden – depending on employers and individuals alone is not sufficient
3. Controlling costs – only a unified system can implement evidence-based methods to control costs fairly
4. Prevention – this is a major area in which the current American system fails, with its overuse of lucrative procedures and lack of emphasis on maintenance of health
5. Sharing responsibility – everyone contributes both to paying the cost of the system and to being responsible for personal lifestyle and health care decisions.

Findings of the CHCWG

1. Strong Support for National Health Care Coverage for All Americans

The most important finding is expressed in the statement:
“Americans should have a health care system where everyone participates, regardless of their financial resources or health status, with benefits that are sufficiently comprehensive to ensure access to appropriate, high-quality care without endangering individual or family financial security.”

There was overwhelming support (94%) that there should be public policy written into law that all Americans have affordable health care. Of participants at community meetings across the nation, 68 – 98% favored guaranteeing a defined set of health care benefits to everyone. In another national poll in September 2005, 75% of U.S. adults favored health insurance that covers all Americans.

2. Financing a National Health Coverage Is Affordable

At $2 trillion per year, about $6,000 per person, or 16% of Gross Domestic Product, there is plenty of money being spent on health care in America. There was also a strong sense in the public responses that reallocation of health care dollars would provide the necessary funds for universal coverage. Nevertheless, a majority of participants in the CHCWG process were willing to pay more in taxes to ensure that all Americans are covered.

There was also strong sentiment that financing methods should be “fair”, meeting the following principles:

* No disproportionate financial burden on the sick

* Responsibility related to a household’s ability to pay

* All segments of society should contribute to funding

3. The Time to Start the Transition to National Health Coverage is NOW

The overwhelming majority of participants want the health care system change to begin now. Full implementation of national health coverage should be accomplished at least by 2012.

4. Band-Aids: Suggestions to Provide Immediate Relief from the Worst Problems of a Grossly Inadequate System

The CHCWG report devotes several pages to schemes to stabilize the failing private health insurance system and to provide help for families bankrupted by catastrophic health care costs. A few more pages were spent on supporting community health clinics as safety net providers for the poor and uninsured.

5. Preparing the Health Care Delivery System for Universal Coverage

CHCWG recommendations 3-6 all relate to this basic issue. There are several ways in which the American health care system needs to be restructured to provide the best care possible for everyone once universal coverage is established. Some of these:

* Increase the number of primary care health professionals – studies of other nations show that ready access to primary care is an essential building block for a successful, cost-effective health care system.

* Develop community-based integrated delivery systems – not just for the poor and/or uninsured. Systems like these already are delivering top quality care in the communities where they exist.

* Implement electronic medical records nation-wide – develop intercommunication among various systems. Information technology on this scale cannot be financed or integrated on the backs of individual physicians and hospitals.

* Fund nation-wide research to document the evidence needed for recommended diagnostic and treatment approaches for common diseases.

* Develop population-based strategies for many health services, especially support for healthy lifestyles, preventive care, and management of common chronic diseases.

* Create a transparent and independent process for defining benefits to be included in universal coverage, and for updating benefits as technology and knowledge change.

* Create a multidisciplinary system to coordinate and deliver end-of-life care.

Washington State Ad Hoc Coalition Opinions

1. Fundamental Reform: Universal Health Coverage for All Americans

We cannot emphasize strongly enough how important it is for Congress to declare its intent to design and implement a universal health coverage system that guarantees affordable health care with dignity to every American. Without this essential first step, other reforms are too expensive, unfair, or simply won’t work. The time to do this is NOW.

A multitude of national polls demonstrate that the public is strongly in favor of guaranteed health coverage, that government should make it happen, and that it should be tax-supported.

2. A Single National Health Coverage Program Will Save Enormous Sums

The CHCWG report did not dwell on the tremendous waste inherent in the current fragmented system, but a large amount of the annual $2 trillion paid for American health care is waste:
* The administrative bureaucracy of hundreds of private and public insurers plus the costs to health providers of their own bureaucracies needed to navigate the billing and collection process of the fragmented payment system costs at least 1/3 of total health care expenditures. (That’s $600 billion per year!) The administrative cost of a single national coverage plan would be less than 10% of total costs, a conservative estimate, – a savings of at least $400 billion per year.

* Without any way to control costs, the U.S. has overbuilt high technology diagnostic and treatment options, and developed too many expensive specialists, while underpaying primary care health professionals.

* Without any organized way to educate and support health professionals, nationally agreed upon evidence-based guidelines for appropriate diagnostic and treatment choices are rarely used, resulting in overuse of some, underuse of others. Unnecessary waste and avoidable suffering result from wrong decisions.

* Lack of health insurance drives millions to seek health care from the most expensive place possible – emergency rooms – when they are sick and/or scared.

* Demand driven by advertising to the general public leads to overuse of medications and devices, with resulting waste of dollars as well as unnecessary suffering from side effects of medications that were not needed in the first place.

The report does state: “…a significant portion of all health care expenditures produce no added health value.” And: “Concentrated efforts in some integrated health care systems have demonstrated care can be improved and waste eliminated.”

3. We Urge Congress to Start the Work of Preparing the Health Care Delivery System for Universal Coverage.

Lulled by the common myth that Americans have “the best health care in the world”, little attention has been given to the delivery system improvements that must be made for our health care system to work as an efficient integrated system once everyone has coverage.

The seven bullets under heading #5 above list a minimum of what is needed. Congress needs to convene another working group to review these areas, think of more problem areas, and develop solutions with funding for implementation. None of these is difficult, and we can use work already done in other nations to find the necessary solutions.

Improving American health care delivery will cost money, but investment in an improved delivery system, in combination with universal coverage, should result in substantial sustained monetary savings and improved health outcomes in the future.

4. Designing a Sufficiently Comprehensive Benefit Package

We believe it is crucial that a national health coverage plan be sufficiently comprehensive to provide good protection for all Americans from excessive out-of-pocket costs. Terms like “basic” and “core” imply skimpiness (who would want just the core of an apple, for example). Americans are not going to be willing to give up what they have now, as imperfect as it is, if they think the new system is going to have skimpy benefits. Public opinion, as tabulated by the CHCWG, is very clear: Americans want to be able to get the health care they need, when they need it, and without risking financial ruin.

The independent committee charged with the transparent, publicly accountable process for determining the benefits package must use evidence-based science demonstrating medical effectiveness as well as cost effectiveness. The process must also assure over time that the benefits package remains current and continues to be both medically effective and cost effective. The benefits must cover wellness care, preventive services, primary care, acute care, prescription drugs and devices, patient education, treatment and management of health problems – physical, mental and dental – with care decisions made by patients and their doctors together. The members of the committee and their families will get the same excellent quality care expected for all Americans.

Conclusion

We wish to re-emphasize the overwhelming support evident in all the public input to the CHCWG for a national health program, financed by taxes, covering all Americans for a sufficiently comprehensive package of health services.

* 97% view the health system as in crisis or having major difficulties
* 94% believe affordable health care should be a matter of public policy, by law
* 90% think health care should cover a level of benefits for everyone.

We think numbers like these represent a consensus. Does Congress have the political will to enact a national health program supported by a consensus of public opinion? We look forward to your leadership and trust that you will make comprehensive health care reform and a commitment to a healthy future for all Americans top priorities in 2007.

Supporting Organizations

(in alphabetical order)
Alliance for Retired Americans – Puget Sound
Alliance for Retired Americans – Washington
Health Care for All – Washington
Health Care That Works (6th Congressional District)
Lutheran Public Policy Office of Washington
Northwest Federation of Community Organizations
Northwest Health Law Advocates
Physicians for a National Health Program – Western Washington
United for National Health Care (2nd Congressional District)
Service Employees International Union 1199NW
Washington Community Action Network

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Letter to Congressman Stark

Physicians for a National Health Program

Western Washington Chapter

8424 California Ave SW, Seattle, Washington, 98136
Phone: 206 9377154
Email: pnhp.westernwashington@comcast.net
WebSite: www.pnhpwesternwashington.org

Congressman Pete Stark, Chairman
House Ways & Means Subcommittee on Health
239 Cannon House Office Building
Washington, DC 20515-0513

RE: Request for hearings on comprehensive health care reform

March 16th 2007

Dear Congressman Stark,

On behalf of Physicians for a National Health Program, Western Washington Chapter, we would like to respectfully request hearings on how to achieve quality, affordable health care for everyone in our country.

We congratulate you for the leadership you have shown in previous Congresses in sponsoring or co-sponsoring legislation for comprehensive health care reform, including The AmeriCare Health Care Act (HR 5886), The American Health Security Act (HR 1200), and The United States National Health Insurance Act (HR 676). We know that for years such legislation has been denied the opportunity for discussion in Congressional hearings. At last, the time has come to renew a serious national discussion on how to solve the health care crisis.

As you plan Health Subcommittee hearings, we urge you to include a review of the 2006 Report of the Citizens Health Care Working Group (CHCWG). The Medicare Modernization Act of 2003 was amended to create a Citizens’ Health Care Working Group to “engage in an informed national public debate” on health care with the American public. In 2006, nearly 30,000 demographically diverse people participated in community meetings and in-depth on-line polling. This was a remarkable, unprecedented process, spurred by widespread grass-roots participation across the country.

The CHCWG Report has some very good points and some important deficiencies. For example, it reflects the views of most participants in recommending that by 2012 “it should be public policy, established in law, that all Americans have affordable health care coverage.” At the same time, it shies away from its own finding that more than 70% of participants in the CHCWG process favored creating a National Health Plan financed by tax payers that guarantees all Americans health insurance coverage.

We are disappointed but not surprised that the Bush administration, on March 14th, rejected the key recommendations of the CHCWG Report. This action underscores the importance of Congressional hearings to further discuss the CHCWG recommendations and to implement viable solutions to the current health care crisis.
Hearings on the CHCWG Report were held this week in the Senate Finance Committee and are supposed to be held by four other committees, including Ways and Means. We believe such hearings could provide a good platform for discussion of how we can achieve quality, affordable health care for all. Our organization and many others with whom we partnered in the CHCWG process would be eager to offer testimony.

As you are well aware, the health care system in this country is unraveling with dire consequences for our economy, our moral fabric, our sense of community, and our human dignity. The current treatment of health as a market commodity denigrates our humanity and subverts our sense of the common good. While millions of Americans are struggling with the ill effects of market-driven medicine, we are committed to raising awareness that another way is possible. Change in our health care system is not only desirable it is imperative and we believe the time for change is now.

There are new signs almost every day that more and more Americans are ready to tackle this crisis. Employers, labor, health care professionals, consumer groups, faith-based communities, advocacy groups, and state and local governments are increasingly vocal about the need to find ways to provide health care for all. This is a dramatic shift compared to just a year ago.

We are grateful for your courageous leadership and we know that you will place the health of the American people as a top priority in the 110th Congress. We look forward to working with Congressman McDermott and your Subcommittee in pursuit of our common goal.