PNHP

Poll Shows Majority Back Health Care for All

Poll Shows Majority Back Health Care for All

By ROBIN TONER and JANET ELDER
New York Times
March 1, 2007

A majority of Americans say the federal government should guarantee health insurance to every American, especially children, and are willing to pay higher taxes to do it, according to the latest New York Times/CBS News Poll.

While the war in Iraq remains the overarching issue in the early stages of the 2008 campaign, access to affordable health care is at the top of the public’s domestic agenda, ranked as far more important than immigration, cutting taxes or promoting traditional values. Only 24 percent said they were satisfied with President Bush’s handling of the issue, despite his recent initiatives, and 62 percent said the Democrats — not the Republicans — were more likely to improve the health care system.

Americans showed a striking willingness in the poll to make tradeoffs for a better health care system, including paying as much as $500 more in taxes a year and forgoing future tax cuts. But the same divisions that doomed the last attempt at creating universal health insurance, under the Clinton administration, are still apparent. Americans remain divided, largely along party lines, over whether the government should require everyone to participate in a national health care plan, and over whether the government would do a better job than the private insurance industry in providing coverage.

Looking ahead to the presidential campaign, 36 percent of Americans said they had confidence in the ability of Senator Hillary Rodham Clinton, the New York Democrat, to “make the right decisions on health care,” while 49 percent said they were uneasy about it. But Mrs. Clinton, who presents herself as a sadder but wiser candidate on health care, retained the confidence of nearly 6 in 10 Democrats on the issue, despite the politically devastating collapse 13 years ago of the national health initiative she helped develop early in her husband’s presidency.

The poll helps explain why health care already looms large in the presidential campaign, and in statehouses from California, where Gov. Arnold Schwarzenegger, a Republican, has proposed a sweeping coverage plan, to Massachusetts, now implementing a program passed under Mitt Romney, the former governor and current Republican presidential candidate. Nearly 47 million Americans, or more than 15 percent of the population, now go without health insurance, up 6.8 million since 2000.

Former Senator John Edwards of North Carolina, the Democratic presidential candidate, recently unveiled his own attempt at a consensus plan — requiring everyone to have insurance and requiring employers to provide it or pay into a fund that would do so. Nearly 4 in 10 said that was a good idea; nearly half said they were unsure.

While Democrats are traditionally strong supporters of expanding health coverage, this survey found many Republicans and independents in agreement.

“I think everybody should have some kind of health care available to them,” said Diane Manning, 66, of Vancouver, Wash., who described herself as an independent.

“I don’t necessarily think that socialized medicine is the answer, but I think everyone should have that right,” said Ms. Manning, who participated in the poll and agreed to a follow-up interview “And there are so many people that don’t.”

The poll also found overwhelming support behind the Childrens’ Health Insurance Program, which covers many low and moderate income children and is up for renewal in Congress this year. Eighty-four percent of those polled said they supported expanding the current program to cover all uninsured children, now estimated at more than eight million. A similar majority said they thought the lack of health insurance for many children was a “very serious” problem for the country.

The nationwide telephone poll was conducted Friday through Tuesday with 1,281 adults, and has a margin of sampling error of plus or minus 3 percentage points.

The poll found Americans across party lines willing to make some sacrifice to insure that every American has access to health insurance. Sixty percent, including 62 percent of independents and 46 percent of Republicans, said they would be willing to pay more in taxes. Half said they would be willing to pay as much as $500 a year more.

Nearly 8 in 10 said they thought it was more important to provide universal access to health insurance than to extend the tax cuts of recent years; 18 percent said the tax cuts were more important.

“I wouldn’t want to pay a lot of taxes, but if it was spread out and everyone paid their fair share, it would be fine,” said Don Galvan, 50, a computer programmer from Ringwood, N.J., who considers himself an independent. “Everybody should have some kind of medical coverage, in case they or their children get sick. Especially children.”

Most Americans in the poll said they were satisfied with the quality of their health care, but there was widespread concern about costs. Nearly half of those with insurance said their employer had cut back on benefits or required them to pay more for their benefits in recent years. A quarter of those with insurance said someone in their household had gone without a medical test or treatment because insurance would not cover it. Six in 10 of those without insurance said someone in their household had gone without care because of the cost.

That level of concern helps explain the striking support for substantial change: Nearly two-thirds said the federal government should guarantee health insurance for all Americans. They were then asked, “What if that meant that the cost of your own health insurance would go up?” Forty-eight percent said they would still support it.

Moreover, an overwhelming majority said the health care system needed either fundamental change or to be completely rebuilt, just as they did in the early 1990s, when a deep recession and soaring health care costs galvanized the public and spurred the Clinton health care drive. But now, as then, this concern did not translate into a consensus on what should replace it.

One question offered a choice between the current system and a national health insurance program covering everyone, administered by the government and financed by taxpayers. Thirty-eight percent said they preferred the current system, while 47 percent preferred a government-run approach.

Nearly half said they thought it would be unfair to require all Americans to participate in a national health care plan, financed by taxpayers.

Robert Blendon, an expert at Harvard on public opinion and health, said politicians have to find some compromise between these philosophical divisions on the role of government, which are deep-seated in American culture, or “We’re going to have the same train wreck we did before.” The Clinton plan, itself an attempt at a compromise, collapsed under the weight of attacks from an array of interests, including the insurance industry, which warned that it amounted to a big government takeover.

Mr. Blendon noted that many politicians, like Mr. Schwarzenegger, were seeking a blend between the private market and the government in their health plans.

Marina Stefan and Marjorie Connelly contributed reporting.

Millions of AFL-CIO Members Support Universal, Single-Payer Health Insurance

By Harry Kelber
The Labor Educator

When the AFL-CIO Executive Council meets March 6-8 in Las Vegas, it will be deciding what to do about the nation’s most important domestic problem, health insurance for all Americans. It should recognize the wishes of millions of union members and endorse and campaign for the United States National Health Insurance Act (H.R. 676) that would establish a single-payer health insurance system with guaranteed coverage for all Americans.

The Council will surely be impressed by the grass-roots, extraordinary support for H.R. 676. Union members in 40 states, represented by 239 labor organizations that include four international unions, 17 state federations, 63 central labor councils and scores of local unions, favor the single-payer measure, which eliminates profiteering by insurance companies, pharmaceutical companies and HMOs.

H.R. 676 would create a publicly-financed, privately-delivered health care system that uses the already existing Medicare program by expanding it and improving it for all U.S. residents. The goal of the legislation is to ensure that all Americans, regardless of employment, income or health care status, will have a legal guarantee for access to the highest quality and cost effective health care services.

The four AFL-CIO international unions that have officially endorsed H.R. 676 are: United Auto Workers, International Longshore Workers Union, United Association of Plumbers and Pipe Fitters, and the National Association of Letter Carriers. In addition, there are many members in virtually every international union who support the bill.

The 17 state federations that have signed on for H.R. 676 (originally introduced by Rep. John Conyers, a pro-labor congressman from Michigan) are: Connecticut, Delaware, Florida, Kentucky, Minnesota, Missouri, North Carolina, North Dakota, Ohio, Pennsylvania, South Carolina, South Dakota, Vermont, Washington State, West Virginia, Wisconsin and Wyoming.

AFL-CIO Can Reclaim Image as Workers’ Champion

The Council’s endorsement would put the single-payer plan in the forefront of the national debate about how to reform the health care system. It would make organized labor a principal player in the debate, giving new hope to the 47 million Americans that have no health care coverage and the millions who are being exploited by insurance and drug companies.

An AFL-CIO campaign for H.R. 676 would receive an immediate and enthusiastic response from tens of thousands of union members across the country, who would gladly volunteer for a cause that means so much for working families. The “talking points” for H.R. 676. are numerous and persuasive: Under single-payer, everyone is guaranteed choice of physician, as well as comprehensive and uniform coverage. Whether you’re rich or poor, you get the same level of treatment.

Even if you are unemployed or lose or change your job, your health coverage goes with you. It ends the insurance companies’ interference with care. There is no denial of coverage due to pre-existing conditions or cancellation of policies for “unreported” minor health problems.

The amount of money that single-payer can save will be enormous. Insurance agencies and drug companies are notorious for their high administrative costs, exorbitant executive salaries, and profits for the stockholders. And perhaps best of all, the single-payer system doesn’t have to start from scratch. It builds on Medicare, which has served millions of Americans for four decades.

All of the current proposals on health care, including President Bush’s, rely on “market forces,” allowing the for-profit companies to continue their exploitive control of an industry that serves a vital human need.

By endorsing H.R. 676 and waging a full-scale campaign for its passage, the AFL-CIO can regain the respectful attention it once had in Washington and across the country. It could probably serve as a boost for the Employee Free Choice Act.

The Executive Council’s decision on national health insurance may be as important as any it has made in years. Let’s hope it is the right one.

Our two weekly columns and their archives (LaborTalk and The World of Labor) can be viewed and downloaded at our website: http://www.laboreducator.org.

Medicare Advantage private fee-for-service plans

Medicare Advantage

Kaiser Family Foundation
February 2007

Most of the 43 million elderly and disabled people on Medicare (81%) have their health bills paid by the traditional fee-for-service program; 19% (8.3 million) receive their Medicare benefits through private health plans that receive payments from Medicare, now generally known as “Medicare Advantage” plans.

Private fee-for-service plans (PFFS) differ from Medicare HMOs and PPOs in that they are not required to establish provider networks or to adopt utilization management strategies, and do not coordinate care like most other Medicare Advantage plans.

In 2006, Medicare began to pay plans under a bidding process. Plans bid against county level benchmarks established by CMS based on the prior year’s MA county payment rate, increased by the projected national growth rate in per capita Medicare spending.

Many plans have expanded services to rural and other areas with benchmarks that are high relative to Medicare FFS spending because these areas were given increases in payment rates under earlier law.

MedPAC analysis based on July 2006 enrollment data shows that Medicare payments to private health plans on behalf of enrollees average 112% of FFS costs for the counties where MA enrollees reside. PFFS plans–prevalent in rural areas where the benchmark rate is significantly higher than Medicare FFS costs–are paid 119% of FFS costs before adjusting for enrollee risk.

http://www.kff.org/medicare/upload/2052-09.pdf

Comment:

By Don McCanne, MD

Of the various Medicare Advantage plans, the private fee-for-service plans most closely resemble the traditional fee-for-service Medicare program. Just as with the traditional Medicare program, the patient can receive care on a fee-for-service basis from any physician willing to accept payment from the plan.

If the private fee-for-service plans work like the traditional Medicare program, then why is the government paying them 119 percent of the costs of the traditional program? That’s much more than the other Medicare Advantage plans receive. Weren’t the private sector plans authorized because they would be much more efficient than the traditional Medicare program run by a government bureaucracy? Aren’t they supposed to be saving the taxpayers money?

Medicare regulations do require that a small portion of the excess payments be used to increase benefits, and so these plans may also offer prescription drug coverage or extra days in the hospital, or a reduction in premiums paid. (They do not need to use very much of the 19 percent overpayment, but only 75 percent of the amount by which the plan’s bid is below the benchmark for the region.)

Why should private plans be paid so much more for duplicating what our more efficient traditional Medicare program is already doing?

Why should patients in the traditional Medicare program be deprived of benefits, such as drug coverage, that are made possible by this deliberate overpayment to the private plans?

Why do our legislators tell us that there isn’t enough money to improve benefits in the traditional program, when they can find plenty of money to reward these plans so generously?

Why do we even have to ask these questions?

What every policy expert knows, but won't say

Profit For Some Or Care For All

By Diane Archer
TomPaine.com
February 27, 2007

The health insurance industry is full of surprises, but history and experience show that insurers will never surprise us with a good, affordable health care system for America. No cocktail of regulations, subsidies and tax credits will provide health security to the uninsured, underinsured and anxiously insured–virtually all Americans.

Unlike private insurance, Medicare works for older and disabled Americans because it pools risk and does not punish people financially because they need costly health care services. It works because it has predictable benefits and offers reliable coverage. And it works because coverage is automatic, unlike Medicaid and SCHIP, ensuring all eligible persons coverage and protecting them against the risk of losing coverage for failing to sign up or recertify.

Of course, every health policy expert out there knows that a publicly administered system would guarantee all Americans good, affordable health care at far less cost than we can ever achieve through private insurers, and they’ll say so at the dinner table. It’s time they went public.

http://www.tompaine.com/articles/2007/02/27/profit_for_some_or_care_for_all.php

Comment:

By Don McCanne, MD

Request to the policy community: Please come out of the closet. We need you!

National progressive political group campaigns for single payer national health insurance

Let's Make History

Tim Carpenter
PDA Executive Director

There are times in American history — “perfect storms,” if you will — when forces are in alignment for the passage of a momentous reform that makes our country qualitatively better. In the 1930s, we won union rights and Social Security. In the 1960s, civil rights and Medicare.

Is this our moment to finally win Universal Health Coverage — improved and expanded Medicare for All? Or at least wage a campaign so powerful that victory will be just around the corner?

We have a Democratic-majority in Congress. A profound crisis with 50 million uninsured Americans, and a similar number under-insured. A New York Times columnist declaring last week that the health insurance business is “a racket.” A presidential campaign in which candidates are being confronted by voters up close.

And most importantly, we now have the re-introduction of Rep. John Conyers’ HR 676: The United States National Healthcare Insurance Act — enhanced Medicare for All.

Please encourage your Congress member to co-sponsor the bill, now — our goal is to quickly double the current 55 co-sponsors.

Progressive Democrats of America is committed with our friends in Congress, labor unions, the Healthcare-Now coalition and nurses and doctors groups to mounting the biggest fight ever for HR 676, a single-payer system of privately-delivered, publicly-financed healthcare.

This approach has been endorsed by Consumers Union, 20,000 physicians, 232 labor unions, and even corporate CEOs tired of being fleeced by private insurance companies and their bureaucracy and waste.

* Get your state legislature to endorse HR 676. The state of Kentucky just did so!

* Challenge presidential candidates to endorse HR 676. Iowa voters recently told Hillary Clinton they backed Medicare for All.

* Contact Diane@pdamerica.org to join our “Healthcare for All” Organizing Team.

What every policy expert knows, but won’t say

Profit For Some Or Care For All

By Diane Archer
TomPaine.com
February 27, 2007

The health insurance industry is full of surprises, but history and experience show that insurers will never surprise us with a good, affordable health care system for America. No cocktail of regulations, subsidies and tax credits will provide health security to the uninsured, underinsured and anxiously insured–virtually all Americans.

Unlike private insurance, Medicare works for older and disabled Americans because it pools risk and does not punish people financially because they need costly health care services. It works because it has predictable benefits and offers reliable coverage. And it works because coverage is automatic, unlike Medicaid and SCHIP, ensuring all eligible persons coverage and protecting them against the risk of losing coverage for failing to sign up or recertify.

Of course, every health policy expert out there knows that a publicly administered system would guarantee all Americans good, affordable health care at far less cost than we can ever achieve through private insurers, and they’ll say so at the dinner table. It’s time they went public.

http://www.tompaine.com/articles/2007/02/27/profit_for_some_or_care_for_all.php

Comment:

By Don McCanne, MD

Request to the policy community: Please come out of the closet. We need you!

Aetna perfects cream skimming for Medicare Advantage

Aetna Launches Employer Health Insurance Plans for Early Retirees

AISHealth.com
From Managed Care Week, Feb. 19, 2007

One objective of Aetna, Inc.’s launch of four new plans for early retirees targeting the 55-to-65 age group Feb. 8 is to create long-term relationships with pre-retirees that can continue as the members age in to Medicare.

Aetna’s new products will enable employers to reduce the benefits they pay for, while ensuring that retired employees have a level of coverage equal to, or slightly less than, what they had before.

The new plans will also enable Aetna to keep members after Medicare becomes their primary payer. Enrollees in an Aetna pre-65 product will be informed about 90 days before becoming eligible for Medicare that they need to convert to some form of post-65 coverage, and one option will be Aetna. Employers may assign beneficiaries to a post-65 Aetna plan, but they must give them notice, information about the plan and opportunity to opt out, (Aetna vice president Jay) Putterman says. The value of staying with Aetna is that “if we’re helping them pre-65 clinically, as they age, we think we’re in the most favorable position to continue to help them after 65.”

Aetna will guarantee issue of policies for people in the employer group, but employers’ rates will be subject to group underwriting.

http://www.aishealth.com/Bnow/022107a.html

Comment:

By Don McCanne, MD

Cream skimming? Well, let’s see.

Aetna has designed these plans to resemble their Medicare Advantage plans. By enrolling individuals in the decade before Medicare eligibility, presumably the patients will become comfortable with their Aetna physicians and want to continue with them under the Medicare Advantage version. Aetna makes the transition very easy by making enrollment essentially automatic unless the beneficiary specifically elects to opt out.

There is an element of cream skimming here since this over 55 group is still employed and comparatively healthy since those no longer employed because of their diasbilities have been removed from this risk pool. Targeting a healthier sector is cream skimming.

But this program is more nefarious than that. The over 55 population has a higher incidence of significant chronic disorders, though many may still be able to continue their employment. Aetna does not want those individuals to enroll in their Medicare Advantage program. So Aetna has established a separate risk pool for these employees over 55 that is subject to group underwriting. If they are healthy, great. But if that pool has an unacceptable level of chronic disorders, Aetna merely sets the premium at a level that is unaffordable so that the employer will decline this program. This is about as close as you can get to a program that is almost 100 percent effective in excluding those with health care needs from their Medicare Advantage plans.

Why do the policymakers continue to insist that the private insurers must be a part of our models of reform? How much more evidence do they need? Have the policymakers no decency?

Health care problem is rooted in insurance

Letter to the Editor
St. Petersburg Times
Friday, February 23, 2007

Our health care system is a national disgrace. We spend far too much money and get too little in return. John Podesta is absolutely right with his condemnation of our current system, but his proposed “fix” would just further complicate an already fragmented and overly complex system.

As a practicing family doctor in Clearwater, I see the increasing problems of our system every day. More of my patients have lost their insurance coverage and struggle to pay for even basic care. For the lucky ones who have coverage, insurers shift more cost to my patients, maintaining their profits while forcing people into difficult choices that can adversely affect their health.

The complex and onerous bureaucracy of our current system is the problem; having taxpayers pay for a carved out “Wellness Trust” just creates more of the administrative waste that already plagues our system. The American taxpayer already pays more than 65 percent of all health care spending in this country and takes on the disproportionate expense of caring for the oldest, the poorest and sickest patients.

The fundamental problem of our system is the enormously parasitic insurance industry that sucks billions of dollars out of our health care system every year, shuns the unhealthy and unwealthy. But what have we gotten in return? Substandard care compared to other nations, soaring costs, adversarial relationships with our providers, treatment and payment denials, “preauthorization” hassles and bureaucratic nightmares.

The problem with our system is for profit insurance companies. What we need is a single public trust to administer all health care in this country, not just for preventative care. That is why I, along with the over 14,000 doctors of the group, Physicians for a National Health Program (www.pnhp.org), advocate an efficient “Medicare for All” program like HR 676, a bill recently re-introduced in Congress.

Numerous polls show that the American people overwhelmingly support such a program. Our only barrier is that we continue to “look the other way” while allowing a self-serving industry to waste over 30 percent of our health care dollars on its own overhead and profits. That wasted money is badly needed to cover the 47 million of us without any insurance, those of us with threadbare coverage and to guarantee that all Americans get needed medical care without the threat of financial ruin or bankruptcy that is rampant today.

Greg M. Silver, M.D.
Board of Directors, Physicians for a National Health Program
Palm Harbor

Taking Back the FDA

by Marcia Angell
Boston Globe
Monday, February 26, 2007

It’s time to take the Food and Drug Administration back from the drug companies.

Before a prescription drug can be sold, the manufacturer must conduct clinical trials to prove to the FDA that the drug is safe and effective. Without that, doctors have no way of knowing how good or bad a drug is. Just trying it out would be not only risky, but unreliable, since individual experience can be misleading. The scrutiny that this agency exists to provide is vital to our health.

But in 1992, Congress put the fox in the chicken coop. It passed the Prescription Drug User Fee Act, which authorizes drug companies to pay “user fees” to the FDA for each brand-name drug considered for approval. Nearly all of the money generated by these fees has been earmarked to speed up the approval process.

In effect, the user fee act put the FDA on the payroll of the industry it regulates. Last year, the fees came to about $300 million, which the companies recoup many times over by getting their drugs to market faster.

But while it’s a small investment for drug companies, it’s a lot of money for the agency, and it has drastically changed the way it operates — creating a disproportionate emphasis on approving brand-name drugs in a hurry. Consequently, the part of the agency that reviews new drugs gets more than half its money from user fees, and it has grown rapidly. Meanwhile, the parts that monitor safety, ensure manufacturing standards, and check ads for accuracy have languished or even shrunk.

Most tellingly, the office that approves generic drugs is so small that approval time for generics is twice as long as for brand-name drugs. There is now a backlog of more than 800 generics. That delay is worth billions of dollars to the drug companies whose high prices depend on not having generic competition.

As part of the emphasis on speed, the FDA often approves brand-name drugs on the basis of less evidence than in the past. In these cases, approval may be contingent on companies conducting further safety studies after the drugs are on the market. But the companies usually don’t honor that commitment. Of the roughly 1,200 such studies outstanding — some for years — over 70 percent haven’t been started.

The FDA is strangely silent about this inexcusable dereliction. When questioned, it weakly protests that it doesn’t have the authority to compel the research. In fact, it has enormous leverage, since it can withdraw drugs from the market.

The FDA also refuses to release unfavorable research results in its possession without the sponsoring company’s permission. Here again, it contends not to have the authority to do so, but providing evidence of side-effects or negative results would seem to be an integral part of its job. It’s no wonder that serious safety concerns about drugs such as Vioxx, Paxil, and Zyprexa have emerged very late in the day — years after they were in widespread use.

The agency’s coziness with industry is underscored by the composition of its 18 advisory committees — outside experts who help evaluate drugs.

Incredibly, many of these advisers work as consultants for drug companies. Although they are supposed to recuse themselves if there is a direct conflict of interest, the FDA regularly grants exemptions from that requirement. Of the six members of the advisory committee that in 1999 recommended approving Vioxx — the arthritis drug pulled from the market in 2004 because it caused heart attacks — four had received waivers from the conflict-of-interest rule.

The FDA now behaves as though the pharmaceutical industry is its user, not the public. Fortunately, the user fee law is subject to renewal every five years, and this is one of those years.

Congress should let the law die this time around and substitute its own support — which ought to be increased. Other reforms recently proposed, such as administratively separating drug approval from safety surveillance, will not mean much as long as this law is in effect.

At $300 million to $400 million a year, the equivalent of about a day in Iraq, Congress can easily afford to buy this vital agency back for the public, and it should.

Dr. Marcia Angell, a senior lecturer at Harvard Medical School, is a guest columnist.

In Health Care Reform Debate, Single-Payer System is Labor's Only Clear Choice

Rose Ann DeMoro
Labor Notes
02/23/07

Summary:

Union members have a huge stake in the present debate on health care reform. At a time when employers routinely slash or eliminate health benefits for workers and their families or force union members on strike to preserve those benefits, when insurance plans routinely restrict workers’ choice of doctors and prescription drugs, and when more working families declare bankruptcy due to medical debt, only one reform can provide the health care security working people need: single-payer.

Story:

Union members have a huge stake in the present debate on health care reform.

At a time when employers routinely slash or eliminate health benefits for workers and their families or force union members on strike to preserve those benefits, when insurance plans routinely restrict workers’ choice of doctors and prescription drugs, and when more working families declare bankruptcy due to medical debt, only one reform can provide the health care security working people need: single-payer.

Under single-payer, you don’t face the loss of health benefits if you lose your job or are forced out on strike. You don’t face employers constantly shifting costs onto your back. You don’t have to worry about retiree health care if you are able to retire before age 65. And you are no longer at the mercy of the insurance industry predators who routinely deny care.

NOT A DREAM

Single-payer is not a dream. It’s legislation–House Resolution 676, introduced by Congressmen John Conyers and Dennis Kucinich, with dozens of co-authors. It also has the backing of 235 labor organizations in 40 states, including 17 AFL-CIO state federations and 60 county/regional central labor councils. Several states, including California and Illinois, also have single-payer bills in the hopper.

Does single-payer work? Every industrialized nation in the world except the U.S. has either a single-payer system, like Medicare, or a national health system, like our veterans health system. That’s why the U.S. stumbles along at 37th in the world in overall health care quality, according to the World Health Organization.

Under single-payer, all health care revenues go into one publicly administered pool of money that pays for all medically necessary services delivered by doctors, hospitals, and other providers.

Its guiding principles are:

* Universality: Everybody in, nobody out.

* Portability: Even if you lose your job or never had one, you still have health coverage, guaranteed.

* Comprehensive, uniform benefits: No Cadillac plans for the wealthy, no tricycle plans–with high deductibles, limited services, and caps on coverage–for everyone else.

* Choice of physician, hospital, clinic, and other caregivers: Most private plans restrict where you can go.

* Cost controls and cost savings: 30 percent of every dollar that currently goes to insurance companies pays for their administrative costs–and their profits. Under single-payer, savings accrue from eliminating this overhead.

* Public oversight: The public sets policies and administers the system, instead of high-priced CEOs meeting in secret and making decisions based on what inflates their compensation packages or company profits.

OBVIOUS SOLUTION

Single-payer is such an obvious solution that one might wonder why there is not overwhelming accord by labor, liberal, and progressive organizations and politicians to campaign for it.

One reason is the enormous economic and political clout of the health care industry. The 20 largest HMOs in the U.S., for example, made $10.8 billion in profits in 2005. Drug companies make even more; the world’s 13 biggest reported $62 billion in profits in 2004.

Health care corporations employ that wealth to block real reform in Washington and in state capitols. They promote “solutions” for the health care crisis that throw more money to the private marketers who created the present mess by putting revenues and profits ahead of the health and well-being of patients.

Thus, we’re presented with a series of market-based approaches masquerading as “universal” coverage, along with browbeating campaigns designed to lower public expectations and promote the conventional wisdom that only substandard solutions are feasible.

We’ve heard this before. From abolition of slavery to women’s suffrage to enacting Social Security and Medicare to ending legal segregation, our history is filled with achievements that the political “realists” repeatedly dismissed as unrealistic.

INADEQUATE REFORMS

Most of the alternatives offered instead are based on expanding the role of the insurance industry. Among the ideas now being touted by, among others, liberal advocacy groups and a few Presidential candidates, are mandates that everyone be required to buy insurance, tax deductions to encourage people to buy insurance, taxes on employers to pay for more insurance, and expansions to existing federal or state programs to buy insurance for the low income.

No wonder that Stephen Hemsley, chief executive of health care giant UnitedHealth Group, calls one such scheme, by California Governor Arnold Schwarzenegger, “an interesting set of proposals that represent real opportunities for our business.”

Both the Schwarzenegger plan and the Massachusetts law on which it is modeled have as their central premise the requirement that all state residents buy health insurance.

Yet neither places any limits on skyrocketing premiums, and in both states individuals and families will face huge deductibles with even the cut-rate plans the law will force them to buy. The result is that many will end up paying for virtually all their medical expenses or gamble with their health by avoiding most services.

On the other hand, the California and Massachusetts models are welcome news in the corporate boardrooms of the insurance industry. Insurers stand to make hundreds of millions more just in California.

Another favored scheme, especially by some in labor, is employer mandate “pay or play” plans that require businesses to provide health benefits or pay into a state pool to buy insurance for the uninsured.

But in addition to being another windfall for the insurers, a federal court ruling throwing out a Maryland law based on this approach cast doubt as to whether any employer mandate will withstand legal challenge.

The health care industry and conservative ideologues hardly need our help. It’s time for labor activists to unite behind the only health care reform that is universal, comprehensive, and assures one standard of quality care for all.

Rose Ann DeMoro is executive director of the California Nurses Association/National Nurses Organizing Committee.

Schwarzenegger on Health Care: People or Profits?

Tuesday, February 27, 2007

Interviews Available

In his speech at the National Press Club yesterday emphasizing his health care proposals and “bipartisanship,” California Governor Arnold Schwarzenegger said: “Whether you’re Republican or Democrat, you don’t have to give up your principles at all. But isn’t the ultimate principle to serve the people? To do the things that are good for the people?” When asked about the role of big insurance and pharmaceutical companies, Schwarzenegger replied: “You must let everyone make their profits.”

The following health care specialists can assess the rhetoric and the substance of Schwarzenegger’s — and others’ — health care proposals:

DAVID HIMMELSTEIN, M.D., cell: (617) 312-0970, (617) 665-1032, david_himmelstein@hms.harvard.edu, https://pnhp.org
Himmelstein is associate professor of medicine at Harvard Medical School; his work was recently cited by Schwarzenegger. Himmelstein said today: “Governor Schwarzenegger’s proposal would make Californians pay tens of billions to insurance companies for defective coverage. And his plan would add to the more than $40 billion wasted annually on insurance bureaucracy and paperwork in California. …
“Only a single-payer system can reap the savings on bureaucracy needed to assure comprehensive coverage for all.
“Two weeks ago the governor cited my work on medical bankruptcy, saying: ‘To quote a Harvard medical professor who did the best study on the subject, “Unless you’re Bill Gates, you’re just one serious illness away from bankruptcy.”‘ What he forgot to mention was that most people bankrupted by illness had exactly the kind of faulty coverage he wants to force Californians to buy. Three-quarters of medical debtors in our study had private insurance. The governor should get his facts right on medical bankruptcy. And he should get his facts right on single payer reform.” Himmelstein is co-founder of Physicians for a National Health Program.

JUDY DUGAN, (213) 280-0175, (310) 392-0522 ext 305, judy@consumerwatchdog.org, http://www.consumerwatchdog.org
Dugan is research director of the Foundation for Taxpayer and Consumer Rights, which puts out the ArnoldWatch.org blog. She said today: “During his news conference at the National Press Club in Washington Monday, Schwarzenegger fielded lots of softballs from the smitten D.C. press corps. He also dodged one hardball from the moderator, asking whether as part of his health reform he’d regulate health insurance rates in the same way that auto insurance rates are successfully regulated in California.
“His response: Well, maybe, ‘if there’s a big problem’ later. He said he believed that requiring everyone to buy insurance on the private market would reduce the cost of health insurance premiums, currently averaging about $11,500 a year for a family of four.
“Then, the tipoff: ‘You must let everyone make their profits,’ he declared.
“Come again? It’s insurance companies’ bloated overhead and record profits that are the biggest driver of health care cost increases. Of course, part of that bloat comes from the $3.5 million the health industry has contributed to Arnold’s political campaigns.” http://www.ArnoldWatch.org/blogs/blogs_000980.php3

DON McCANNE, M.D., (949) 493-3714, don@mccanne.org, https://pnhp.org/news/quote_of_the_day.php
Senior health policy fellow with the group Physicians for a National Health Program, McCanne writes a daily health policy update. He said today: “Governor Schwarzenegger, in his remarks before the National Press Club, touts his ‘post-partisan’ era of compromise in California. Yet, in health care reform, he is unwilling to compromise with his position that each individual be responsible for purchasing private health care coverage, even though the insurers have not been able to create a product that is both affordable and that provides enough coverage to prevent financial hardship for moderate-income individuals with significant health care needs.
“And for low-income individuals, he expects the federal government to increase funding for Medicaid and SCHIP (children’s insurance) at a time that the Bush administration is attempting to reduce income-eligibility levels and eliminate parents from coverage. He is emphatic about wanting health care coverage for everyone, yet he is obstructing reform by his uncompromising support of the private insurance industry that cannot deliver the effective, affordable product that we need, and by his dependence on federal funding that is not forthcoming. He could have reform simply by compromising in his opposition to single-payer insurance coverage, but he rejects that simply because of his own anti-government ideology. A spirit of post-partisanship requires compromise from everyone, including the governor. A compromise in ideology is a very small price to pay for achieving reform that would work for everyone — except the private insurance companies.”

For more information, contact at the Institute for Public Accuracy:
Sam Husseini, (202) 347-0020, (202) 421-6858; or David Zupan, (541) 484-9167

In Health Care Reform Debate, Single-Payer System is Labor’s Only Clear Choice

Rose Ann DeMoro
Labor Notes
02/23/07

Summary:

Union members have a huge stake in the present debate on health care reform. At a time when employers routinely slash or eliminate health benefits for workers and their families or force union members on strike to preserve those benefits, when insurance plans routinely restrict workers’ choice of doctors and prescription drugs, and when more working families declare bankruptcy due to medical debt, only one reform can provide the health care security working people need: single-payer.

Story:

Union members have a huge stake in the present debate on health care reform.

At a time when employers routinely slash or eliminate health benefits for workers and their families or force union members on strike to preserve those benefits, when insurance plans routinely restrict workers’ choice of doctors and prescription drugs, and when more working families declare bankruptcy due to medical debt, only one reform can provide the health care security working people need: single-payer.

Under single-payer, you don’t face the loss of health benefits if you lose your job or are forced out on strike. You don’t face employers constantly shifting costs onto your back. You don’t have to worry about retiree health care if you are able to retire before age 65. And you are no longer at the mercy of the insurance industry predators who routinely deny care.

NOT A DREAM

Single-payer is not a dream. It’s legislation–House Resolution 676, introduced by Congressmen John Conyers and Dennis Kucinich, with dozens of co-authors. It also has the backing of 235 labor organizations in 40 states, including 17 AFL-CIO state federations and 60 county/regional central labor councils. Several states, including California and Illinois, also have single-payer bills in the hopper.

Does single-payer work? Every industrialized nation in the world except the U.S. has either a single-payer system, like Medicare, or a national health system, like our veterans health system. That’s why the U.S. stumbles along at 37th in the world in overall health care quality, according to the World Health Organization.

Under single-payer, all health care revenues go into one publicly administered pool of money that pays for all medically necessary services delivered by doctors, hospitals, and other providers.

Its guiding principles are:

* Universality: Everybody in, nobody out.

* Portability: Even if you lose your job or never had one, you still have health coverage, guaranteed.

* Comprehensive, uniform benefits: No Cadillac plans for the wealthy, no tricycle plans–with high deductibles, limited services, and caps on coverage–for everyone else.

* Choice of physician, hospital, clinic, and other caregivers: Most private plans restrict where you can go.

* Cost controls and cost savings: 30 percent of every dollar that currently goes to insurance companies pays for their administrative costs–and their profits. Under single-payer, savings accrue from eliminating this overhead.

* Public oversight: The public sets policies and administers the system, instead of high-priced CEOs meeting in secret and making decisions based on what inflates their compensation packages or company profits.

OBVIOUS SOLUTION

Single-payer is such an obvious solution that one might wonder why there is not overwhelming accord by labor, liberal, and progressive organizations and politicians to campaign for it.

One reason is the enormous economic and political clout of the health care industry. The 20 largest HMOs in the U.S., for example, made $10.8 billion in profits in 2005. Drug companies make even more; the world’s 13 biggest reported $62 billion in profits in 2004.

Health care corporations employ that wealth to block real reform in Washington and in state capitols. They promote “solutions” for the health care crisis that throw more money to the private marketers who created the present mess by putting revenues and profits ahead of the health and well-being of patients.

Thus, we’re presented with a series of market-based approaches masquerading as “universal” coverage, along with browbeating campaigns designed to lower public expectations and promote the conventional wisdom that only substandard solutions are feasible.

We’ve heard this before. From abolition of slavery to women’s suffrage to enacting Social Security and Medicare to ending legal segregation, our history is filled with achievements that the political “realists” repeatedly dismissed as unrealistic.

INADEQUATE REFORMS

Most of the alternatives offered instead are based on expanding the role of the insurance industry. Among the ideas now being touted by, among others, liberal advocacy groups and a few Presidential candidates, are mandates that everyone be required to buy insurance, tax deductions to encourage people to buy insurance, taxes on employers to pay for more insurance, and expansions to existing federal or state programs to buy insurance for the low income.

No wonder that Stephen Hemsley, chief executive of health care giant UnitedHealth Group, calls one such scheme, by California Governor Arnold Schwarzenegger, “an interesting set of proposals that represent real opportunities for our business.”

Both the Schwarzenegger plan and the Massachusetts law on which it is modeled have as their central premise the requirement that all state residents buy health insurance.

Yet neither places any limits on skyrocketing premiums, and in both states individuals and families will face huge deductibles with even the cut-rate plans the law will force them to buy. The result is that many will end up paying for virtually all their medical expenses or gamble with their health by avoiding most services.

On the other hand, the California and Massachusetts models are welcome news in the corporate boardrooms of the insurance industry. Insurers stand to make hundreds of millions more just in California.

Another favored scheme, especially by some in labor, is employer mandate “pay or play” plans that require businesses to provide health benefits or pay into a state pool to buy insurance for the uninsured.

But in addition to being another windfall for the insurers, a federal court ruling throwing out a Maryland law based on this approach cast doubt as to whether any employer mandate will withstand legal challenge.

The health care industry and conservative ideologues hardly need our help. It’s time for labor activists to unite behind the only health care reform that is universal, comprehensive, and assures one standard of quality care for all.

Rose Ann DeMoro is executive director of the California Nurses Association/National Nurses Organizing Committee.