By Paul Heise
Lebanon Daily News

The only part of the American health-care system that seems to be working is Medicare and Medicaid. Our employment-based, managed-care system is clearly collapsing from inefficiency, rising costs and loss of the industrial base that paid for it. Now, when we don’t have enough health coverage as it is, President George W. Bush proposes fiddling with the tax code to set up tax incentives for workers to buy less insurance. Not to worry. Bush is simply making political noises. He only means to look responsive to health-care complaints, to make sure he reframes the later debate and, more importantly, to distract us from his Iraq surge. Nothing is going to happen to your health care until after the presidential election of 2008. However, that election could well be decided by the health-care issue.

Until then, everyone will lament the lack of progress; the states will tinker with patchwork solutions; and Bush will muddy the waters with the tax code fiddling we heard about in the State of the Union address.

In the interim, it is important to make sure we properly identify the problem and frame the question so we can address it in a national election.

The health-care crisis is real. As a nation, we spend twice as much as others and get worse outcomes. The U.S. spends $2 trillion per year, or 15 percent of our total output, on health care while other industrialized countries spend only six to 10 percent. Using an outcomes-based test, our infant mortality is higher than even some Latin American countries, our life expectancy is less than other rich countries, 15 percent of our people lack insurance, lawyers are undermining physicians, and medical bills are bankrupting even insured workers.

How bad is it? The U.S. spent $6,102 per person on health care in 2004 while Canada spent $3,165, France $3,159 and Australia $3,120, and 47 million people are not covered at all. We have a broken system.

When we round up the usual suspects, we blame soaring health-care costs on new and expensive technology, an aging population, rising expectations, lawyers and soaring drug costs in an ever-more-drug-focused therapy. The problem, aside from our peculiarly litigious nature, is that the rest of the industrialized world shares these “causes” but does not share anything near America’s cost problems.

To begin an intelligent debate, we have to isolate what is different about the American system that makes it the world’s highest-cost system with some of the world’s worst outcomes.

Two things pop up: the administrative costs of our multi-payer system and the control of prices by our suppliers. According to the New England Journal of Medicine, 30 percent, or $600 billion, of that $2 trillion we spend per year on health care goes for the administration, marketing and profits associated with a multiplicity of insurance collectors and payers. Medicare, a single-payer system, and much of the rest of the world pays as little as two percent in administrative costs.

The provision that forbids Medicare to negotiate prices is probably the most absurd thing in these last six years of this government of the absurd. Maybe even worse, the U.S. government pays for the research then gives the patents to the drug companies and research firms and lets them charge monopoly prices.

Medicare, at least Part A–Hospitalization, is the quintessential single-payer system: you choose your own doctor while medical practices, hospitals and pharmaceutical companies remain privately owned and compete. The government acts only as the payer. Part B–Medical, with its confusion of firms and forms, is an unnecessary concession to the insurance companies.

The point of putting health care into the State of the Union message is to reframe the debate away from the real problem, which is affordable health care, and put the focus on affordable insurance. The president has to get hold of this. If the Congress ever started looking at the sources of the increased health-care costs, the dysfunctional insurance industry could lose billions in profit.

The question has to be framed in terms of an affordable health-care system and not availability of insurance. The best way to do that is simply to take the age provisions and Part B firms out of Medicare and apply to all that single-payer system that we know and love.

I’m over 65; it works for me.

http://www.ldnews.com/portlet/article/html/fragments/print_article.jsp?articleId=5084586&siteId=139

A resident of Mt. Gretna, Heise holds a Ph.D. in economics and is professor emeritus of economics at Lebanon Valley College. His column appears every other Thursday. He maintains a web log at weboped.com, and he can also be reached at:

heise@lvc.edu

By PAUL KRUGMAN
Op-Ed Columnist
New York Times
January 26, 2007

American politics is ugly these days, and many people wish things were different. For example, Barack Obama recently lamented the fact that “politics has become so bitter and partisan” — which it certainly has.

But he then went on to say that partisanship is why “we can’t tackle the big problems that demand solutions. And that’s what we have to change first.” Um, no. If history is any guide, what we need are political leaders willing to tackle the big problems despite bitter partisan opposition. If all goes well, we’ll eventually have a new era of bipartisanship — but that will be the end of the story, not the beginning.

Or to put it another way: what we need now is another F.D.R., not another Dwight Eisenhower.

You see, the nastiness of modern American politics isn’t the result of a random outbreak of bad manners. It’s a symptom of deeper factors — mainly the growing polarization of our economy. And history says that we’ll see a return to bipartisanship only if and when that economic polarization is reversed.

After all, American politics has been nasty in the past. Before the New Deal, America was a nation with a vast gap between the rich and everyone else, and this gap was reflected in a sharp political divide. The Republican Party, in effect, represented the interests of the economic elite, and the Democratic Party, in an often confused way, represented the populist alternative.

In that divided political system, the Democrats probably came much closer to representing the interests of the typical American. But the G.O.P.’s advantage in money, and the superior organization that money bought, usually allowed it to dominate national politics. “I am not a member of any organized party,” Will Rogers said. “I am a Democrat.”

Then came the New Deal. I urge Mr. Obama — and everyone else who thinks that good will alone is enough to change the tone of our politics — to read the speeches of Franklin Delano Roosevelt, the quintessential example of a president who tackled big problems that demanded solutions.

For the fact is that F.D.R. faced fierce opposition as he created the institutions — Social Security, unemployment insurance, more progressive taxation and beyond — that helped alleviate inequality. And he didn’t shy away from confrontation.

“We had to struggle,” he declared in 1936, “with the old enemies of peace — business and financial monopoly, speculation, reckless banking, class antagonism, sectionalism, war profiteering. … Never before in all our history have these forces been so united against one candidate as they stand today. They are unanimous in their hate for me — and I welcome their hatred.”

It was only after F.D.R. had created a more equal society, and the old class warriors of the G.O.P. were replaced by “modern Republicans” who accepted the New Deal, that bipartisanship began to prevail.

The history of the last few decades has basically been the story of the New Deal in reverse. Income inequality has returned to levels not seen since the pre-New Deal era, and so have political divisions in Congress as the Republicans have moved right, once again becoming the party of the economic elite. The signature domestic policy initiatives of the Bush administration have been attempts to undo F.D.R.’s legacy, from slashing taxes on the rich to privatizing Social Security. And a bitter partisan gap has opened up between the G.O.P. and Democrats, who have tried to defend that legacy.

What about the smear campaigns, like Karl Rove’s 2005 declaration that after 9/11 liberals wanted to “offer therapy and understanding for our attackers”? Well, they’re reminiscent of the vicious anti-Catholic propaganda used to defeat Al Smith in 1928: smear tactics are what a well-organized, well-financed party with a fundamentally unpopular domestic agenda uses to change the subject.

So am I calling for partisanship for its own sake? Certainly not. By all means pass legislation, if you can, with plenty of votes from the other party: the Social Security Act of 1935 received 77 Republican votes in the House, about the same as the number of Republicans who recently voted for a minimum wage increase.

But politicians who try to push forward the elements of a new New Deal, especially universal health care, are sure to face the hatred of a large bloc on the right — and they should welcome that hatred, not fear it.

Copyright 2007 The New York Times Company

Jim Winkler spoke at a January 24, 2007, press conference hosted by Physicians for a National Health Program and the California Nurses Association at the National Press Club in Washington, D.C. Here is his statement.

How to Get Healthy

by Jim Winkler

I speak today as national co-chair of Healthcare-NOW!, a growing movement committed to a national quality healthcare system with single-payer financing and as general secretary of the General Board of Church and Society of the United Methodist Church. Our denomination supports a single-payer health insurance program.

Last night President Bush highlighted the crisis of affordable and available health care in his State of the Union address. He would not have given this matter as much time and attention as he did if we were not in the middle of an unfolding tragedy. He noted that “many” Americans cannot afford a health insurance policy. “Many” is an interesting word choice. I think we’ve reached a point where the use of phrases such as “tens of millions” and “too many” are the only ones that work.

One could argue that instead he chose to focus on solutions. Very well. It may be that his recommendation for a standard tax deduction for health insurance will help. He says this will mean more than 100 million men, women, and children who are now covered–already covered, that is–will benefit from lower tax bills.

The President also says the tax deduction will put a basic, private health insurance plan within the reach of those Americans who cannot purchase health insurance on their own. The question before us today is whether we say, “Thank you, Mr. President, for giving some help to the American people” or do we say, “This is not the time for half or quarter or one-eighth measures?” The answer to that is clear: we must have a better and comprehensive single-payer solution to this problem.

The President says the best health care decisions are made not by government and insurance companies, but by patients and their doctors. Yet, he remains committed to the insurance companies. They have to get their vig, their cut, of the health care dollar. Every city in the United States has one or more tall buildings dotting its skyline built by the insurance companies from the excess money they have collected from ordinary Americans. This is money that could be used for better and less expensive health care, for clinics and doctors and nurses, for education and prevention.

And yet these skyscrapers stand as monuments to corporate egos, undeserved profits, and greed. This wasted money prevents patients and doctors from making the best health care decisions. What we want is to eliminate the middle man, the corporate paper-pushers who have bought up the politicians of both major parties in our land, so that health care can become efficient and trustworthy.

Just last night, I was reading the February 2007 issue of Money magazine. Allyson Ranallo of Westlake Village, Calif., wrote to Ellen McGirt who pens the “Money Helps” column. Ms. Rannallo said her husband was treated at an urgent-care facility last March. Afterward she and her husband called their health insurer to confirm this was covered and they were told it was. They mailed the receipt and waited to be reimbursed. They followed up repeatedly and did not receive a check.

Ms. McGirt intervened on their behalf. PacifiCare spokeswoman Cheryl Randolph investigated and found their paperwork fell into “a bureaucratic black hole.” Randolph was mystified as to why the claim was refused. Eventually, they received their check. There are far, far too many people facing the same insurance company denials and obfuscation who do not have a magazine ombudsperson to intervene on their behalf.

Throughout the scriptures, God warns us that nations and rulers who do not care for the sick and the poor and the widows and the orphans will fall, that those nations are corrupt and rotten. Ours is a nation filled with people who study and believe the Bible, but too many have been seduced by the false gods of the market ideology.

Private health insurance has failed us. “Surging” private health insurance will fail just as “surging” the war in Iraq will fail. When you are going down the wrong road, the answer is not to continue traveling in the wrong direction more forcefully. It is to go down the right road.

Date: 1/24/2007

(c) 2005-2006

Jim Winkler spoke at a January 24, 2007, press conference hosted by Physicians for a National Health Program and the California Nurses Association at the National Press Club in Washington, D.C. Here is his statement.

How to Get Healthy

by Jim Winkler

I speak today as national co-chair of Healthcare-NOW!, a growing movement committed to a national quality healthcare system with single-payer financing and as general secretary of the General Board of Church and Society of the United Methodist Church. Our denomination supports a single-payer health insurance program.

Last night President Bush highlighted the crisis of affordable and available health care in his State of the Union address. He would not have given this matter as much time and attention as he did if we were not in the middle of an unfolding tragedy. He noted that “many” Americans cannot afford a health insurance policy. “Many” is an interesting word choice. I think we’ve reached a point where the use of phrases such as “tens of millions” and “too many” are the only ones that work.

One could argue that instead he chose to focus on solutions. Very well. It may be that his recommendation for a standard tax deduction for health insurance will help. He says this will mean more than 100 million men, women, and children who are now covered–already covered, that is–will benefit from lower tax bills.

The President also says the tax deduction will put a basic, private health insurance plan within the reach of those Americans who cannot purchase health insurance on their own. The question before us today is whether we say, “Thank you, Mr. President, for giving some help to the American people” or do we say, “This is not the time for half or quarter or one-eighth measures?” The answer to that is clear: we must have a better and comprehensive single-payer solution to this problem.

The President says the best health care decisions are made not by government and insurance companies, but by patients and their doctors. Yet, he remains committed to the insurance companies. They have to get their vig, their cut, of the health care dollar. Every city in the United States has one or more tall buildings dotting its skyline built by the insurance companies from the excess money they have collected from ordinary Americans. This is money that could be used for better and less expensive health care, for clinics and doctors and nurses, for education and prevention.

And yet these skyscrapers stand as monuments to corporate egos, undeserved profits, and greed. This wasted money prevents patients and doctors from making the best health care decisions. What we want is to eliminate the middle man, the corporate paper-pushers who have bought up the politicians of both major parties in our land, so that health care can become efficient and trustworthy.

Just last night, I was reading the February 2007 issue of Money magazine. Allyson Ranallo of Westlake Village, Calif., wrote to Ellen McGirt who pens the “Money Helps” column. Ms. Rannallo said her husband was treated at an urgent-care facility last March. Afterward she and her husband called their health insurer to confirm this was covered and they were told it was. They mailed the receipt and waited to be reimbursed. They followed up repeatedly and did not receive a check.

Ms. McGirt intervened on their behalf. PacifiCare spokeswoman Cheryl Randolph investigated and found their paperwork fell into “a bureaucratic black hole.” Randolph was mystified as to why the claim was refused. Eventually, they received their check. There are far, far too many people facing the same insurance company denials and obfuscation who do not have a magazine ombudsperson to intervene on their behalf.

Throughout the scriptures, God warns us that nations and rulers who do not care for the sick and the poor and the widows and the orphans will fall, that those nations are corrupt and rotten. Ours is a nation filled with people who study and believe the Bible, but too many have been seduced by the false gods of the market ideology.

Private health insurance has failed us. “Surging” private health insurance will fail just as “surging” the war in Iraq will fail. When you are going down the wrong road, the answer is not to continue traveling in the wrong direction more forcefully. It is to go down the right road.

Date: 1/24/2007

(c) 2005-2006

Less than a year after Massachusetts’s controversial healthcare initiative was first revealed, evidence is accumulating to bolster critics who said the system is faulty by design.

by Megan Tady
TheNewStandard

Jan. 26 — Members of a panel charged with implementing the Massachusetts “universal” healthcare plan redirected some insurers this week to make their premiums more affordable. But critics of the plan say it’s the government that needs to go back to the drawing board.

In April, the Massachusetts legislature passed what supporters called a universal healthcare initiative: one that forces state residents to obtain health insurance. The plan offers a sliding-scale subsidy for residents who earn up to three times the poverty level. Those who exceed the income-eligibility threshold for subsidies are required to purchase their own health insurance without help or face tax penalties and fines.

Then-Governor Mitt Romney pledged that healthcare plans would be affordable for everyone and predicted that low-cost plans would be offered for about $200 a month. Romney vetoed a provision in the bill that would have penalized employers for not offering affordable healthcare to their employees.

Last Friday, a subcommittee of the Commonwealth Health Insurance Connector Authority (the Connector), reviewed insurance company proposals for Minimum Credit Coverage — plans that are the cheapest consumers can purchase.

Disappointed by the high costs of the minimum insurance plans — which average around $340 to $380 per month — the Connector told insurers to “sharpen their pencils and come back with more affordable options,” said Joe Landolfi, spokesperson for Connector chair Leslie Kirwan.

But critics of the state’s plan have been warning the government that universal health care achieved through the requirement to buy private insurance will lead to bloated premiums and bare-bones coverage for middle-income residents who can only afford the minimum plans.

“We should not let these board members get away with telling us that they’re surprised [about the costs for the minimum plans],” said Steffie Woolhandler, a physician at Cambridge Hospital and the co-founder of Physicians for a National Health Program, a nonprofit organization pushing for comprehensive national health plan.

In an April interview with The NewStandard, Woolhandler predicted: “Many people will be forced to pay thousands of dollars for a policy that is only a piece of paper. If someone actually does get sick, the policy will be so full of gaps — like large co-pays — that they could go bankrupt. They’ll be facing the worst of both worlds: [being] forced to hand over thousands of dollars to the private health-insurance companies, and finding that they’re not actually covered when they get sick.”

Benjamin Day, executive director of Mass-Care, a coalition advocating a single-payer healthcare system for Massachusetts, said making a low-cost but effective private-insurance plan is impossible.

“You can’t just tell insurers to provide more-affordable health insurance,” Day told TNS. “Unless they’re willing to erode the quality of the plan, they’re not going to get an affordable plan because health insurance is just not affordable [through private insurers].”

Day said the US’s fragmented private insurance system keeps administrative costs — such as marketing expenses — too high to offer cheaper insurance. According to analysis by the Kaiser Family Foundation, administrative costs have risen from $85 in 1986 to $421 in 2003.

Day predicted insurers will offset the cheaper plans by raising deductibles and co-payments — the amount consumers have to pay out of pocket before their insurance kicks in. “It’s not making it more affordable,” he said. “It’s just shifting the money around.”

Day and Woolhandler’s predictions are already materializing. At the same time the subcommittee called for lower premium costs, committee members lowered their expectations for what benefits lower-cost plans should offer.

The recommendations include a cap on out-of-pocket medical expenses at $5,000 per year for individual coverage, and between $7,500 and $10,000 for family coverage. According to a chart released by the Connector, in November, the board had discussed a $3,000 – $4,000 cap on out-of-pocket expenses.

However, insurance companies are not even required to follow these downgraded recommendations in order to get a “seal of approval” from the Connector; spokesperson Landolfi said they are simply guidelines for the insurers to follow, not mandates.

Asked what would happen if insurance companies dismissed the guidelines, Landolfi said on behalf of the Connector chair: “We’ll cross that bridge when we come to it. We think everyone wants this plan to succeed.”

He added there were some plans submitted that were affordable and “well within the range that we had anticipated. We’re confident that in the next couple of weeks… the carriers will submit plans that will address most of all of the recommendations.”

But Landolfi would not provide TNS with details of the plans that he said met the recommendations.

Even if insurers follow the Connector’s suggestions, critics say health care will remain unaffordable for many people.

“Most people don’t have $5,000 lying around in a bank account,” said Woolhandler, of the recommended maximum out-of-pocket expenses subscribers could incur.

Judy Dugan, research director of the California-based Foundation for Taxpayer and Consumer Rights (FTCR), predicted that plans like the Massachusetts initiative and one proposed for his state could leave families in dire situations.

“For a family who is just above the limit on subsidized insurance, if they have a family member that falls seriously ill and needs treatment year-after-year, that $10,000 out-of-pocket can be a formula for bankruptcy,” Dugan told TNS.

Several of the committee’s recommendations were not unanimous, possibly giving insurance companies a sense of further discretion on the minimum plans offered. For instance, three members of the committee favored a ceiling on deductibles, while one member opposed such a cap and another member abstained.

The committee also could not decide on a number of covered routine doctor visits the plans should offer.

Critics of the plan say it’s the government, not the insurance companies, that needs to roll up its sleeves to fix the problem, particularly as other states — such as California and Maine — consider copying the Massachusetts model.

FTCR said states implementing individual healthcare mandates need to couple affordable health care with insurer oversight.

“Something has to give: either the big-bucks lifestyle of insurers and the rest of the medical industry or policyholder benefits,” said Carmen Balber, consumer advocate with FTCR, in a press statement. Regulation would rein in “the excesses of the

medical establishment to make benefits affordable,” Balber added.

But both Woolhandler and Day said no matter what controls are in place, states can never achieve meaningful universal health care through the current system of private bureaucracies.
Promotional Tools
Share this article with the world using these popular services!

“It’s asking people to buy their own way out of their predicament — I call it a ‘Marie Antoinette’ policy,” Woolhandler said. “Private insurance is the problem, not the solution.”

By Alice Dembner
Boston Globe
1/25/2007

An advocacy group urged the state Wednesday to delay a key part of the new universal health insurance law, saying that a survey shows that many families cannot afford even subsidized insurance.

The Greater Boston Interfaith Organization, which pressed for passage of the law, said the state should not impose penalties for at least a year on low- and moderate-income people who fail to obtain insurance by the July 1 deadline.

Governor Deval Patrick declined to take a position on the proposed change, but he met with the group Wednesday, signaling growing concern among state leaders about the affordability of health insurance plans being established under the new law.

“We are committed to doing anything we can, working with providers, to deliver affordable options,” Patrick said in a statement after the meeting.

Administration and Finance Secretary Leslie Kirwan, who is overseeing implementation, said, “It’s very premature to talk about changing the law.”

Leaders of the interfaith group want the change to ease pressure on about 300,000 individuals earning up to $49,000 a year, who the advocates said face the greatest challenge in paying for insurance. The one-year delay would allow time to negotiate better, less-expensive insurance and could ultimately help ensure the success of the law, the group’s leaders said.

“You only get to do this once with the public, and if you get it wrong it’s going to blow up,” said the Rev. Hurmon Hamilton, pastor of Roxbury Presbyterian Church and president of the Greater Boston Interfaith Organization, a coalition of 65 religious congregations, labor unions, and community groups. “People will not permit the Commonwealth to force them into deeper debt.”

Senator Richard T. Moore, cochairman of the Legislature’s Committee on Health Care Financing, and Richard Lord, president of Associated Industries of Massachusetts, said the penalty delay is worth considering, particularly if insurers do not cut prices and if many people decline to sign up for subsidized plans.

“Assuming we validate … [the interfaith organization’s] numbers, we might want to ease the penalties for a year or two to see how the market shakes out,” said Moore.

But Representative Patricia A. Walrath, Moore’s counterpart in the House, said she doesn’t think the answer is eliminating the penalty for a majority of people.

The interfaith organization made its case with data from a survey it conducted of 367 people with low and moderate incomes who attended the group’s workshops and shared details of their income and expenses. The information is the first on what state residents can afford, but it’s unclear whether the results are representative of the Commonwealth. Most of the people had insurance, but many were at risk of losing it because of unstable job situations.

Nearly one-half of those with incomes low enough to qualify for state-subsidized insurance did not have enough discretionary income to afford the monthly premiums, which range from $18 to $106 for an individual, the survey found.

Nearly 40 percent of those with incomes between 300 and 500 percent of the poverty level could not afford the $380 per month premium plus out-of-pocket costs discussed by state officials last week. Several state officials said they hoped to bring that cost closer to $250 per month, but the survey found that 28 percent of those eligible could not afford that lower cost either.