United States House of Representatives Committee on Ways and Means Subcommittee on Health April 4, 2001
Testimony of Sara J. Singer, Executive Director, Center for Health Policy, Stanford University:

“Our plan would provide near-universal coverage among the non-Medicare population by making private plans more affordable. It would do so by using insurance exchanges to promote competition among plans.”

http://waysandmeans.house.gov/health/107cong/4-4-01/4-4sing.htm

Comment: The proposal of Sara Singer and her colleagues, Alain Enthoven and Alan Garber, includes the following:

* Insurance exchanges (private or public) – would offer individuals a choice of at least two plans, one that “provides some coverage for treatment by most providers,” and one that is a “low-priced alternative”

* U.S. Insurance Exchange (USIX) – like Federal Employees Health Benefits Program, for small employers in “areas in which private exchanges do not emerge”

* Refundable tax credits – for families who purchase insurance through an exchange, phased out with increasing income

* Default plan – automatic for lower income individuals who do not enroll in a health plan – federal funding at 50% of the tax credit – for financing of public hospitals and clinics and “open access” providers

* Phased in cap – limit amount of exclusion of premiums from taxable income to “encourage value-based purchasing”

* Independent Exchange Commission (IEC) – similar to the SEC, to “encourage smooth information flow and functioning of insurance exchange markets”

It is amazing how tenaciously Singer, Enthoven and Garber adhere to the doctrine that the solution to our health care problems is to promote competition between health plans, in spite of the overwhelming evidence that the private bureaucracies of health plans continue to waste a tremendous amount of valuable resources, while failing to provide for the unmet needs of the uninsured and underinsured. It is also ironic that, in recognizing that this model has not worked, they now are proposing government bureaucracies, including the USIX and IEC, along with tax subsidization. Yet this very expensive program will enable only “some coverage,” or a “low-priced alternative,” or additional funding of public facilities as a default (doctrinaire multi-tiered health care). To allow the “market” to function, they are recommending more government involvement and more taxpayer funds, while doing virtually nothing to correct the excesses of the industry, and failing to propose a satisfactory level of assured coverage.

What is even more amazing to me is that Sara Singer continues to reject the brilliant proposal strongly supported by her cousin and our friend, Quentin Young. It is a proposal that would meet their goal of controlling health care costs, but on the supply side by utilizing health planning and global budgeting, a much more humane approach than making health care unaffordable for low and moderate income individuals by providing only inadequate, Spartan coverage. That proposal, of course, is universal, comprehensive, publicly-administered insurance, with everybody in and nobody out!

Don McCanne

United States House of Representatives Committee on Ways and Means Subcommittee on Health April 4, 2001
Testimony of Sara J. Singer, Executive Director, Center for Health Policy, Stanford University:

“Our plan would provide near-universal coverage among the non-Medicare population by making private plans more affordable. It would do so by using insurance exchanges to promote competition among plans.”

http://waysandmeans.house.gov/health/107cong/4-4-01/4-4sing.htm

Comment: The proposal of Sara Singer and her colleagues, Alain Enthoven and Alan Garber, includes the following:

* Insurance exchanges (private or public) – would offer individuals a choice of at least two plans, one that “provides some coverage for treatment by most providers,” and one that is a “low-priced alternative”

* U.S. Insurance Exchange (USIX) – like Federal Employees Health Benefits Program, for small employers in “areas in which private exchanges do not emerge”

* Refundable tax credits – for families who purchase insurance through an exchange, phased out with increasing income

* Default plan – automatic for lower income individuals who do not enroll in a health plan – federal funding at 50% of the tax credit – for financing of public hospitals and clinics and “open access” providers

* Phased in cap – limit amount of exclusion of premiums from taxable income to “encourage value-based purchasing”

* Independent Exchange Commission (IEC) – similar to the SEC, to “encourage smooth information flow and functioning of insurance exchange markets”

It is amazing how tenaciously Singer, Enthoven and Garber adhere to the doctrine that the solution to our health care problems is to promote competition between health plans, in spite of the overwhelming evidence that the private bureaucracies of health plans continue to waste a tremendous amount of valuable resources, while failing to provide for the unmet needs of the uninsured and underinsured. It is also ironic that, in recognizing that this model has not worked, they now are proposing government bureaucracies, including the USIX and IEC, along with tax subsidization. Yet this very expensive program will enable only “some coverage,” or a “low-priced alternative,” or additional funding of public facilities as a default (doctrinaire multi-tiered health care). To allow the “market” to function, they are recommending more government involvement and more taxpayer funds, while doing virtually nothing to correct the excesses of the industry, and failing to propose a satisfactory level of assured coverage.

What is even more amazing to me is that Sara Singer continues to reject the brilliant proposal strongly supported by her cousin and our friend, Quentin Young. It is a proposal that would meet their goal of controlling health care costs, but on the supply side by utilizing health planning and global budgeting, a much more humane approach than making health care unaffordable for low and moderate income individuals by providing only inadequate, Spartan coverage. That proposal, of course, is universal, comprehensive, publicly-administered insurance, with everybody in and nobody out!

Don McCanne

The Austin American-Statesman May 18, 2001 Letters
Insurance for all
Re: May 13 editorial :

“Teachers and public school employees will get a state-supported health insurance plan. That is certain. What has yet to be decided is whether they will drive away in a Cadillac or a Chevrolet.”

This leaves 5 million Texans driving Yugos, because they do not have any health insurance but are forced to pay for the health insurance of state employees.

“Health Care For All Texans” endorses a comprehensive health care system that would guarantee:

* Access to affordable, quality health care without regard to income, employment or health status.

* Freedom to choose their doctors and other health professionals.

* Participation in a comprehensive, age-specific, quality health benefits package.

To help, contact Health Care For All Texans, 206 W. Woodlawn, San Antonio, 78212 or send e-mail to makstool@earthlink.net.

Milton A. Braun Dallas

Comment: Milt Braun is a retired CPA and now a very dedicated health care reform activist. His e-mail address is: mrtex@webtv.net

The University of California at San Diego Healthwise
May 2001

Lawrence Schneiderman, MD, Professor, Family and Preventive Medicine, UCSD:

“Every responsible ethicist agrees that we are violating our moral obligations to our citizens by not providing a decent minimum of universal health care…. We are proud to be a free enterprise, capitalist society that has produced many remarkable achievements, but we are trying to use that concept in health care. We are trying to build health care on the profit-based market model and it’s failing miserably…. A fundamental duty of a just society is to all of the citizens. They all are owed a decent minimum standard of health care, and only the government can take that responsibility…. (E)very responsible ethicist I know who has thought about this issue has a similar opinion.”

(Thanks to Jeoff Gordon for today’s quote.)

Health Affairs
May/June 2001

“How many more people have to die before we accept that quality is everyone’s problem?” by Elizabeth A. McGlynn and Robert H. Brook

“The science that the nation spent so much public and private money developing could produce its promised results.”

“We spend more money on health care than any country in the world; one of every seven dollars spent in this country goes to medical care. We have sophisticated physicians and social scientists. But we lack the will to reengineer our own health system.”

“Leadership for this reengineering will have to come from both government and the private sector. The government role is particularly critical, something that has been recognized in all other Western nations except the United States.”

“We must find a way to keep quality care at the top of the health policy agenda. After providing insurance to all Americans, there is no issue of equal importance.”

http://www.healthaffairs.org/archives_library.htm

The Washington Post
May 17, 2001
“Professional Groups Lose International Delegation Spots” by Karen DeYoung

“The American Public Health Association assumed it would be invited to join the official U.S. delegation to this week’s World Health Assembly in Geneva. As the nation’s oldest and largest organization of public health professionals, the APHA has been a U.S. delegate to the annual meeting of the world’s health ministers for many years…”

Instead, “… ‘five private-sector advisors’ are on the official team,” along with Tommy Thompson and other government officials, that will discuss issues such as global strategies for infant and child feeding, the AIDS pandemic, strengthening health systems, and the health effects of depleted uranium.

Mohammad Akhter, executive director of the American Public Health Association:

“I think this is setting a bad precedent. This is not at all what America is about. It doesn’t matter who the president is, we represent the people. That’s what has put us above all the other countries in the world…. Now, we’re the same as third world countries where they bring in their friends and make a mess of things.”

http://www.washingtonpost.com/wp-dyn/articles/A36643-2001May16.html

Comment: Is the APHA is being punished for supporting health care for everyone?

The Washington Post
May 17, 2001
“Professional Groups Lose International Delegation Spots” by Karen DeYoung

“The American Public Health Association assumed it would be invited to join the official U.S. delegation to this week’s World Health Assembly in Geneva. As the nation’s oldest and largest organization of public health professionals, the APHA has been a U.S. delegate to the annual meeting of the world’s health ministers for many years…”

Instead, “… ‘five private-sector advisors’ are on the official team,” along with Tommy Thompson and other government officials, that will discuss issues such as global strategies for infant and child feeding, the AIDS pandemic, strengthening health systems, and the health effects of depleted uranium.

Mohammad Akhter, executive director of the American Public Health Association:

“I think this is setting a bad precedent. This is not at all what America is about. It doesn’t matter who the president is, we represent the people. That’s what has put us above all the other countries in the world…. Now, we’re the same as third world countries where they bring in their friends and make a mess of things.”

http://www.washingtonpost.com/wp-dyn/articles/A36643-2001May16.html

Comment: Is the APHA is being punished for supporting health care for everyone?

The Sacramento Bee
May 16, 2001
by Lisa Rapaport

Bert Clark, a retired enrollee: “A lot of people will gripe and say these rates are hard to take. What gets me is I pay Medicare, then I pay CalPERS, and then I pay for drugs.”

David Thompson, a public agency representative: “We get a wonderful benefit structure that’s all you could want — it’s just expensive. It’s fair as long as we have a choice.”

Comment: A choice? Making health care unaffordable gives many retired folks the choice of not eating or paying rent as the price of health care. Some choice!

The Sacramento Bee
May 16, 2001
by Lisa Rapaport

Bert Clark, a retired enrollee: “A lot of people will gripe and say these rates are hard to take. What gets me is I pay Medicare, then I pay CalPERS, and then I pay for drugs.”

David Thompson, a public agency representative: “We get a wonderful benefit structure that’s all you could want — it’s just expensive. It’s fair as long as we have a choice.”

Comment: A choice? Making health care unaffordable gives many retired folks the choice of not eating or paying rent as the price of health care. Some choice!

H-165.960 Health Access America Refinements

Excerpts:

(11) The AMA should achieve the right to negotiate for physicians program payment and the other conditions in government health entitlement programs, where legislative and/or administrative restrictions are unilaterally applied to physicians’ freedom to set their own fees. Any such fee restrictions should be limited to those patients who cannot reasonably afford to pay the difference between the physician fees and government reimbursement levels. In the private sector, where insurance arrangements for thousands of patients are increasingly controlled by single third party payers, physicians should have the ability to negotiate collectively on behalf of their patients and themselves.

(12) Single-payer systems are not in the best interests of the public, physicians or the health care of this nation and should be strenuously resisted.

http://www.ama-assn.org/apps/pf_online/pf_online (Check “House of Delegates” and enter “H-165.960”)

Comment: It is unfortunate that the leadership of the American Medical Association continues to endorse official AMA policies that protect physicians’ income while essentially neglecting the great, unmet, health care needs of the nation. As long as they continue to support grossly deficient policies such as tax credits and medical savings accounts, the AMA will have very limited legitimacy in the process of reforming health care in America.

Should the AMA ever take a strong advocacy role on behalf of physicians? The answer may be, “Yes.” I’ll explain.

Most of us engaged in compassionate reform activities firmly believe that our abundant health care resources can be allocated much more effectively, resulting in comprehensive, high quality care for everyone. But under our current sick structure, efforts to remove cost restraints for the purpose of embellishing physician wealth can only place additional stresses on our deficient mechanisms of delivering resources for care of the medically underserved. Physicians must advocate for structural reform that will improve resource allocation before they can legitimately advocate for their own financial interests.

Once we have in place an effective system that will assure comprehensive care for everyone, mechanisms of cost containment will be essential. At that time, physicians will need a strong and effective voice in negotiating rates and practice environment. Otherwise, those in control will divert physician resources into other sectors of the budget. Very soon medicine as an occupation would be appealing only to the Mother Teresas of this nation, and, frankly, there simply are not enough individuals that are so dedicated. So it is in the best interests of patients to be certain that physicians are rewarded at a level that will assure that prime candidates will continue to be attracted to the medical work force.

The AMA’s position that it should “achieve the right to negotiate (collectively) for physicians” is a proper stance, but not within our current sick system. If the AMA actively participates in bringing about the ethical reforms that will cure the ills of our system, than it will have earned its position as negotiator on behalf of the medical profession.

Don McCanne

May 21, 2001

“Several prominent physicians, fed up with ‘market-based medicine’ have banded together to advocate for single-payer national health insurance.” by Amy Snow Landa

Quentin Young, M.D., commenting on a conversation he had with Rep. John Conyers Jr.:

“I represented to him that the leaders of medicine are no longer to be painted with one stripe as conservative, even reactionary obstacles to universal health care, but that leadership is taking quite a different tack, and he accepted my comments and challenged me to produce that group.”

http://www.ama-assn.org/sci-pubs/amnews/pick_01/gvsb0521.htm

Comment: This is yet another article on the pivotal, landmark meeting of several Congressional caucuses and the Physicians’ Working Group for Single-Payer National Health Insurance. The objectivity of this article is to be commended considering that this is a publication of the American Medical Association.

A picture of our Santa Barbara friends:

http://community.webshots.com/photo/14083539/14083762FJqxqmJZsP

Thanks to Robert Bernstein, Chair, Sierra Club – Santa Barbara Group