PNHP

Can we talk about single payer? (Flowers, Baker & Folbre)

Can we talk about single payer? (Flowers, Baker & Folbre)

Obamacare Debate: Flowers vs. Baker

The Real News, October 1, 2013 JESSICA DESVARIEUX, TRNN PRODUCER:  With us to discuss the Affordable Care Act are Dean Baker and Dr. Margaret Flowers. Dr. Flowers joins us in-studio. She’s a pediatrician in the Baltimore area and the Maryland chapter of Physicians for a National Health Program cochair, and she’s the secretary of health for the Green Shadow Cabinet… And joining us from Washington, D.C., is Dean Baker. He’s the codirector of the Center for Economic and Policy Research. DEAN BAKER, CODIRECTOR, CEPR:  There’s lots of grounds for criticizing the ACA. But this is a huge step forward. We’re going to have tens of millions of people that will be able to get insurance who haven’t had it previously. And, again, for the 100-plus million who are now insured, they will actually have real insurance, because if they do get sick, lose their job, they’ll still in most cases be able to get affordable insurance through the exchanges. So I have to see that as a big step forward. DESVARIEUX: Okay. Let’s have Dr. Flowers respond to that. Do you see that as a step forward? DR. MARGARET FLOWERS, COCHAIR, PNHP:  No, I actually see the Affordable Care Act as a step backwards. It takes us farther in the direction of privatized health care. And the way that we really need to go is towards greater–a publicly financed universal health care system. That’s the most efficient and most equitable way to provide health care… BAKER: Well, it’d be great to have, you know, universal Medicare, but that wasn’t about to be coming. So basically our choice is having health care provided through private insurers or not having it at all. And the fact is, we have 100-plus million people who get most of their health care through private insurers now. And yeah, they do lots of bad things, but the alternative is not getting it all. So I can’t somehow tell people they’re better off not getting health care than having it provided through private insurers, as much as I may not like them. DESVARIEUX: But is that true? Is that really the alternative? We only have two choices here? FLOWERS: No. And, actually, during the health reform debate, a point that we were making, especially towards the end when it looked like the Affordable Care Act was going to go through, was don’t give hundreds of millions of dollars in subsidies to private insurance companies where they’re going to hang on to a lot of that and still deny people care. We should be giving that to our public programs to expand them more and really shift us in the direction we need to go, towards a greater publicly financed health care system. Part of the reason that the Affordable Care Act went through is that it wasn’t challenged by people on the left, by people that supported single-payer. People were told, well, this is all that we can get, and so they accepted that. http://therealnews.com/t2/index.php?option=com_content&task=view&id=31&Itemid=74&jumival=10805

The Single-Payer Alternative

By Nancy Folbre
The New York Times, November 25, 2013 Rush Limbaugh’s take on the disastrous rollout of the Affordable Care Act could, ironically, warm the hearts of those at the other end of the political spectrum. He contends that President Obama knew all along that the Affordable Care Act would crash and burn, but pushed it through so that the conflagration would clear the way for single-payer health insurance. Yet one of the greatest advantages of a single-payer system — its relatively low administrative costs — has been thrown into sharp relief by problems registering with the new health exchanges. In theory, competition and choice should increase efficiency. In practice, health insurance companies are able to take advantage of the complexity and uncertainty surrounding health care choices to make comparison shopping very difficult. The process of negotiating relationships with new health care providers because old ones are “out of network” is physically and emotionally exhausting. Insurance companies benefit from promoting policies that are difficult to understand and make consumers fearful of any change in their coverage. David Himmelstein and Steffie Woolhandler, co-founders of Physicians for a National Health Program, regularly assert that elimination of the huge paperwork and overhead imposed by private insurance companies could save enough to cover the estimated 31 million of Americans who will remain uninsured under the Affordable Care Act. My fellow Economix blogger Uwe E. Reinhardt, expanding on this theme, notes that the Institute of Medicine of the National Academy of Sciences recently estimated excess administrative costs of $191 billion, again more than enough to attain truly universal health care coverage. Most such estimates are limited to the monetary costs incurred by insurers, doctors and hospitals and don’t include the value of the time that health care consumers must devote to managing a torrent of inscrutable paperwork that can become truly frightening for the critically ill. A single-payer insurance system, whether based on an extension of Medicare or on the Canadian model, promises many profoundly important benefits. Right off the mark, it promises simplicity. No wonder conservative pundits are afraid of it. (Nancy Folbre is professor emerita of economics at the University of Massachusetts, Amherst.) http://economix.blogs.nytimes.com/2013/11/25/the-single-payer-alternative/

Comment:

By Don McCanne, M.D. Experts across the political spectrum have long understood how much more effective a single payer system would be in achieving our goals of universality, comprehensiveness and affordability than is our current financing infrastructure that was left in place by the Affordable Care Act. When this fact was so obvious at the time reform was being crafted, even to President Obama, then why did we reject single payer in favor of our highly flawed system? It was the progressive community, of all people, that took it off of the table. The words of Dean Baker echo the prevailing view of many progressives at that time: “Well, it’d be great to have, you know, universal Medicare, but that wasn’t about to be coming. So basically our choice is having health care provided through private insurers or not having it at all.” So the view was, single payer is the system that will work for us, so let’s choose between expanding our current dysfunctional system of private insurers or let’s have nothing at all. Talk about a non sequitur! Two developments stem from this unwise choice in reform, both related to how unsatisfactory the policies are – costly but all too ineffective. On the one hand, the conservatives opposed to any effective reform are telling us that things are in such a mess that we will have to resort to single payer to bail us out. On the other hand, many progressives, like Professor Nancy Folbre, are now motivated to speak up in favor of single payer since the Affordable Care Act clearly is going to fall intolerably short of our goals. Most moderates and even some conservatives understand the imperative of single payer. The point is that now is the time to talk about single payer, with a loud and clear voice. As the deficiencies in the Affordable Care Act become ever more obvious to the public at large, they need to know that there is a way out. Let’s hear it, loud and clear now: We should have gone for single payer… and we still can!

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Kip Sullivan on “If you like your plan…”

Too little, too late on “You can keep it”

By Trudy Lieberman
Columbia Journalism Review, October 31, 2013 I have a question for all the reporters busy asking whether Obama misled Americans with his oft-repeated line that “if you like your health plan, you can keep it”: Where have you been? You should have challenged this claim well before now. You should have been reporting that some people in the individual insurance market might receive cancellation letters … well before it started happening to them…. http://www.cjr.org/the_second_opinion/reporting_too_little_too_late_on_obamas_you_can_keep_it.php?page=all

The origins of, “If you like your health insurance you can keep it”

By Richard Kirsch
Huffington Post, November 1, 2013 There are good reasons why President Obama’s leading message on health care during the 2008 campaign … was “if you like your health insurance, you can keep it.” That message was created to overcome the fear-mongering that had blocked legislative efforts to make health care a government-guaranteed right in the United States for a century…. As one of the people who engaged early on in building the effort that led to the passage of the Affordable Care Act, I am keenly aware of this history. … As we predicted, the opponents of reform used fear-mongering … to try to kill the Affordable Care Act…. The opponents of reform have used reckless, baseless charges to try to kill reform. I’m glad that President Obama used a slight exaggeration to finally provide secure health coverage for all Americans. http://www.huffingtonpost.com/richard-kirsch/the-origins-of-if-you-lik_b_4190922.html

Comment:

By Kip Sullivan As Trudy Lieberman noted in her article for Columbia Journalism Review, and as some noted as early as 2008 (1), it has been known for a long time that millions of Americans would not be able to keep their health insurance under the Affordable Care Act. Yet President Obama and many other proponents of the ACA claimed this would not happen. They said people who liked their health insurance could keep it. If Obama et al. had made this claim once or twice in the heat of a debate, few would be questioning their integrity now. But they made this claim repeatedly, both before and after the ACA was enacted. The chickens are coming home to roost. Obama and other Democrats are taking a terrible beating for having made a promise they knew or should have known they couldn’t keep. What explains such irrational behavior? In his essay for the Huffington Post, Richard Kirsch takes a stab at an answer. Kirsch is in an ideal position to give us one. He was present at the creation of the marketing strategy that was supposed to neutralize the inevitable attacks on the ACA from the right. Kirsch was the chairman of the “health policy refinement committee” of the Herndon Alliance, a coalition formed in 2005 to promote whatever it was the Democrats decided to put forward in the name of “health care reform,” and he later became the campaign director for Health Care for America Now, the leading organization in the fight to enact whatever it was the Democrats decided they could get through Congress. Kirsch tells us the mantra was invented to “overcome … fear-mongering” that he and the entire rest of the world predicted conservatives would use to stop the ACA. But this argument merely begs another question: Why would the public be reassured by an argument that was so easily rebutted, at first by commonsense and eventually by reality as well? Why wasn’t it obvious to Kirsch et al. that inaccurate statements would come back to haunt the makers of those statements? The answer can be found in the “framing” and “messaging” craze that erupted late in 2004 after John Kerry lost to George Bush.(2) George Lakoff and other “framing” gurus claimed that conservatives were winning elections liberals should have won because conservatives were “messaging” better than liberals. More specifically, the argument was that voters respond to emotions, not “facts,” and if voters and conservatives don’t care about facts, liberals shouldn’t either. Instead, liberals should convene focus groups and conduct polls to determine what buzzwords and claims “resonate” with voters’ emotions – their “frames” – and use those buzzwords and make those claims. In this comment I don’t propose to take sides on whether Lakoff and other “framing” proponents were promoting science or pseudoscience. I do argue that “framing” theology was easily interpreted as an excuse to say anything regardless of the evidence, regardless of whether a proposal or legislation actually existed, and, after legislation had been introduced, regardless of the actual language in that legislation. I argue that that’s what happened to Kirsch, the Herndon Alliance, and other advocates of the ACA. Consider this memo published by the Herndon Alliance and others in June 2008.(3) The memo urged advocates of “health care reform” to claim that “reform” (“reform” was not explained) would: •  guarantee “choice among plans,”
•  guarantee that Americans could “keep our current doctor,”
•  “make insurance companies compete to keep costs down and quality up,”
•  stop insurance companies from “overriding doctors’ decisions about what their patients need,” 
•  keep “deductibles low,” and
•  save “billions by cutting administrative waste and moving to electronic medical records.” The memo made no attempt to document the truthfulness of these claims. That is not surprising, because not one of these claims was accurate then, and not one is accurate now. So how did the Herndon Alliance et al. justify urging advocates to make these claims? They cited “framing” theology. They said these claims had been “market-tested” on focus groups and “online dial groups” of “swing voters” to determine what “frames” lurked in the minds of the participants and what “messages” were consistent with those “frames.” In short, the Herndon Alliance et al. convinced themselves that misrepresentation is moral and effective if the misrepresentation has been shown to elicit positive responses in focus groups and surveys. Several factors contributed to the widespread acceptance of this flimsy rationale for inaccuracy among the leaders of the pro-ACA movement. One was the failure of the media to question the buzzwords and claims concocted by the Herndon Alliance and promoted by HCAN and eventually Obama and members of Congress. Trudy Lieberman criticized the media for this failure even before the ACA was enacted. In a 2009 article she called the Herndon Alliance’s buzzwords “hollow as straw” and “Orwellian” and recommended that reporters “avoid quoting someone who uses those words unless they have something more significant to say.”(4) But the media did not do that, and the Herndon Alliance’s claims quickly mutated into conventional groupthink among leaders of the pro-ACA movement. To those leaders and members of Congress who could have warned Democrats not to repeat “if you like your health insurance etc.” and now lament the fallout from the constant repetition of that canard, I repeat Ms. Lieberman’s question: Where have you been? (1) https://pnhp.org/blog/2013/11/08/editorial-who-first-said-you-can-keep-the-insurance-you-have (2) http://www.nytimes.com/2005/07/17/magazine/17DEMOCRATS.html?pagewanted=all&_r=0G (3) http://familiesusa2.org/assets/pdfs/drew-and-celinda-short-memo-revised-6-11-08.pdf (4) http://www.cjr.org/campaign_desk/what_journalists_can_learn_fro_1.php?page=all

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Private health insurance got us into this mess

By Andrew D. Coates, M.D., F.A.C.P.
WAMC Northeast Public Radio, Nov. 22, 2013
 
The Republican Party projects a perpetual political war against Obamacare. The talking points include things like “Because of Obamacare, I Lost My Insurance,” “Obamacare Increases Health Care Costs,” and that old chestnut, “You can’t trust the government.”
 
Progressive Democrats, in response, have called for a defense of the president and the changes the Affordable Care Act will bring. If the president’s health care law is not defended, the editors of The Nation magazine write, the result will be “a crisis not just for healthcare in America but for the notion that government can and should repair the breaches that threaten civil and humane society.”
 
Within this mainstream debate both sides agree about the stakes – the legitimacy of the government. Yet beneath the narrow terms of the debate, there is an undertow of irony. For all of the Sturm und Drang, neither side proposes fundamental change. But by placing health care at center stage, the real question of the nation’s health can’t be avoided, in spite of efforts to focus and spin the debate.
 
One side says that without the Affordable Care Act we would have the best of all possible worlds. The other side says that although it may be “flawed,” the Affordable Care Act puts us on a path to the best of all possible worlds.
 
Yet in focusing the debate narrowly upon getting or keeping private health insurance, the whole process loses credibility. Instead of one side embarrassing the other side, each side in this debate embarrasses itself.
 
That is because getting private health insurance is not the same as getting health care. Those us working in hospitals and clinics and nursing homes, as well as those of us who are patients have to ask ourselves, “What are they talking about?”
 
To mobilize opposition to Obamacare, congressional Republicans plan to seek out stories from their constituents about the ongoing problems with the health system. To mobilize support, Democratic loyalists vow to help get more people to sign up for private health insurance available through the Affordable Care Act.
 
Any real attention to what this means for patients and their families will highlight the fact that private health insurance has progressively become an unaffordable, defective product. To make premiums “affordable,” co-insurance fees, co-payments and high deductibles have become standard issue. Any serious illness threatens bankruptcy upon our families, even when we have private health insurance.
 
When it comes to getting care, in spite of being the wealthiest nation, in spite of spending more than twice as much per person on health care, the United States lags behind all developed nations in health indicators. We have shocking problems – mediocre and poor health outcomes, unjustifiable disparities, communities that are woefully underserved, with a great burden avoidable illnesses and even outright harm to patients.
 
Private health insurance is what got us into this mess. Private health insurance won’t get us out of it.
 
Most ironically of all, perhaps those who see attacking or defending the president’s health care law bound up with the legitimacy of the government will turn out to be right. Can we call a nation a modern democracy it if fails to meet the health needs of its population?
 
Dr. Andrew Coates practices internal medicine in Upstate New York. He is president of Physicians for a National Health Program.
 
You can listen to Dr. Coates’ radio broadcast here: http://wamc.org/post/coates-private-health-insurance-got-us-mess

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Single-Payer Advocates: It Hurts To Say I Told You So

By Jeffrey Young
Huffington Post, November 22, 2013

The botched implementation of Obamacare has created a bittersweet moment for advocates of a universal, single-payer health care system: They saw this coming, but they can’t gloat about it.

“We may have an ‘I-told-you-so’ moment, but it’s hard to get any pleasure out of it knowing how many people are actually going to get hurt,” said Stephanie Woolhandler, a New York-based doctor who co-founded Physicians for a National Health Program, a group that pushes for universal health care. “You had a bad system, and you’re putting a patch on it using the same flawed insurance companies that got us here in the first place,” she said.

In the seven weeks since the insurance exchanges created by the Affordable Care Act debuted, Obamacare has been defined by faulty websites, millions of canceled health plans and uncertainty about whether President Barack Obama’s administration can set up a new marketplace for private health insurance that protects consumers against industry practices like excluding the sick, while ensuring less-well-off Americans can afford coverage.

Single-payer advocates favor scrapping private health insurance and enrolling everyone in a program akin to Medicare with a comprehensive set of benefits that is financed through taxation, one whose primary focus is providing medical care, not earning profits.

To them, the messiness of Obamacare’s infancy was inevitable; the law is built upon a fragmented health care system and a private insurance industry that they believe, by definition, is focused on profit first and the needs of its customers second.

“What you’re seeing right now is the kind of compromise that was reached, kind of cobbled together, for the Affordable Care Act,” said Sen. Bernie Sanders (I-Vt.) a vocal single-payer supporter who voted for the bill in 2010 after shelving his amendment to create a single-payer plan. “What’s happening now just reinforces to me that what we need is a simple system focused on providing health care,” he said.

The difficulties of launching insurance exchanges in every state and dealing with dozens of insurance companies are considerably greater than just signing up every American for a Medicare-like program, Woolhandler said. “The single-payer system’s simple. They rolled out Medicare less than a year after passage,” he said.

“I have always thought that was the most efficient way to deliver quality health care to people, keeping the best of the private enterprise system but, at the same time, making it possible for all Americans to be covered,” said Rep. Jim McDermott (D-Wash.), a medical doctor who like Sanders has sponsored several single-payer bills.

When Congress debated health-care reform in 2009 and 2010, the creation of a government-run, single-payer program that would provide health coverage to everyone was never seriously considered. Although Obama and many congressional Democrats say they support the idea, none forced it onto the agenda.

“I didn’t talk about single-payer a lot during the run-up because it was clear that was not going to happen, and I didn’t want to get people away from looking at what we can get done,” McDermott said. “We got a hell of a lot done, and I’m proud to be a part of it.”

Democrats focused on preserving and expanding the private health-insurance system, with all its complexities and shortcomings, to minimize disruption for consumers. And in a bid to secure support from insurers, hospitals and other private health care interests, the Senate — with the White House’s blessing — eliminated the so-called public option, a government-run health plan that would have competed alongside private plans on Obamacare’s insurance exchanges.

“When you have a system which is so complex, its main function is to enable insurance companies, drug companies, medical equipment suppliers to be making huge amounts of money off of the system. The more complex it is, the easier it is for them to do that,” Sanders said.

Sanders credits the Affordable Care Act with providing coverage to millions and guaranteeing access to health insurance for people with pre-existing conditions. But he rues the missed opportunity to move the United States in the direction other developed nations went decades ago, especially since study after study shows the American system is more expensive but doesn’t provide the highest-quality care.

“In this whole health care debate, there’s been very little discussion as to why it is that, in America, with 48 million people uninsured, we end up paying almost twice as much as do the people of any other country,” Sanders said. “But we can’t ask that question because the insurance companies and the drug companies are too powerful.”

California Democrat Lee Rogers, a podiatrist from Simi Valley, unsuccessfully challenged Republican Rep. Buck McKeon for Congress in 2012 on a platform emphasizing single-payer, and he plans to run again next year.

To Rogers, the problems with Obamacare’s websites pale in comparison to the program’s greatest shortcoming: It fails to achieve universal coverage. According to the Congressional Budget Office, even though the Affordable Care Act will reduce the ranks of the uninsured by 25 million over the next decade, 30 million people will still lack health coverage.

“It is not universal coverage. It doesn’t even get close to it; it just gets closer. So that’s been a disappointment to me looking at the original way that they had gone about the reform,” Rogers said.

None of these single-payer advocates has given up hope that their goal will one day be achieved, despite the struggles of Obamacare. Sanders’s home state of Vermont is using authority created by the Affordable Care Act to enact its own single-payer program, which is slated to be in place in 2017.

“If Vermont can do it, and do it well, I think it will have a real impact on discussions in other states,” Sanders said.

The troubles of getting Obamacare off the ground could hurt or help the single-payer cause, Sanders said. “What many people are going to say is that the federal government can’t even run a bloody website,” he said. On the other hand, the headaches of the insurance exchanges could generate renewed interest in a more straightforward approach, he said: “We need a system that is not as complicated as this system is.”

Obama tried to make his health care reforms as non-disruptive as he and congressional Democrats thought possible. But the outcry from the several million people whose health insurance plans are being canceled underscores the pitfalls of shaking up the health care system — as throwing out the private insurance industry and enrolling everyone in a single-payer program certainly would.

As McDermott sees it, that’s the price of progress. “Whenever you make a big social change, you’re going to have some turmoil,” he said. “And I don’t get put off by turmoil.”

http://www.huffingtonpost.com/2013/11/22/obamacare-single-payer_n_4312394.html

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Single-payer is the cure

By the Editorial Board
San Francisco Bay Guardian, Nov. 19, 2013 We’re sorry to see all the problems surrounding President Obama’s Affordable Care Act, which has made some important improvements to the country’s healthcare system, such as helping those with preexisting conditions get coverage and preventing those who do have coverage from being arbitrarily dropped. Given a break from being exploited by the insurance industry, there’s no way this country’s citizens will want to go back to how things were. But the convoluted Obamacare system was a foreseeable mess, one that is now causing unnecessary anxiety across the country and bringing right-wing extremists back from the political dead as the mid-term elections approach. Republicans may not be correct when they trumpet the old system as the best on the world, but their criticisms of Obamacare are already finding increasing resonance, and we haven’t even gotten to the point yet where it will be illegal not to have health insurance. It doesn’t make sense to leave something as important as our healthcare system in the hands of for-profit corporations with the incentive to drive up costs. The New York Times has done some excellent work this year showing how US residents pay astronomically more for every procedure and drug than citizens of other countries. We should have all been suspicious when the insurance industry cooperated with enacting Obamacare and helped preclude a public option, leaving us with the insurance exchanges that have been so problematic. There’s really only one remedy to this country’s ailing healthcare system, which we said at the time that Obamacare was being passed and we’ll repeat again now that there’s even more evidence supporting our position: We need socialized medicine in this country. Conservatives who read that assertion are probably shaking their heads in disbelief right now, believing that Obamacare’s shortcomings prove that government can’t run a healthcare system. And the inexcusable technical problems with the federal healthcare.gov website and its related state exchanges unfortunately reinforce that view. But they’re wrong, and the single-payer advocates have been right all along, noting among other things that the government runs Medicare well and with far lower overhead than insurance companies. The problems with Obamacare are similar to the problems it sought to address, and they stem from the fact that an insurance-based model is a terrible way to run a healthcare system. It’s too expensive and does too little to hold down medical costs, it’s confusing and stressful to people who are already wrestling with disease or injury, and it unjustly creates different standards of care for the rich and poor. Socialized medicine — or a single-payer system, administered by either government or a private contractor, but paid for automatically through our taxes — works well in just about every other industrialized country, most of which are far less expensive and yet have better healthcare outcomes. A single-payer system could utilize the existing healthcare infrastructure, it would simply change how we pay for it and bring much-needed price controls and regulatory oversight. Think about it: Healthcare coverage is something that every citizen needs in equal measure. We all need the right to see a doctor when we’re sick or injured. None of us should have to gamble with our health by weighing the cost of various monthly insurance premiums against our likelihood of ending up in the hospital. And it really shouldn’t be up to struggling small businesses to pay expensive health insurance premiums for their employees, even though that’s really the only way to make the fatally flawed insurance model work. There’s infighting among congressional Democrats now about whether to roll back parts of Obamacare, such as hospital subsidies and whether to let people remain on minimal catastrophic coverage plans, and all that will do it upset the careful balance the plan tried to achieve to hold down long-term costs. For now, we need to apply whatever bandages needed to stop the bleeding and limp the flawed Obamacare along for a little while. But we also need to immediately start the difficult work of transitioning to a socialized medicine system. http://www.sfbg.com/2013/11/19/single-payer-cure

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21 ways the Canadian health care system is better than Obamacare

By Ralph Nader
The Nader Page, Nov. 21, 2013
 
Dear America:
 
Costly complexity is baked into Obamacare. No health insurance system is without problems but Canadian style single-payer full Medicare for all is simple, affordable, comprehensive and universal.
 
In the early 1960s, President Lyndon Johnson enrolled 20 million elderly Americans into Medicare in six months. There were no websites. They did it with index cards!
 
Below please find 21 ways the Canadian health care system is better than Obamacare.
 
Repeal Obamacare and replace it with the much more efficient single-payer, everybody in, nobody out, free choice of doctor and hospital.
 
Love, Canada
 
Number 21: In Canada, everyone is covered automatically at birth – everybody in, nobody out. In the United States, under Obamacare, 31 million Americans will still be uninsured by 2023 and millions more will remain underinsured.
 
Number 20: In Canada, the health system is designed to put people, not profits, first. In the United States, Obamacare will do little to curb insurance industry profits and will actually enhance insurance industry profits.
 
Number 19: In Canada, coverage is not tied to a job or dependent on your income – rich and poor are in the same system, the best guaranty of quality. In the United States, under Obamacare, much still depends on your job or income. Lose your job or lose your income, and you might lose your existing health insurance or have to settle for lesser coverage.
 
Number 18: In Canada, health care coverage stays with you for your entire life. In the United States, under Obamacare, for tens of millions of Americans, health care coverage stays with you for as long as you can afford your share.
 
Number 17: In Canada, you can freely choose your doctors and hospitals and keep them. There are no lists of “in-network” vendors and no extra hidden charges for going “out of network.” In the United States, under Obamacare, the in-network list of places where you can get treated is shrinking – thus restricting freedom of choice – and if you want to go out of network, you pay for it.
 
Number 16: In Canada, the health care system is funded by income, sales and corporate taxes that, combined, are much lower than what Americans pay in premiums. In the United States, under Obamacare, for thousands of Americans, it’s pay or die – if you can’t pay, you die. That’s why many thousands will still die every year under Obamacare from lack of health insurance to get diagnosed and treated in time.
 
Number 15: In Canada, there are no complex hospital or doctor bills. In fact, usually you don’t even see a bill. In the United States, under Obamacare, hospital and doctor bills will still be terribly complex, making it impossible to discover the many costly overcharges.
 
Number 14: In Canada, costs are controlled. Canada pays 10 percent of its GDP for its health care system, covering everyone. In the United States, under Obamacare, costs continue to skyrocket. The U.S. currently pays 18 percent of its GDP and still doesn’t cover tens of millions of people.
 
Number 13: In Canada, it is unheard of for anyone to go bankrupt due to health care costs. In the United States, under Obamacare, health care driven bankruptcy will continue to plague Americans.
 
Number 12: In Canada, simplicity leads to major savings in administrative costs and overhead. In the United States, under Obamacare, complexity will lead to ratcheting up administrative costs and overhead.
 
Number 11: In Canada, when you go to a doctor or hospital the first thing they ask you is: “What’s wrong?” In the United States, the first thing they ask you is: “What kind of insurance do you have?”
 
Number 10: In Canada, the government negotiates drug prices so they are more affordable. In the United States, under Obamacare, Congress made it specifically illegal for the government to negotiate drug prices for volume purchases, so they remain unaffordable.
 
Number 9: In Canada, the government health care funds are not profitably diverted to the top 1 percent. In the United States, under Obamacare, health care funds will continue to flow to the top. In 2012, CEOs at six of the largest insurance companies in the U.S. received a total of $83.3 million in pay, plus benefits.
 
Number 8: In Canada, there are no necessary co-pays or deductibles. In the United States, under Obamacare, the deductibles and co-pays will continue to be unaffordable for many millions of Americans.
 
Number 7: In Canada, the health care system contributes to social solidarity and national pride. In the United States, Obamacare is divisive, with rich and poor in different systems and tens of millions left out or with sorely limited benefits.
 
Number 6: In Canada, delays in health care are not due to the cost of insurance. In the United States, under Obamacare, patients without health insurance or who are underinsured will continue to delay or forgo care and put their lives at risk.
 
Number 5: In Canada, nobody dies due to lack of health insurance. In the United States, under Obamacare, many thousands will continue to die every year due to lack of health insurance.
 
Number 4: In Canada, an increasing majority supports their health care system, which costs half as much, per person, as in the United States. And in Canada, everyone is covered. In the United States, a majority – many for different reasons – oppose Obamacare.
 
Number 3: In Canada, the tax payments to fund the health care system are progressive – the lowest 20 percent pays 6 percent of income into the system while the highest 20 percent pays 8 percent. In the United States, under Obamacare, the poor pay a larger share of their income for health care than the affluent.
 
Number 2: In Canada, the administration of the system is simple. You get a health care card when you are born. And you swipe it when you go to a doctor or hospital. End of story. In the United States, Obamacare’s 2,500 pages-plus regulations (the Canadian Medicare Bill was 13 pages) is so complex that then Speaker of the House Nancy Pelosi said before passage “we have to pass the bill so that you can find out what is in it.”
 
Number 1: In Canada, the majority of citizens love their health care system. In the United States, the majority of citizens, physicians, and nurses prefer the Canadian type system – single-payer, free choice of doctor and hospital , everybody in, nobody out.
 
For more information see Single Payer Action.
 
Ralph Nader is a consumer advocate, lawyer, and author. He has founded many organizations, including the Center for Study of Responsive Law, the Public Interest Research Group (PIRG), and Public Citizen.
 
http://nader.org/2013/11/21/21-ways-canadian-health-care-system-better-obamacare/

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A perspective on the relationship between national and state single-payer efforts

By Steffie Woolhandler, M.D., and David Himmelstein, M.D.
 
PNHP note: The following article was among the materials distributed to participants at PNHP’s Annual Meeting in Boston on Nov. 2, 2013.
 
Virtually all single-payer supporters aspire to a nationwide reform. Absent a national solution, many regions with the gravest problems in access to care will lag further and further behind. Living in New York or Massachusetts doesn’t lessen our sense of responsibility for millions in the Deep South and other “red state” areas for whom national legislation is the only realistic option for health care progress.
 
Yet with the Congress currently tied in knots, prospects for the passage of a national single-payer bill are dim for the next few years. Meanwhile, in a number of states the political environment offers more openings for single-payer work, in no small part due to years of work by local PNHP members and other activists. These efforts are educating and pressuring many state legislators, and even governors, to embrace single payer – at least rhetorically. We outline below our views of the opportunities and obstacles to state-based work.
 
Opportunities
 
1. In some locales, the apparently lower bar to state single-payer legislation is facilitating mobilization of activists who might be daunted by the scale and seemingly dim prospects for congressional action.
 
2. State-based efforts empower local leadership. Such local leadership is critical to development of a nationwide movement.
 
3. Media outlets are often more willing to cover state-based efforts, both because they view such efforts as more feasible and because attention to local issues and personalities is a central focus of local media.
 
4. State legislators and local politicians who become single-payer supporters influence, and sometimes themselves become, U.S. representatives and senators.
 
5. State programs can be tailored to address local problems, e.g. thorny rural health issues.
 
6. Some feel that a state program may avoid some of baggage of Washington-based lobbying and rule making. The Affordable Care Act, flawed from the outset, has been further compromised in HHS’ rule-making process, which has bent to corporate pressures.
 
7. Many point to the Saskatchewan example of state- (or province-) level reform that served as a springboard to national legislation.
 
Obstacles
 
1. Federal waivers are required to include Medicare, Medicaid and SCHIP enrollees in a state single payer. While HHS can grant Medicaid and SCHIP waivers, an act of Congress is required for a Medicare waiver.
 
2. Leaving Medicare outside of the single-payer funding stream makes it impossible to realize many cost savings possible under a true single-payer reform. Hospitals can’t be paid global budgets, precluding the elimination of their wasteful per-patient billing apparatus; health planning via control of new capital investments is obstructed; and Medicare-paid, for-profit HMOs, dialysis facilities, hospices, home care agencies, etc., will continue to distort the system.
 
3. Waivers are not without risk. We fear that conservative forces in red states may take advantage of loosened federal restrictions on Medicaid, and particularly Medicare, to further undermine these programs. For instance, while Massachusetts was able to secure a progressive Medicaid waiver to help fund care of the uninsured, Arkansas took advantage of this process to fully privatize its Medicaid program.
 
4. It’s not clear how – absent an act of Congress – a state program could fully integrate federal workers and military personnel and retirees covered by Tricare. As with Medicare, maintaining these separate funding streams sacrifices most administrative cost savings.
 
5. In some states, many people cross state borders to work and get medical care, greatly complicating the design of state-based programs.
 
6. The political power of corporations is highly portable. While national insurers, drug firms and billionaire conservative activists often stand back in earlier stages of state single-payer efforts, as a state moves closer to implementation we can expect a massive influx of outside funding for efforts to disrupt it. Hence, the advantage of a locally progressive political climate is likely to erode as a movement gets closer to binding legislation.
 
7. State (but not federal) programs must skirt the federal ERISA law that prohibits state regulation of employee benefits, i.e. to ban private coverage that duplicates the single-payer coverage. Such duplicate private coverage erodes political support for continued adequate funding of the public system, and encourages the development of two-class care.
 
8. While the Saskatchewan example is inspiring, its applicability in the U.S. context is questionable. The division of powers under the Canadian constitution reserves most responsibility for health care to the provinces; the Canadian federal government exercises leverage almost exclusively by offering the provinces funding. Hence, Saskatchewan faced few federal hurdles to implementation.
 
9. Applying the term “single payer” to a state program compromised by corporate and federal government interference risks sullying the public image of such reform.
 
In sum, we believe that state-level work offers a valuable opportunity to educate and mobilize for single payer. But we’re also convinced that a fully workable state program is not possible without explicit congressional endorsement, or at least acquiescence. Hence a continuing focus on national-level work is essential, not only to save Texas, but to allow real progress in Vermont.
 
Drs. Steffie Woolhandler and David Himmelstein are professors at the City University School of Public Health at Hunter College and visiting professors at Harvard Medical School. They are co-founders of Physicians for a National Health Program.

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A Simpler, Better Solution

By David Himmelstein and Steffie Woolhandler
The New York Times, Room for Debate, May 29, 2013
 
PNHP note: The following article by PNHP’s co-founders, while written in May, is still pertinent. For the most recent analysis, see our Articles of Interest, Dr. Don McCanne’s Quote of the Day, and the public radio commentaries of PNHP’s president, Dr. Andrew D. Coates.
 
Gordon Schiff, an expert on medical quality, frequently admonishes: “Avoid workarounds.” It’s better to fix system defects than to force doctors and nurses to squander time and creativity (and to court disaster) by sidestepping problems like broken equipment, missing charts or computer bugs.
 
The Affordable Care Act is a giant workaround. Overwhelming evidence says that public insurers like Medicare (with overhead costs of 2 percent) are more efficient than private ones (overhead of private Medicare Advantage plans is 14 percent). And multiple insurers means multiple contracts, with varying coverage, billing procedures, documentation requirements, etc. – all of which force doctors and hospitals to waste billions more. The obvious fix is to cut out the insurance middlemen and cover everyone under a single public program paid for by taxes – with equal coverage for all. But the insurance lobby blocked that, so instead the Affordable Care Act took the Rube Goldberg route.
 
If your income is below $31,321 for a family of four (133 percent of the poverty line), you will get Medicaid (unless you live in a red state that declined the federal assistance, like Texas or Alabama). And “Medicaid” nowadays means a privately run Medicaid H.M.O. But make one dollar more (or if Junior moves out, leaving a family of three) and Medicaid disappears; now you’re shopping for subsidized private insurance in the state-run exchange. That’s not a rare occurrence: 28 million adults cross the 133 percent line annually.
 
In the exchange, “bronze” plans look cheapest – at first glance. But if your income is under 250 percent of poverty there are special discounts for copayments, but only in “silver” plans.
 
Move from 400 percent of poverty to 401 percent, and individual premiums rise $2,303. Can’t quit smoking? Add $3,365.
 
Stop paying your premium? You’ll stay enrolled for three months, but your insurer only has to pay your medical bills for one month.
 
The health care law’s consumer protections apply to everyone, except the 58.5 percent of private sector workers whose employers self-insure.
 
Employers who do not offer coverage must pay a fine, unless you work less than 30 hours a week, averaged over three months, or maybe 12 months.
 
Small employers can get help with premiums, unless they buy coverage through a Taft-Hartley Fund.
 
Got it? We don’t either. And there’s much more arcane detail that can mean life or death for thousands, penury or plenty for millions.
 
Government already pays two-thirds of total health costs, but much of that money takes a detour through a maze of private insurers. This manufactured complexity sows confusion and adds huge expense – the cost of a workaround.
 
David Himmelstein and Steffie Woolhandler are professors at the City University School of Public Health at Hunter College and visiting professors at Harvard Medical School. They are co-founders of Physicians for a National Health Program.
 
http://www.nytimes.com/roomfordebate/2013/05/29/is-obamacare-too-complicated-to-succeed/a-single-payer-system-would-be-better-than-obamacare

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Single-payer easier, more efficient method of health insurance

By Michael C. Huntington, M.D.
Corvallis Gazette-Times, Letters, Nov. 19, 2013 I agree with Peter Day when he said in his letter Oct. 21 letter that the Affordable Care Act (“Obamacare”) is a great deal for the insurance companies because it uses government authority to force people to buy private insurance. He ended his letter with the comment that he did not know the answer to our health care mess, but that the ACA was a step in the wrong direction. The answer to our health care mess is a publicly designed, financed and managed health care system, commonly known as single-payer healthcare or Medicare For All. The Affordable Care Act, despite its good features such as prohibition of insurance denial because of pre-existing conditions, is programmed to fail because it does not control costs, and it maintains the fragmented private insurance system that is geared for profit of a few instead of health for all. The very complicated system of eligibilities and subsidies in the ACA has made its rollout unnecessarily complex. Medicare was quickly implemented in 1965 using index cards to register people. Eligibility was easy to define, i.e., if you were 65 years of age or more, you qualified. We simply need to open Medicare to all residents of the nation and use scientific evidence and public review, as other nations do, to determine what services actually produce health and should be paid for. By doing so we could reduce costs of healthcare by 20 percent to 30 percent and eliminate healthcare-induced bankruptcies and untold suffering due to neglected illness. Dr. Michael C. Huntington resides in Corvallis. http://www.gazettetimes.com/news/opinion/mailbag/letter-single-payer-easier-more-efficient-method-of-health-insurance/article_a4a24f76-50f4-11e3-8bbf-001a4bcf887a.html

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Single-Payer Plan, Not Obamacare, Will Mend Healthcare, Panelists Tell F&M Crowd

By Peter Durantine
Franklin & Marshall College News, Nov. 19, 2013 PHILADELPHIA – The Affordable Care Act, also known as Obamacare, will not heal America’s “wasteful, fractured healthcare system,” a four-member panel of healthcare experts told a Franklin & Marshall College audience Nov. 18.
 
The panelists advocated for a single-payer system in which the federal government would absorb the cost of care. Funding would come from a healthcare tax that would be based on income level. They also said it would drive down costs by eliminating the majority of administrative expenses.
 
“Single-payer is not only fair, it’s moral,” said Patty Eakin, president of the 5,500-member Pennsylvania Association of Staff Nurses and Allied Professionals, who has been a registered nurse for 37 years. “I’d say the system we have now is immoral.”
 
Organized by F&M’s Department of Economics under the direction of Professor of Economics Sean Flaherty, the public event, “Beyond Obamacare: Fixing a Broken Healthcare System with a One-Payer Solution and a Focus on Prevention and Healing, Not Profits,” brought together members of the campus and local community in Lisa Bonchek Adams Auditorium in Kaufman Hall to gain insights into the national conversation on health care reform.
 
“We’re not trying to undo Obamacare,” said the event’s moderator, Chuck Pennacchio, executive director of the grassroots advocacy group Healthcare For All PA. “We’re trying to work with Obamacare and take it to the next step.”
 
In arguing for a single-payer system, which, among other things, would eliminate filing insurance claims, the panelists provided an array of statistics that showed that the poor pay more for healthcare than the wealthy, and that administrative costs and waste consumed two-thirds of the nation’s healthcare costs.
 
“Healthcare is becoming more and more expensive, and the burden is not being borne equally,” said Professor of Economics Gerald Friedman of the University of Massachusetts, Amherst. Friedman has conducted a comparative study on the economics of the single-payer systems employed around the world.
 
During his presentation, Friedman showed the cost of healthcare has increased from 6 percent of average wages in 1970 to 20 percent in 2010. The percentage is projected to rise to 24 percent in 2021. Among low-income working Americans, 25 percent of income goes to healthcare, versus 5 percent for the wealthiest Americans.
 
Healthcare costs vs. life expectancy
 
Friedman said the United States spends more per capita on healthcare than any other nation, yet ranks among the lowest in life expectancy.
 
“The reason we die young compared to other countries is because we lack access to healthcare,” Friedman said. And why? “Because of costs.”
 
Rising costs limit access to quality care, even for people with insurance, and compel manufacturers to move operations overseas to avoid labor-related healthcare costs, said another panelist, Walter Tsou, board adviser to Physicians for a National Health Program and an expert on health reform and healthcare financing. He briefs members of Congress on healthcare issues.
 
“Our labor costs are out of control,” Tsou said. “In another 50 years we really are going to become a second-class nation.”
 
Tsou said that in 2008 the U.S. spent $7,538 per capita on healthcare, with 31 percent of that total covering administrative costs. That same year, Taiwan spent $1,087 per capita, of which 1.6 percent went to administrative costs. Yet, Taiwan has a higher life expectancy than the U.S., he said.
 
“The current trend in healthcare costs are going to bankrupt this country,” Tsou said.
 
The fourth panelist, Tom Gates, a physician for 30 years who works in Family and Community Medicine at Lancaster General Hospital, said wasteful spending, to the tune of $765 billion a year, inflates healthcare costs by 30 percent.
 
A fundamental change in how physicians are paid could significantly reduce costs, he said, noting that the current process of paying doctors on a fee-for-service basis creates incentives for ordering unnecessary office visits and procedures.
 
Gates said that a single-payer system would also eliminate the high markups hospitals place on certain services, procedures and prescriptions in order to realize a profit from what insurance companies are willing to pay.
 
The decline of general practitioners over the last five to six decades, and the rise of doctor specialists, also have contributed to lower-quality care and higher costs, Gates said. In 1930, the ratio of general practitioners to specialists was 80:20. By 1970 those numbers had reversed.
 
“We let the tradition of general practice disappear,” Gates said.
 
One F&M student, senior Adam Taylor, a government and economics major, wasn’t convinced America needed a single-payer system, but he called the event “informative.”
 
Another student, Jack Mandy, a senior business major who said he came in thinking that a single-payer plan was socialist, said the discussion was enlightening.
 
“I didn’t realize how much waste was going on,” Mandy said. “I thought it was socialist. Now I agree that [single-payer] is very patriotic.”
 
Flaherty, who was pleased by the student and public turnout for the event that filled about half the auditorium, said, “I don’t know how you can hear these statistics and not think that something radical has to be done. I’m not saying something radical is going to be done, but the fight has to be fought.”
 
http://www.fandm.edu/news/article/single-payer-plan-not-obamacare-will-mend-healthcare-panelists-tell-f-m-crowd

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Low payment rates for exchange plans threaten adequacy of provider networks

Doctors Complain They Will Be Paid Less By Exchange Plans

By Roni Caryn Rabin
Kaiser Health News, November 19, 2013 Many doctors are disturbed they will be paid less — often a lot less — to care for the millions of patients projected to buy coverage through the health law’s new insurance marketplaces. Some have complained to medical associations, including those in New York, California, Connecticut, Texas and Georgia, saying the discounted rates could lead to a two-tiered system in which fewer doctors participate, potentially making it harder for consumers to get the care they need. “As it is, there is a shortage of primary care physicians in the country, and they don’t have enough time to see all the patients who are calling them,” said Peter Cunningham, a senior fellow at the nonpartisan Center for Studying Health System Change in Washington D.C. If providers are paid less, “are [enrollees] going to have difficulty getting physicians to accept them as patients?” Physicians are uncomfortable discussing their rates because of antitrust laws, and insurers say the information is proprietary. But information cobbled together from interviews suggests that if the Medicare pays $90 for an office visit of a complex nature, and a commercial plan pays $100 or more, some exchange plans are offering $60 to $70. Insurance officials acknowledge they have reduced rates in some plans, saying they are under enormous pressure to keep premiums affordable. They say physicians will make up for the lower pay by seeing more patients, since the plans tend to have smaller networks of doctors. http://www.kaiserhealthnews.org/Stories/2013/November/19/doctor-rates-marketplace-insurance-plans.aspx

Comment:

By Don McCanne, M.D. Insurers will be paying physicians less through their exchange plans than they do through their existing commercial plans. If the rates turn out to be typically 30 or 40 percent less, as this article suggests, they will have problems maintaining adequate provider networks. An insurance card is of little value if you cannot find physicians who will accept it. As we said from the start, those designing health care reform were making a terrible mistake when they decided to make health insurance premiums affordable while largely ignoring health care costs. Look what they did: * They assigned very low actuarial values to the plans that most individuals will select, leaving 30 to 40 percent of health care costs to be paid by the patient, though some will receive inadequate subsidies. * They designed plans with very high deductibles, causing the large percentage of patients who need less care to receive virtually no sickness or injury benefits from their plans. * They reduced the size of their provider networks which will reduce spending by making care less accessible, especially specialized care. * Now it appears that they will be reducing provider payments to levels that will be rejected by many physicians. Although employer-sponsored plans are moving in the same direction, it is likely that many physicians will limit their practices to these plans and cash-paying patients, while avoiding patients in the exchange plans and the chronically-underfunded Medicaid program. * As part of the SGR fix, legislators are considering not allowing any inflationary increases in the Medicare program for the next ten years – keeping the payment rates flat. If so, physicians are apt to leave the Medicare program as payment rates approach that of Medicaid. As we approach $3 trillion in health care spending, this is criminal! For that kind of spending, everyone could have high quality health care. Instead, we get a system that perpetuates disparities in health care while creating financial burdens for precisely those individuals who most need health care. The entire health care system will not collapse, but this experiment will perform so miserably that most will consider it to be a failure. We don’t need to go back to the drawing boards. We merely need to enact a system that we already know will achieve our goals – an improved Medicare for all.

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