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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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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Truthout, Nov. 16, 2013 PNHP note: Here are three items of special interest to single-payer supporters who were involved with, or followed, the Occupy Wall Street movement.

Two Years After the Eviction of OWS, Here’s 5 People Keeping the Movement Alive

By Kathleen Ann Bradley
Yes! Magazine It was a cold night in late January 2012. The New York subway doors opened and a tall, dark-haired, 30-ish young man dressed entirely in black—leather jacket, jeans, and boots—stepped into the car. Hanging from his backpack were an orange plastic bullhorn and a small drum; tied on top was a thin sleeping mat. He was one of the small army of Occupy Wall Streeters who had been driven from the park on November 15—two years ago today. He and some friends had been camping out in a vacant house to prevent the bank from foreclosing on it, he told us, but the winter weather had forced them to leave. After protesters like him were evicted, no one knew where the movement was going and what it was going to do next. Two years later, though, the answers to those questions are beginning to become clear. One way to get a handle on what became of the Occupy movement is to track the continuing work of its participants, five of whom we’ve profiled here. All of them were active in Occupy encampments, and now they are focused on channeling the energy and commitment to direct social action that fueled the movement into ensuring that Occupy groups born in the parks will continue to grow and work for lasting change. Laurie Wen: Healthcare for the 99% Just a week or so into the occupation, Laurie Wen and other members of Physicians for a National Health Program joined a solidarity march and then camped out overnight in Zuccotti Park to advocate for single-payer, publicly financed universal health insurance. “That is still the mission of the group,” she says. At the group’s speak-outs and teach-ins in parks around the city, doctors and patients talked about what is wrong with the nation’s healthcare system and how to fix it. “The doctors would talk about how painful it is to see their patients suffering because they don’t have enough insurance or have the wrong kind,” Wen says. During “99 Doctors Give Flu Shots to the 99%,” an event the group held on November 13, 2011, members gave a couple hundred flu shots to people in Zuccotti Park. They also held rallies and marches—some targeting private insurance companies “because their mission is profit, not necessarily to provide care,” Wen says. “And that very much jibes with the central tenet of OWS—corporate greed versus human need.” Physicians for a National Health Program continues to advocate for putting human needs first, she says. Right now they’re working on a bill that would provide universal single payer healthcare in New York state, and pushing for its passage. “We have majority co-sponsorship in the New York State Assembly—enough legislators to pass the bill if Speaker Sheldon Silver would just bring it to the floor.” The group also supports the proposed “Robin Hood tax” on financial speculation. “That money could very well fund a lot of human needs,” she notes, “including health care.” Full: http://truth-out.org/news/item/20084-two-years-after-the-eviction-of-ows-heres-5-people-keeping-the-movement-alive *****

Reflections on Occupy

By Katie Robbins
At the Heart of an Occupation blog, Oct. 14, 2013 I started showing up at Liberty Square a few days after the occupation began. I was living in New York and working on single-payer universal health care and had been doing that for about four years. I had basically come to the realization that the political process was broken, that in order to have any sort of fair debate about how to provide health care to people in this country we would have to have some serious change in the political process and in the influence that corporations have over that process. I had followed the debate of the biggest players—the pharmaceutical companies, the hospitals, the insurance companies making a law that would benefit their interest and not the people or the people’s health. Anytime we tried to insert our message, we ran into brick walls. I was actually arrested in Congress in 2009 trying to get Max Baucus to let doctors and nurses testify on behalf of the need for a universal health care system. The tactic of camping out and occupying a space had been used in New York City and other places before Occupy Wall Street started. There was the Bloombergville demonstration at City Hall a year prior. I was excited to see people coming together, but I didn’t quite see how I fit in until there was a movement happening. It was so exciting. I showed up with friends of mine, and we started to navigate through the aspects of what it would look like to have a specific working group around healthcare, and we started Health Care for the 99%. We supported the work of the medic tent. We helped with supplies. When we did engage people who were medical professionals or had some kind of training, we would make sure that they knew that the medic tent was always looking for volunteers. We also worked on the more political aspect of the health care system that’s dominated by corporate interests. We raised awareness around that.Just looking at the signs people had at Zuccotti Park showed how important health care was to people there. I remember a woman holding a sign that said, “The dogs I walk have health insurance, but I don’t.” We had a pretty tremendous response from the beginning on the issue of health care. We had a really active working group that met weekly, sometimes more than weekly for more than a year. We’re still around, but there aren’t regular meetings. We will come together as Health Care for the 99% when we can. We had founded the group in late September of 2011. A few weeks later, we called for a demonstration on health insurance companies to protest their greed and their denial of care to people, and we had five hundred people show up for this demonstration, and we marched for a while. Across the street from Liberty Square is a Blue Cross Blue Shield office, which is a subsidiary of the largest private health insurance company in the country, so we started there and marched up to St. Vincent’s Hospital. It had been closed a few years ago to be turned into luxury condos, leaving the lower west side without a hospital, which is really a public health crisis in New York City—to have that much space without an emergency room to help people. That hospital had such a long history of being a part of the community. It was really devastating to see that kind of decision made, seeing something people so desperately need to have in their community taken away from them, turned into the last thing that we need more of in this city, which is more condos. The hospital closing issue is still going on, and people in our group are still very involved with that. There are hospitals being closed in Brooklyn illegally. In addition to that, we had speak-outs for consciousness-raising.  We would come together, and people would step forward and share their health care testimonial. It was such a powerful process. We still have this network of people that continue to work in some capacity with health care. Doctors, nurses and health professional have been involved. There have been existing groups in New York for some time, like the New York State Nurses Association and National Nurses United, who are hugely important for getting energy going. There’s also Physicians for a National Health Program and Health Care Now. They’ve all been working on this issue, but Occupy helped to solidify and bring a lot of people together that hadn’t been working together. It was an important time. Occupy helped to bring attention to the deep inequality in the country. The majority of the people have been so left out of the process and so marginalized. Anytime we can model and put into motion alternative ways of living or organizing ourselves is a really important exercise in thinking about developing another world, which is probably going to be a reality for us at some point. A lot of people talk about the unsustainability of our lifestyle. There are probably going to be some big changes because it’s not possible to continue our way of life forever. I think it’s really important that people come together and really imagine alternative ways of existing that don’t rely on capitalism. In the United States, unlike any other developed industrialized countries, we rely on a totally commoditized health care system. We have rationing based on if you can pay for health care. If you can’t pay for it, then you’re not going to get it. We do have programs to assist people who might have trouble paying, but they are very limited. It’s very hard to be eligible. There’s inconsistency and restrictions in care. The kind of profits being made off of health care, off of sick people, are huge, and that in and of itself is a totally moral crisis. Just the morality of the health care system, the fact that it’s based on requiring payment in order to receive care from the individual to the provider is immoral, but there’s also the economic crisis, which is that we spend twice as much as any other country on health care, but we get so much less. We have huge numbers of people who are totally uninsured. Even after the Affordable Care Act or Obamacare is implemented, they are estimating around 30 million people will remain uninsured. In addition, we will have a new growing concept of underinsured, which is people who have insurance and pay a lot of money for this insurance but still can’t afford to use that insurance because of the financial barrios—co-pays, huge deductibles. All of those things really add up, and people are going to have a really difficult time making ends meet even though they supposedly have this insurance, which is supposed to protect you from bankruptcy and guarantee that you get the health care you need when you need it, but private health insurance doesn’t do either. About 60% of bankruptcies are due to medical debt. When most of those people filed for bankruptcy, they had health insurance. That problem isn’t going to go away, unfortunately, even with the changes that we’re seeing to the health care system through Obamacare. There’s an increase in consolidation of corporate power within the health care system. I hear the expression that patients are treated more and more like widgets as electronic medical records are utilized. The way it’s being implemented is that the doctor or the nurse is so engrossed in a database and entering information into a computer that they’re not even looking at the patient to see what’s going on with them. That’s not good health care. People will have to think about alternative means of caring for themselves, quite frankly. We just won’t be able to get it form the system. We need to think creatively about how we make sure it’s still available to people. For me personally, I have a $15,000 annual deductible for my family, so we ration care all of the time, and it resets every year. We are so on the brink of bankruptcy should we ever have a serious illness. Our insurance works best for us when we don’t use it, so we just try to avoid using it as much as possible. I’m a student in Public Health, so I don’t do a lot of direct care service, but I know that there are a lot of doctors and nurses who can tell you a new story everyday about how the lack of insurance or the restrictions of a private health insurance company have hurt the patient, either by delaying the care that they need, costing too much or lack of insurance preventing them the care that they need totally. I would like to see a world that meets human needs, where we think logically about how to use our resources collectively, where we can imagine a way of exchanging services not based on a monetary foundation, where we realize that there are other ways to measure human experience and enhance our lives and make us be full human beings living with dignity. For me, what it would feel like is the energy that I put in, the work that I do would be rewarded by society. I wouldn’t have to choose between rent or health insurance. I wouldn’t have to make a decision to skip a meal, so that I can pay my electric bill. These kinds of choices would be eliminated, and there would be a fair system rewarding people on the work they do. That includes things that we consider work now and things that we don’t. Women, for example, raise up an entire generation of people in this country for free. I imagine that there would be a more fair social contract with the people around us, and that could take a lot of different shapes. It’s more about the principles of fairness and not ignoring the work we do to exist and be part of a society. For me, it would mean that I would have more time and less stress. Maybe I could create things. I love to paint. I like to garden, and I rarely get to do the things that I most want to do. People would be able to pursue their actual interests. Occupy made me realize that I should value the parts of my life in ways that society may not. Another world IS possible. http://attheheartofanoccupation.blogspot.com/2013/10/katie-robbins.html *****

Occupy’s ‘Strike Debt’ buys debt cheaply… then forgives it

RT America, Nov. 14, 2013 (video) http://www.youtube.com/watch?v=VaFGC8jGS3k Jacques LaRoche of Strike Debt talking about the Rolling Jubilee’s recent purchase of medical debt.

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