PNHP

New Coalition to Advocate for Universal Health Care in Oregon

New Coalition to Advocate for Universal Health Care in Oregon

'Oregon's current health care system is neither humane nor cost-effective'

Salem-News.com (Ore.), Feb. 4, 2012

PORTLAND, Ore. — Delegates from 28 unions, nonprofits and grassroots organizations gathered in Portland on Friday, January 27, to form a new coalition that will advocate for universal health care in Oregon and the U.S. Seven labor unions joined with 21 community organizations to sign the membership agreement, approve bylaws, and elect an interim executive committee.

The coalition grew out of a partnership between four organizations – Health Care for All–Oregon, Portland Jobs With Justice, Mad As Hell Doctors (MAHD) and Physicians for a National Health Program (PNHP). Two years ago these organizations formed the Oregon Single Payer Campaign (OSPC), which last year organized a conference at the First Unitarian Church in Portland attended by 500 people. OSPC also spearheaded the introduction of HB 3510 last year in the Oregon legislature by Rep. Michael Dembrow (D-HD 45). HB 3510 would create a single-payer financing system that guaranteed universal access to health care for all Oregonians, including the more than 600,000 Oregonians who do not have health insurance. Rep. Dembrow was in attendance at the founding meeting of the coalition.

The goal of OSPC was to get the issue of universal access health care on the table, since its advocates had been shut out of the federal health care reform debate,” said Michael Moore, delegate from Sisters of the Road and newly elected interim president of the coalition. “The goal of the new coalition is to engage all communities across Oregon in a conversation about what we can and should expect from our health care system. We think providing universal access, as almost all other industrialized nations do, is the only truly humane and cost-effective system available. We need a broad and diverse coalition of organizations to help us understand how to take that message to all the constituencies we need to reach.

Oregon’s current health care system is neither humane nor cost-effective. The only health care resources available to many uninsured adults are hospital emergency rooms and pay-for-service options at some clinics. Even in communities such as Scappoose, only 21 miles from Portland, the Oregon Health Sciences University clinic does not accept uninsured patients. In Oregon, it is estimated that the cost of uncompensated care for uninsured and under-insured adults and children will exceed $1.1 billion in 2012.

Rosalie Pedroza, delegate from the Rural Organizing Project, said, “In rural communities, many areas don¹t have insurance options, and facilities are limited. Current cost increases are unsustainable; we need affordable health care for all.”

The unions signing on to the coalition’s founding are: American Federation of Government Employees Local 2157, Communication Workers of America Local 7901, Laborers Local 483, National Association of Letter Carriers Branch 82, National Association of Social Workers ­ Oregon, Oregon Nurses’ Association and Service Employees International Union Local 49. The nonprofits joining them are: Alliance for Democracy, Center for Inter-cultural Organizing, Community Alliance of Tenants, Elders in Action, Fellowship of Reconciliation, Health Care for All Oregon, Health Care for All Oregon–Eugene, Jobs with Justice-Central Oregon, Jobs with Justice–Portland, Jobs with Justice–Southern Oregon, Mad as Hell Doctors, Mid-Valley Health Care Advocates, Oregon Action, Oregon Latino Health Coalition, OSPC-Florence Organizing Committee, Physicians for a National Health Program–Eugene, Mid Valley and Portland, Rural Organizing Project, Sisters of the Road. The Tree Institute, and Universal Health Care for Oregon. Six affiliated or pledged organizations were unable to attend, and ten organizations sent delegates as observers.

The coalition does not plan to introduce legislation this year. In the near term, it will focus on grassroots community organizing and outreach. It plans to meet again in six to eight weeks to elect a full board of directors, develop a strategic plan and finalize the selection of a name.

http://www.salem-news.com/articles/february042012/healthcare-oregon.php

The battle for Vermont's health

Insurance firms seeking to sow doubt about proposed single-payer system

By Wendell Potter
iWatch News, Feb. 6, 2012

MONTPELIER, Vt. — You can’t see them. They’re hidden from view and probably always will be. But the health insurance industry’s big guns are in place and pointed directly at the citizens of Vermont.

Health insurers were not able to stop the state’s drive last year toward a single-payer health care system, which insurers have spent millions to scare Americans into believing would be the worst thing ever. Despite the ceaseless spin, Vermont lawmakers last May demonstrated they could not be bought nor intimidated when they became the first in the nation to pass a bill that will probably establish a single-payer beachhead in the U.S.

When he signed Act 48 into law on May 27, surrounded by dozens of state residents who worked for many years to achieve universal coverage, Governor Peter Shumlin expressed great pride in what had been accomplished.

“We gather here today to launch the first single payer system in America, to do in Vermont what has taken too long—to have a health care (system) that is the best in the world, that treats health care as a right and not a privilege, where health care follows the individual, not the employer,” Shumlin said.

The problem for Shumlin and his allies is this: it will take five years before Vermont can fully implement its new system, partly because the federal health care reform law prohibits states from undertaking more far-reaching reforms until 2017 unless granted waivers from the feds to do so. And though Vermont’s Congressional delegation is on board to pursue a waiver that would let the state set up a single payer system two years from now, the insurance industry’s friends in Washington are not keen to let that happen. That’s because they want to use those five years to persuade Vermonters that they really don’t want to go the single payer route after all.

During my 20 years as a health insurance PR executive, I was involved in numerous efforts to make the very term “single payer” toxic to most Americans. We even spent hundreds of thousands of premium dollars in 2007 to help finance the operation of a front group, called Health Care America, for the sole purpose of trashing a movie — Michael Moore’s “Sicko” — that put single payer systems abroad in a favorable light. You can rest assured that the industry will spend much, much more to make sure that Vermont does not succeed.

I have observed in Vermont over the past several days just how the invisible hand of the insurance industry is working. Insurers know their efforts will be more effective if they can get others — third party advocates, they call them — to carry out them out. I recognized the campaign because the tactics are the same as those used in previous attempts to kill reforms insurers don’t like.

Part of the strategy is to get key groups of individuals to begin raising doubts, to get Vermonters to second-guess themselves. Among the first groups the insurers have targeted are those most easily spooked — certain business owners and physicians, especially specialists who thrive in the current system.

Last Wednesday, legislators got a sampling of what they’re in for. At a hearing on creation of the state’s health care exchange, or marketplace — mandated by the federal reform law — employers worried about losing the ability to choose from numerous competing insurers. And they worried too about not being able to shift their employees into benefit plans with high deductibles. Insurers and employers have been collaborating for the past several years in a mutually beneficial effort to shift more of us into high-deductible policies. The higher the deductible, the less insurers and employers have to pay for our care. This collaboration has been so successful that increasing numbers of American families filing for bankruptcy are, at least theoretically, insured.

At a hearing a few days earlier in Rutland, this one for health care providers, several physicians were, wittingly or not, using some of the same industry talking points I used to write for insurers’ allies.

Dermatologist Dan McCauliffe was one of several doctors there who suggested that patients needed to pay more — not less — out of their own pocket for care. Ironically, this skin doctor joined other physician specialists in arguing that health care costs would never stabilize until patients had “more skin in the game,” a term my former colleagues used frequently as we tried to spin the “advantages” of high-deductible plans. According to statistics from the American Medical Association, dermatologists are among the highest paid specialists, making on average more than $230,000. 

So why do insurers care so much about Vermont? Even though Vermont is a small state where most for-profit insurers have little business, the insurers don’t want a single state to go single payer. Just last week, single payer advocates in California fell just a few votes short of getting a bill to the floor of the Senate for a vote. If Vermont succeeds, California lawmakers might actually get the votes they need. 

Health insurers make enormous amounts of money off of us, something they cannot do so effectively in other countries, especially Canada. The four largest insurers, United, WellPoint, Aetna and CIGNA, reported earning a combined $11 billion on nearly $220 billion in revenues last year. For years insurers have been successful in persuading Americans to believe something that is at best debatable — that they play a useful role in the U.S. health care system. They are nervous that if Vermont proves to the rest of the country that health insurers are about as useful as teats on a boar, they might have to figure out another way to make a few billion bucks.

Former CIGNA executive-turned-whistleblower Wendell Potter writes about the health care industry and the ongoing battle for health reform. Potter is the author of “Deadly Spin: An Insurance Company Insider Speaks Out on How Corporate PR is Killing Health Care and Deceiving Americans.”

http://www.iwatchnews.org/2012/02/06/8094/analysis-battle-vermonts-health

The battle for Vermont’s health

Insurance firms seeking to sow doubt about proposed single-payer system

By Wendell Potter
iWatch News, Feb. 6, 2012

MONTPELIER, Vt. — You can’t see them. They’re hidden from view and probably always will be. But the health insurance industry’s big guns are in place and pointed directly at the citizens of Vermont.

Health insurers were not able to stop the state’s drive last year toward a single-payer health care system, which insurers have spent millions to scare Americans into believing would be the worst thing ever. Despite the ceaseless spin, Vermont lawmakers last May demonstrated they could not be bought nor intimidated when they became the first in the nation to pass a bill that will probably establish a single-payer beachhead in the U.S.

When he signed Act 48 into law on May 27, surrounded by dozens of state residents who worked for many years to achieve universal coverage, Governor Peter Shumlin expressed great pride in what had been accomplished.

“We gather here today to launch the first single payer system in America, to do in Vermont what has taken too long—to have a health care (system) that is the best in the world, that treats health care as a right and not a privilege, where health care follows the individual, not the employer,” Shumlin said.

The problem for Shumlin and his allies is this: it will take five years before Vermont can fully implement its new system, partly because the federal health care reform law prohibits states from undertaking more far-reaching reforms until 2017 unless granted waivers from the feds to do so. And though Vermont’s Congressional delegation is on board to pursue a waiver that would let the state set up a single payer system two years from now, the insurance industry’s friends in Washington are not keen to let that happen. That’s because they want to use those five years to persuade Vermonters that they really don’t want to go the single payer route after all.

During my 20 years as a health insurance PR executive, I was involved in numerous efforts to make the very term “single payer” toxic to most Americans. We even spent hundreds of thousands of premium dollars in 2007 to help finance the operation of a front group, called Health Care America, for the sole purpose of trashing a movie — Michael Moore’s “Sicko” — that put single payer systems abroad in a favorable light. You can rest assured that the industry will spend much, much more to make sure that Vermont does not succeed.

I have observed in Vermont over the past several days just how the invisible hand of the insurance industry is working. Insurers know their efforts will be more effective if they can get others — third party advocates, they call them — to carry out them out. I recognized the campaign because the tactics are the same as those used in previous attempts to kill reforms insurers don’t like.

Part of the strategy is to get key groups of individuals to begin raising doubts, to get Vermonters to second-guess themselves. Among the first groups the insurers have targeted are those most easily spooked — certain business owners and physicians, especially specialists who thrive in the current system.

Last Wednesday, legislators got a sampling of what they’re in for. At a hearing on creation of the state’s health care exchange, or marketplace — mandated by the federal reform law — employers worried about losing the ability to choose from numerous competing insurers. And they worried too about not being able to shift their employees into benefit plans with high deductibles. Insurers and employers have been collaborating for the past several years in a mutually beneficial effort to shift more of us into high-deductible policies. The higher the deductible, the less insurers and employers have to pay for our care. This collaboration has been so successful that increasing numbers of American families filing for bankruptcy are, at least theoretically, insured.

At a hearing a few days earlier in Rutland, this one for health care providers, several physicians were, wittingly or not, using some of the same industry talking points I used to write for insurers’ allies.

Dermatologist Dan McCauliffe was one of several doctors there who suggested that patients needed to pay more — not less — out of their own pocket for care. Ironically, this skin doctor joined other physician specialists in arguing that health care costs would never stabilize until patients had “more skin in the game,” a term my former colleagues used frequently as we tried to spin the “advantages” of high-deductible plans. According to statistics from the American Medical Association, dermatologists are among the highest paid specialists, making on average more than $230,000. 

So why do insurers care so much about Vermont? Even though Vermont is a small state where most for-profit insurers have little business, the insurers don’t want a single state to go single payer. Just last week, single payer advocates in California fell just a few votes short of getting a bill to the floor of the Senate for a vote. If Vermont succeeds, California lawmakers might actually get the votes they need. 

Health insurers make enormous amounts of money off of us, something they cannot do so effectively in other countries, especially Canada. The four largest insurers, United, WellPoint, Aetna and CIGNA, reported earning a combined $11 billion on nearly $220 billion in revenues last year. For years insurers have been successful in persuading Americans to believe something that is at best debatable — that they play a useful role in the U.S. health care system. They are nervous that if Vermont proves to the rest of the country that health insurers are about as useful as teats on a boar, they might have to figure out another way to make a few billion bucks.

Former CIGNA executive-turned-whistleblower Wendell Potter writes about the health care industry and the ongoing battle for health reform. Potter is the author of “Deadly Spin: An Insurance Company Insider Speaks Out on How Corporate PR is Killing Health Care and Deceiving Americans.”

http://www.iwatchnews.org/2012/02/06/8094/analysis-battle-vermonts-health

Uwe Reinhardt describes single payer, and we respond

Health Care Payers Push Back Against Costs

By Uwe E. Reinhardt
The New York Times, February 3, 2012
In a paper, “Divide et Impera: Protecting the Growth of Health Care Incomes (Costs),” published this month in the British journal Health Economics, I summarize themes touched on here and there in several earlier posts on this blog.
My argument in the paper is that what is often called overuse of health care by what are often described as excessively insured Americans — especially their use of high-cost, high-tech procedures — is at best a partial explanation for the high cost of American health care.
Yet cost-containment initiatives like high deductibles and co-insurance have taken use of health care as their chief target. These efforts will be only partly successful in controlling national health spending.
Equally important contributors to our high health spending, and probably more so, have been two other factors.
The first is the much higher administrative overhead costs loaded onto the American health system. David Cutler and Dan Ly, both of Harvard University, illuminate this proposition in their recent paper, “The (Paper) Work of Medicine: Understanding International Medical Costs,” in which they compare health spending in Canada and the United States.
Earlier, in a 2003 paper, “Costs of Health Care Administration in the United States and Canada,” Dr. Steffie Woolhandler, Terry Campbell and Dr. David Himmelstein estimated that in 1999 total administrative costs of health insurers and all other parties in health care, save patients, accounted for 31 percent of health care expenditures in the United States and 16.7 percent of health care expenditures in Canada.
A second major factor accounting for high health spending per capita in the United States is the significantly higher prices Americans pay for virtually all health care services and products.
My thesis on this issue — expressed in the title of my paper — is that these much higher prices are the product of a deliberate strategy, hashed out in our political bazaars between the supply side of health care and state and federal legislators, always to keep the payment side of our health system fragmented and relatively weak vis à vis the supply side of health care.
http://economix.blogs.nytimes.com/2012/02/03/health-care-payers-push-back-against-costs/

All comments originally published on the NYT blog
Don McCanne
San Juan Capistrano, CA
In his paper, “Divide et Impera,” Professor Reinhardt discusses three approaches to controlling health spending: single payer, all-payer, and rationing by prices.
The last, of course, is what we now have and is rejected by most of us who wish to see a more humane method of financing care. It is still supported by those who believe the health care consumer should use their own funds to shop for care, even though these supporters are reluctant to call it what is is – rationing by ability to pay.
In his article, single payer is dismissed based on lack of political feasibility, a view widely held in the United States.
In contrast, Dr, Reinhardt discusses an all-payer system in which prices are standardized and budgeted by associations – a great improvement over our current system (which Dr. Reinhardt discussed in a previous blog). However, he states, “Admittedly, a transition from the current to an all-payer system for all providers of health care in all states would be challenging, both analytically and politically.”
Politically challenging. Isn’t that like questioning political feasibility?
Is the political hurdle for an equitable and efficient single payer system really that much greater than the hurdle for a less efficient, less equitable and more fragmented all-payer system?
If we’re going to have to break down political barriers, why don’t we go for the best?
http://economix.blogs.nytimes.com/2012/02/03/health-care-payers-push-back-against-costs/?comments#permid=1

Nathan Punwani
Cambridge, MA
If we’re really interested in cost control, do we really need a public option? What about an all-payer system? What are the advantages and disadvantages of an all-payer system relative to a single-payer system (besides private insurers don’t like single payer)?
Nathan Punwani
MPH Candidate – Harvard School of Public Health
http://economix.blogs.nytimes.com/2012/02/03/health-care-payers-push-back-against-costs/?comments#permid=24

And…

Uwe Reinhardt
Princeton, NJ
The advantages of a single-payer system are:
1. They are simple and easily understood by all concerned.
2. They foster egalitarian health care delivery, because they usually are financed on the ability-to-pay principle. and providers are paid the same fee regardless of the socio-economic status of the patient.
3. They are ideal platforms for the smart application of electronic health information systems.
4. They have relatively low administrative overhead costs.
5. They give the insurer (the single-payer) a financial incentive to invest in preventive care and behavioral health care, because patients have automatic life cycle insurance under these systems so that the insurer reaps the savings in acute care treatment costs over the longer run.
6. Cost control is easy with these systems.
The disadvantages are:
1. Prospective insured do not have a choice among different insurers and different benefit packages.
2. Government, which usually operates these systems, may underfund them relative to what the people actually want and would be willing to pay for, although one should think that in a properly functioning democracy that could not go on for very long.
3. Mistakes at the center in coverage or payment matters quickly diffuse to all corners of the system.
4. Some people, notably Americans, just oppose all forms of centralized power, however efficient it may be.
http://economix.blogs.nytimes.com/2012/02/03/health-care-payers-push-back-against-costs/?comments#permid=24:15

Don McCanne
San Juan Capistrano, CA
Some of the other effective tools of the single payer model, as supported by Physicians for a National Health Program, include the following:
* Administratively efficient global budgeting of hospitals, as with police and fire departments
* Negotiation of fair rates with physicians
* Bulk purchasing of pharmaceuticals, like the VA
* Reducing diversion of patient care funds by eliminating for-profit corporations and their passive investors
* Planning and separate budgeting of capital improvements to prevent wasteful excess capacity, while ensuring adequate capacity in under-served areas
* Replacing choice of restrictive, wasteful, expensive private insurers with the choice we want – choice of our health care professionals and institutions
The greatest problem with single payer systems is that conservative governments strive to privatize and underfund the programs, such as the current efforts in England and Canada, and also here with the conservative attack on our Medicare program. Such anti-egalitarian approaches tend to shift burdensome costs to patients who are already suffering from ill health.
The efficient and equitable policies of the single payer model which would provide us with much greater value in our health care purchasing are precisely what we need. It’s the politics that we need to change, something that we should be able to do with a “properly functioning democracy.”
http://economix.blogs.nytimes.com/2012/02/03/health-care-payers-push-back-against-costs/?comments#permid=24:17

A word about the Susan G. Komen Foundation

A Painful Betrayal

Editorial
The New York Times, February 2, 2012

With its roster of corporate sponsors and the pink ribbons that lend a halo to almost any kind of product you can think of, the Susan G. Komen for the Cure foundation has a longstanding reputation as a staunch protector of women’s health. That reputation suffered a grievous, perhaps mortal, wound this week from the news that Komen, the world’s largest breast cancer organization, decided to betray that mission. It threw itself into the middle of one of America’s nastiest political battles, on the side of hard-right forces working to demonize Planned Parenthood and undermine women’s health and freedom.

The Associated Press reported on Tuesday that the foundation is cutting off its financing of breast cancer screening and education programs run by Planned Parenthood affiliates. That means nearly $700,000 less for Planned Parenthood, which performed 750,000 such screenings last year, many thousands of them with money from the Komen foundation.

http://www.nytimes.com/2012/02/03/opinion/a-painful-betrayal.html

And…

Consolidated Statements of Functional Expenses

The Susan G. Komen Breast Cancer Foundation, Inc.
Year Ended March 31, 2011

Public support and revenue – $471,750,158

Program services
Research – $75,301,537
Public health education – $181,092,283
Health Screening Services – $54,089,036
Treatment services – $23,251,563
Total program services – $333,734,419

http://ww5.komen.org/uploadedFiles/Content/AboutUs/Financial/2011%20Komen%20Financial%20Statements%20FINAL(3).pdf

Comment: 

By Don McCanne, MD

Nothing further needs to be said about how unwise it was for the Susan G. Komen Foundation to cut off funds for breast cancer services at Planned Parenthood facilities. Having made an error so grievous that some suggest could result in the demise of this public service organization dedicated to fighting breast cancer, we should ask if we can afford to lose their contributions to this effort.

We need to take a look at their program services.

The $75 million that they spend on research could easily be incorporated into the budget of the National Institutes of Health, the world’s largest medical research institute.

The $181 million spent on public education has reached all of us through their pink ribbon campaign. Although it certainly is important for the public to know about screening mammography, isn’t it likely that this will still be common knowledge, even without the pink ribbons?

The $54 million for screening and the $23 million for treatment actually are already being paid for by taxpayers. If you consider that the marginal tax rate for Komen donors likely averages about 30 percent, then tax subsidies for the $471 million in public support amount to about $141 million, far more than the $77 million being spent on screening and treatment. In fact, the balance of our tax subsidies would pay for most of the research that they fund.

A more fundamental question is why aren’t all women guaranteed appropriate screening and necessary treatment for breast cancer? They would be if we had a single payer national health program – an improved Medicare for all. If so, the loss of the Komen Foundation would not be all that tragic, though it is still painful to say that.

A word about the Susan G. Komen Foundation

A Painful Betrayal

Editorial
The New York Times, February 2, 2012
With its roster of corporate sponsors and the pink ribbons that lend a halo to almost any kind of product you can think of, the Susan G. Komen for the Cure foundation has a longstanding reputation as a staunch protector of women’s health. That reputation suffered a grievous, perhaps mortal, wound this week from the news that Komen, the world’s largest breast cancer organization, decided to betray that mission. It threw itself into the middle of one of America’s nastiest political battles, on the side of hard-right forces working to demonize Planned Parenthood and undermine women’s health and freedom.
The Associated Press reported on Tuesday that the foundation is cutting off its financing of breast cancer screening and education programs run by Planned Parenthood affiliates. That means nearly $700,000 less for Planned Parenthood, which performed 750,000 such screenings last year, many thousands of them with money from the Komen foundation.
http://www.nytimes.com/2012/02/03/opinion/a-painful-betrayal.html

And…

Consolidated Statements of Functional Expenses

The Susan G. Komen Breast Cancer Foundation, Inc.
Year Ended March 31, 2011
Public support and revenue – $471,750,158
Program services
Research – $75,301,537
Public health education – $181,092,283
Health Screening Services – $54,089,036
Treatment services – $23,251,563
Total program services – $333,734,419
http://ww5.komen.org/uploadedFiles/Content/AboutUs/Financial/2011%20Komen%20Financial%20Statements%20FINAL(3).pdf

Nothing further needs to be said about how unwise it was for the Susan G. Komen Foundation to cut off funds for breast cancer services at Planned Parenthood facilities. Having made an error so grievous that some suggest could result in the demise of this public service organization dedicated to fighting breast cancer, we should ask if we can afford to lose their contributions to this effort.
We need to take a look at their program services.
The $75 million that they spend on research could easily be incorporated into the budget of the National Institutes of Health, the world’s largest medical research institute.
The $181 million spent on public education has reached all of us through their pink ribbon campaign. Although it certainly is important for the public to know about screening mammography, isn’t it likely that this will still be common knowledge, even without the pink ribbons?
The $54 million for screening and the $23 million for treatment actually are already being paid for by taxpayers. If you consider that the marginal tax rate for Komen donors likely averages about 30 percent, then tax subsidies for the $471 million in public support amount to about $141 million, far more than the $77 million being spent on screening and treatment. In fact, the balance of our tax subsidies would pay for most of the research that they fund.
A more fundamental question is why aren’t all women guaranteed appropriate screening and necessary treatment for breast cancer? They would be if we had a single payer national health program – an improved Medicare for all. If so, the loss of the Komen Foundation would not be all that tragic, though it is still painful to say that.

More bad news about "essential health benefits"

HHS Essential Benefits 'Bulletin' Draws Tide Of Comments

Kaiser Health News
February 2, 2012

As the official window of time allowed for groups to react to the Department of Health and Human Services essential benefits proposal closed, a variety of objections, concerns and common themes became clear.

CQ HealthBeat: State ‘Flexibility’ For Essential Benefits Gets Cool Reception

A tide of objections and worries rolled in just before Tuesday’s deadline for health groups to react to a Department of Health and Human Services proposal on essential health benefits. Input from health interests and consumers on the benefits “bulletin” is not being made public by the Obama administration, which asked that comments be sent to an email address rather than posted on a government website as would be the practice with a proposed regulation (Norman, 2/1).

Politico Pro: EHB Comments Show Some Common Themes

Believe it or not, businesses, insurers and consumers do see eye to eye on essential health benefits — well, on some parts, anyway. They’re at odds on some of the bigger issues, which doesn’t exactly come as a surprise. The comments submitted to HHS on its essential health benefits approach shows a wide divide between consumers … and businesses and insurers, who don’t see enough safeguards to keep the essential health benefits package affordable (Millman, 2/2).

http://www.kaiserhealthnews.org/Daily-Reports/2012/February/02/essential-benefits.aspx

Comment:

By Don McCanne, MD

Yesterday we reported that some of the most politically powerful organizations in the nation have joined together in a coalition to try to weaken the package of “essential health benefits” that will be required of health plans under the Affordable Care Act.  Excerpts from two new articles covered in the Kaiser Daily Health Policy Report should have us even more concerned.

In Politico Pro, it is reported that businesses and insurers “don’t see enough safeguards to keep the essential health benefits package affordable.” The proposal already has reduced the required benefits down to the relatively austere level of small group plans offered in the various states. These plans leave patients facing financial hardship when they must access health care.

Yet the powerful businesses and insurers want an even lower standard of benefits in order to keep the health benefits package affordable. The insurers want to protect their markets by keeping the insurance premiums affordable, and businesses also want the lowest premiums they can negotiate. Low premiums equate with higher out-of-pocket expenses for those with medical needs. In trying to make the health insurance plans more affordable, actual health care for the patients will be even less affordable.

As we have seen, the process has always been about powerful interests, with only a passive concern for patients.

In CQ HealthBeat, we see that comments on the proposal are being “sent to an email address rather than posted on a government website as would be the practice with a proposed regulation,” and are “not being made public by the Obama administration.”

The White House gave these special interests carte blanche with secretive access during the reform process. Secrecy continues. Should we be surprised when the final rule on “essential health benefits” pleases business and insurance interests, at a cost of exposing those with health care needs to greater financial hardship? No, not surprised. Outraged is more like it!

More bad news about “essential health benefits”

HHS Essential Benefits ‘Bulletin’ Draws Tide Of Comments

Kaiser Health News
February 2, 2012

As the official window of time allowed for groups to react to the Department of Health and Human Services essential benefits proposal closed, a variety of objections, concerns and common themes became clear.

CQ HealthBeat: State ‘Flexibility’ For Essential Benefits Gets Cool Reception

A tide of objections and worries rolled in just before Tuesday’s deadline for health groups to react to a Department of Health and Human Services proposal on essential health benefits. Input from health interests and consumers on the benefits “bulletin” is not being made public by the Obama administration, which asked that comments be sent to an email address rather than posted on a government website as would be the practice with a proposed regulation (Norman, 2/1).

Politico Pro: EHB Comments Show Some Common Themes

Believe it or not, businesses, insurers and consumers do see eye to eye on essential health benefits — well, on some parts, anyway. They’re at odds on some of the bigger issues, which doesn’t exactly come as a surprise. The comments submitted to HHS on its essential health benefits approach shows a wide divide between consumers … and businesses and insurers, who don’t see enough safeguards to keep the essential health benefits package affordable (Millman, 2/2).

http://www.kaiserhealthnews.org/Daily-Reports/2012/February/02/essential-benefits.aspx

Comment:

By Don McCanne, MD

Yesterday we reported that some of the most politically powerful organizations in the nation have joined together in a coalition to try to weaken the package of “essential health benefits” that will be required of health plans under the Affordable Care Act.  Excerpts from two new articles covered in the Kaiser Daily Health Policy Report should have us even more concerned.

In Politico Pro, it is reported that businesses and insurers “don’t see enough safeguards to keep the essential health benefits package affordable.” The proposal already has reduced the required benefits down to the relatively austere level of small group plans offered in the various states. These plans leave patients facing financial hardship when they must access health care.

Yet the powerful businesses and insurers want an even lower standard of benefits in order to keep the health benefits package affordable. The insurers want to protect their markets by keeping the insurance premiums affordable, and businesses also want the lowest premiums they can negotiate. Low premiums equate with higher out-of-pocket expenses for those with medical needs. In trying to make the health insurance plans more affordable, actual health care for the patients will be even less affordable.

As we have seen, the process has always been about powerful interests, with only a passive concern for patients.

In CQ HealthBeat, we see that comments on the proposal are being “sent to an email address rather than posted on a government website as would be the practice with a proposed regulation,” and are “not being made public by the Obama administration.”

The White House gave these special interests carte blanche with secretive access during the reform process. Secrecy continues. Should we be surprised when the final rule on “essential health benefits” pleases business and insurance interests, at a cost of exposing those with health care needs to greater financial hardship? No, not surprised. Outraged is more like it!

Time to raise our voices: health justice still not won

The following remarks by Dr. Claudia Fegan, past president of Physicians for a National Health Program, were delivered to the annual strategy conference of Healthcare-Now! on Jan. 28 in Houston.

By Claudia Fegan, M.D.


Dr. Claudia Fegan

On Jan. 19, Sarah Burke, a Canadian treasure, a pioneer in the sport of freeskiing who was instrumental in getting that sport added to the next Winter Olympics, died at the age of 29.

Sarah, a resident of British Columbia, died from injuries sustained in a fall on Jan.10 at the end of a practice run in Salt Lake City, Utah.

Sarah Burke was a phenomenal skier, immensely talented and tremendously enthusiastic about her sport. If you want to see grace in motion you should search Sarah Burke’s name on YouTube. She soared like an eagle and glided through the air effortlessly.

Immediately following her death her young husband and parents were presented with a bill for $550,000.

While she is Canadian and had cradle-to-grave coverage by Canadian medicare, she did not have coverage for this accident which occurred in the United States. She was covered by her professional skiing organization when she participated in sanctioned events; however, her training run in Salt Lake City was not a part of a sanctioned event.

Now it is true Canadians were stunned by the bill she had racked up during her 10-day ICU stay. However, they were shocked to learn that how much you are billed depends upon your insurance status. They were even more appalled to discover that being uninsured would result in being charged more for health care than if you were insured.

Sarah’s friends took to the Internet and have already raised $294,200 toward her outstanding bills. Unfortunately, most of the 50 million people who are uninsured in the United States today aren’t lucky enough to have a following to raise money to pay their medical bills.

That brings me to why I am here today. I would like to do five things this evening, although my English teacher husband tells me I should never to try to do more than three. So here goes:

1. I want to tell you what I do

2. Tell you why I do what I do

3. Tell you what Barack Obama did

4. Tell you why you must do why you must do what I do

5. Tell you how you can do it

What I do

So I am the Chief Medical Officer for the John H. Stroger Jr. Hospital of Cook County, or as most people outside of Chicago know us, Cook County Hospital. We are unusual among the public hospitals that remain open in the United States today because we still take care of everyone who comes to our door, regardless of their ability to pay.

That means last year 80 percent of the outpatients we saw were uninsured. Fifty-six percent of the patients we admitted were uninsured. The variance is because almost a quarter of those we admitted were able to get insurance once they were in the hospital and we had a chance to apply for coverage on their behalf.

Over the years I have spoken a lot about health care and I usually speak about my patients.

I remember at the Democratic National Convention in 2008 I talked about my patient Nina, who was a hairdresser who had no insurance. When she found a lump in her breast she was afraid to come to the hospital. When her daughter finally brought her in both breasts were rock hard and the tumor had begun to drain from one of the breasts.

Camille had been diagnosed with breast cancer when she was employed and was initially cared for at the University of Chicago where got excellent care. A couple of years later, after she had been laid off, she began to have problems again. Her surgical oncologist wouldn’t return her phone calls and her oncologist told her she couldn’t see her without insurance. So she came to County, where we took care of her.

I have talked about my 63-year-old patient Delois who needed a hip replacement because her joint had been destroyed by arthritis and she had bone grinding on bone. At County we don’t do joint replacements because we can’t afford the prosthetics. All we can do is give those patients pain medication, try to get them disability coverage so they can go somewhere else or wait for them to turn 65.

Then there is my patient Joan, who after a career as a bookkeeper thought she could contribute more to society by teaching music to children. She was frugal with her funds, purchased a small studio and some instruments. She hired instructors, most of them part-time. It means most of the instructors are musicians or schoolteachers whose available time coincides with when there is the most demand for lessons.

For years Joan was able to provide affordable lessons for students and sometimes free instruments for students who couldn’t afford them. She never made much money, but it gives her great joy to bring music to children. Joan does this work because she says it makes us a better society.

In the last three years the number of parents bringing their children for lessons has decreased, the expenses for the studio have increased and Joan has struggled to make ends meet.

For years I have managed Joan’s blood pressure and that has been a cost-saving to her because in the Cook County Health and Hospital System we charge patients based on their ability to pay. So last winter when she fell from her bicycle in Chicago snow and broke her ankle, there was no one to raise money for the surgery she would need to put it back together. With a broken ankle she couldn’t even climb the stairs to her second-floor studio.

Joan did the only thing she knew to do — she dragged herself with her broken ankle to our emergency room, where she knew she would be treated with dignity and respect and where she knew she would not receive a bigger bill because she was uninsured. Surgery went well and Joan has not traded her bike for a car; she has splurged on a three-wheeler instead.

So what I do is advocate for the 50 million uninsured in this country who seek nothing more than Health Care Justice. Yes, I personally take care of the Ninas, Deloises, Camilles and Joans who come to our doors, but in my spare time I fight for social justice.

Why do I do what I do?

Martin Luther King said, “The time is always right to do what’s right.” Well it is not right to punish people who don’t hav
e health insurance. We live in one of the wealthiest, most powerful nations in the world. We have no problems marching all over this world to tell developing nations how they should treat their citizens and yet we don’t have the common decency to provide for our own.

We are an arrogant lot, we Americans. We always think we know what is best for everyone else, but we refuse to look in the mirror and see the indignity and humiliation we impose on those of who do not have health insurance in this country.

We allow the health insurance industry and the pharmaceutical industry to profit tremendously on the misfortunes of many. Most pharmaceutical companies today are multinational entities that sell the same medications in the U.S. as they sell elsewhere in the world, but in the U.S. they are able to sell these medications for twice, three times and sometimes 10 times as much as they sell them elsewhere. That is because the U.S. allows them to sell medications for whatever the market will bear and most of the rest of the world regulates the cost of medications.

Why do I do what I do? Because my parents taught me right from wrong and they taught me to fight for what is right. What we do to people in this country without health insurance is wrong. Single-Payer National Health Insurance would provide our country with health care justice and that is right.

What did Barack Obama do?

Barack Obama pushed for and passed the Patient Protection and Affordable Care Act. Now let’s be clear, I’m a big fan of Barack Obama. His home in Chicago is less than two blocks from mine, he was my state representative before he was my senator and he is a very smart man.

But at the end of the day, he is a politician and I am a physician. I think our values are different, not right or wrong, just different. I think he is the best president we have had in a generation, but it is the job of a politician to compromise and I happen to disagree with where he has chosen to compromise. Passing the Patient Protection and Affordable Care Act was nothing short of miraculous — every single president since Franklin Roosevelt attempted to pass legislation for national health insurance, and not one before Obama had succeeded.

In the book “The Heart of Power,” David Blumenthal chronicles the efforts of presidents from Franklin Roosevelt through George W. Bush to achieve access to health care for the American public. He writes, “Major health reform is virtually impossible: difficult to understand, swarming with interests, powered by money, and resonating with popular anxiety.”

Blumenthal quotes congressional veteran and co-chair of the 9/11 Commission, Lee Hamilton: “Health care is so difficult because Congress is an incremental body and health care is a non-incremental issue.”

PPACA, or the Affordable Care Act as it is commonly called today¸ is badly flawed. It has no cost containment and will not address the issues of cost, access and quality. Single payer will.

Why must you do what I do?

The Affordable Care Act, once fully implemented, will leave 23 million people uninsured. About 45,000 people die each year as a result of not having health insurance, which means 180,000 more people will die before full implementation of the Affordable Care Act.

Single payer will cover everyone.

Barack Obama worked hard and maneuvered a massive piece of legislation through an intellectually constipated Congress, but he did not get us what we need. We need health care justice for this country.

He and others might argue that we did not make him fight for single payer. We weren’t marching up the front lawn of Congress or the White House shouting for it, or not shouting loudly enough, so there was no incentive for those on the inside to fight for it.

We didn’t lose the war to gain access to health care for all Americans. We got battered in an ugly skirmish, but we’re not done.

It is time to change our tactics

The opportunity for change is still ahead of us. The Affordable Care Act has not made health care a right.

Access to care in this country a profit center controlled by the insurance industry. We pay them to limit access to care. We spend more per capita on health care than any country in the world more than $7,500 per person and yet we are ranked only 37th in the world by the World Health Organization for the care we provide.

What we have done now is required everyone to purchase insurance. For those who can’t afford it, we’ve required states to either cover them under Medicaid or we’ve provided federal subsidies so they can purchase private insurance.

This is an industry that has a history of profiteering by retroactively denying coverage to people with illnesses. So now we are requiring everyone to buy coverage and, yes, we have told the insurance companies they can’t deny coverage to those with illnesses.

My question is this: Why can’t we just pay for care without having to go through the insurance industry?

We spend enough money on health care in this country. We just let too many people who aren’t involved in providing care take profit from it.

This is about justice. Health care should be a right to which everyone is entitled.

Remember we live in the wealthiest country in the world. We spend more on health care than any other country; it is time we got our money’s worth. It is time we got the health care we deserve, not the care the insurance industry is willing to let us have. It is time we made health care a right and not a privilege.

How can you do it?

You have to speak up. You have to speak loudly. You have to make your voices heard. The Affordable Care Act is an opportunity. It is not going to work!

You have to remind the people that there is still a simpler, easier solution. People want to know, they have questions. They will ask, is the new health law the answer? Will this work? Will this solve the problem? The answer is NO, the answer is NO!

The Affordable Care Act didn’t go too far, it didn’t go far enough and we can’t be afraid to say that. You have to tell the truth, you have to fight for what is right. You can’t be afraid to tell our representatives who are under attack from the right that what they have done in not enough and there are important points on which they cannot compromise. They need us to demand single payer, they need us to make them do it.

Being right is not enough; you have to fight and you have to fight hard to win the hearts and minds of th
e American public.

I keep reminding you that this is an issue of social justice and issues of social justice require struggle and tenacity because there are always reactionary forces ready and willing to push back against change. There are always people who benefit from the status quo. They will resist the change that will provide more for the many and instead want to retain the most for a few. We have to fight that.

My father was a labor union organizer, but he loved literature. He taught me a poem by Langston Hughes that I think applies to our current struggle. It is called “Mother to Son.”

Mother to Son

Well, son, I’ll tell you:
Life for me ain’t been no crystal stair.
It’s had tacks in it,
And splinters,
And boards torn up,
And places with no carpet on the floor —
Bare.
But all the time
I’se been a-climbin’ on,
And reachin’ landin’s,
And turnin’ corners,
And sometimes goin’ in the dark
Where there ain’t been no light.
So, boy, don’t you turn back.
Don’t you set down on the steps.
‘Cause you finds it’s kinder hard.
Don’t you fall now —
For I’se still goin’, honey,
I’se still climbin’,
And life for me ain’t been no crystal stair.

You are going to spend some time tonight and tomorrow discussing strategy, it is important that strategy be about getting the politicians to do what is right and not about compromising on the basic principle of single payer: Everybody in and nobody out! Everybody in and nobody out!

Calif. single-payer campaign to begin new push

Special to The Union
The Union (Grass Valley, Calif.), Feb. 1, 2012

The Campaign for a Healthy California on Wednesday denounced the failure of the California Senate to pass SB 810, the California Universal Care Act. The bill died when it remained two votes short of passage.

Democrats fell short of previous levels of support, which successfully passed similar bills through the legislature twice before, only to be vetoed by then Gov. Arnold Schwarzenegger. This year 19 voted in favor of the bill, two against, and four abstaining in spite of intensive efforts at persuasion by grassroots proponents. The bill received no support from Republicans.

The California Universal Care Act would have created a single public health insurance program for all Californians, much like an improved Medicare-for-All plan that has been proposed at the federal level.

CHC member organizations spoke out against the disappointing vote, “Nurses will not give up on winning guaranteed universal healthcare, like SB 810” stated DeAnn McEwen, RN, co-president of the California Nurses Association, “because we will not abandon our patients who need this vital reform.”

Nan Brasmer, president of the California Alliance for Retired Americans, stated: “This is a very sad day for seniors and all Californians. With millions of us uninsured or underinsured, SB 810 offered the only solution to our skyrocketing health care costs while covering everyone. And the added bonus is that it would save the State billions of dollars once implemented, at a time when essential programs for seniors are being slashed and out of pocket costs for health care have gone through the roof. We will continue to fight for single payer in the legislature and at the ballot box.”

SB 810 would create a new California Healthcare System to provide health insurance for all Californians, replacing the private insurance providers. Critics claim that such as system, often referred to as “single payer,” would be too costly. “Not true,” said Dr. Henry L. Abrons, president of PNHP California. “Currently the U.S. spends twice as much as any other country on health care. We have plenty of money in the system, enough to insure 100% of us; we just need to spend it more wisely.” He continued, “The best way to save money is to take the private insurers out of the system. They are responsible for 30% of each healthcare dollar being lost to pay for exorbitant CEO salaries, lobbyists, sales and marketing, administration and shareholder profit. Medicare’s overhead by contrast is only 3%. Californians would still be free to seek services from any medical provider in the private sector — only the financing would change. The difference is that that everyone in California would be fully covered.”

Joseph Foy, spokesman for the California Health Professional Student Alliance said, “Grassroots activists are not deterred by this setback in the Senate. The movement for single-payer health insurance is growing stronger every day among students who are the doctors, nurses, and other caregivers of the future.”

“Healthcare is a human right,” Progressive Democrats of America’s California state coordinator and emergency physician Dr. Bill Honigman stated, “It is immoral for businesses to profit from the illness of others, just as we would not expect them to profit from other public services such as police, fire, or education.”

“We’re disappointed today, but this is just the beginning of our efforts to win quality, comprehensive health care for all,” said Pilar Schiavo, the CHC campaign coordinator. “We will continue to build on the momentum we have created through our recent actions and statewide activism, and build an even broader and more powerful grass roots movement to ensure we win universal healthcare in California.”

The Campaign for a Healthy California represents over 1.4 million Californians and includes: California Alliance for Retired Americans, Physicians for a National Health Program – California, California Health Professional Student Alliance, Communication Workers of America – District 9 (California & Nevada), Health Care For All, Single Payer Now, California Nurses Association, California OneCare, California School Employee Association, Democracy For America, The Progressive Caucus of California, and Progressive Democrats of America.

http://www.theunion.com/article/20120201/BREAKINGNEWS/120209999/1001&parentprofile=1053

More bad news about "essential health benefits"

HHS Essential Benefits ‘Bulletin’ Draws Tide Of Comments

Kaiser Health News
February 2, 2012
As the official window of time allowed for groups to react to the Department of Health and Human Services essential benefits proposal closed, a variety of objections, concerns and common themes became clear.
CQ HealthBeat: State ‘Flexibility’ For Essential Benefits Gets Cool Reception
A tide of objections and worries rolled in just before Tuesday’s deadline for health groups to react to a Department of Health and Human Services proposal on essential health benefits. Input from health interests and consumers on the benefits “bulletin” is not being made public by the Obama administration, which asked that comments be sent to an email address rather than posted on a government website as would be the practice with a proposed regulation (Norman, 2/1).
Politico Pro: EHB Comments Show Some Common Themes
Believe it or not, businesses, insurers and consumers do see eye to eye on essential health benefits — well, on some parts, anyway. They’re at odds on some of the bigger issues, which doesn’t exactly come as a surprise. The comments submitted to HHS on its essential health benefits approach shows a wide divide between consumers … and businesses and insurers, who don’t see enough safeguards to keep the essential health benefits package affordable (Millman, 2/2).
http://www.kaiserhealthnews.org/Daily-Reports/2012/February/02/essential-benefits.aspx

Yesterday we reported that some of the most politically powerful organizations in the nation have joined together in a coalition to try to weaken the package of “essential health benefits” that will be required of health plans under the Affordable Care Act.  Excerpts from two new articles covered in the Kaiser Daily Health Policy Report should have us even more concerned.
In Politico Pro, it is reported that businesses and insurers “don’t see enough safeguards to keep the essential health benefits package affordable.” The proposal already has reduced the required benefits down to the relatively austere level of small group plans offered in the various states. These plans leave patients facing financial hardship when they must access health care.
Yet the powerful businesses and insurers want an even lower standard of benefits in order to keep the health benefits package affordable. The insurers want to protect their markets by keeping the insurance premiums affordable, and businesses also want the lowest premiums they can negotiate. Low premiums equate with higher out-of-pocket expenses for those with medical needs. In trying to make the health insurance plans more affordable, actual health care for the patients will be even less affordable.
As we have seen, the process has always been about powerful interests, with only a passive concern for patients.
In CQ HealthBeat, we see that comments on the proposal are being “sent to an email address rather than posted on a government website as would be the practice with a proposed regulation,” and are “not being made public by the Obama administration.”
The White House gave these special interests carte blanche with secretive access during the reform process. Secrecy continues. Should we be surprised when the final rule on “essential health benefits” pleases business and insurance interests, at a cost of exposing those with health care needs to greater financial hardship? No, not surprised. Outraged is more like it!