PNHP

Vt. doctors at Statehouse support single-payer

Vt. doctors at Statehouse support single-payer

AP/CNBC, Jan. 27, 2011

MONTPELIER, Vt. – Donning lab coats, Vermont doctors are taking to the halls of the Statehouse to lend their backing to Gov. Peter Shumlin’s push for a single-payer health care system.

More than two dozen doctors, nurses and nurse practitioners held forth in a committee room Thursday, taking turns at a microphone to explain why they feel a universal health care system would better serve patients than the existing system.

Many, including psychiatrist Dr. Alice Silverman of St. Johnsbury, said restrictions on access to care and the high cost of some tests were causing people to avoid getting the care they need.

http://www.cnbc.com/id/41298302

Why don't Americans live longer?

Why Don’t Americans Live Longer?

By David Leonhardt
The New York Times
January 25, 2011

The National Academy of Sciences has just released a fascinating report on life expectancy in rich countries around the world. The researchers who wrote the report — public-health experts, demographers, economists and others, from around the world — have tried to figure out why Americans don’t live as long as people in many other countries.

From a summary of the report:

“Over the last 25 years, life expectancy at age 50 in the U.S. has been rising, but at a slower pace than in many other high-income countries, such as Japan and Australia. This difference is particularly notable given that the U.S. spends more on health care than any other nation….

“Three to five decades ago, smoking was much more widespread in the U.S. than in Europe or Japan, and the health consequences are still playing out in today’s mortality rates, the report says. Smoking appears to be responsible for a good deal of the differences in life expectancy, especially for women….

“Obesity’s contribution to lagging life expectancies in the U.S. also appears to be significant, the report says. While there is still uncertainty in the literature about the magnitude of the relationship between obesity and mortality, it may account for a fifth to a third of the shortfall in longevity in the U.S. compared to other nations, the report says….

“Lack of universal access to health care in the U.S. also has increased mortality and reduced life expectancy, the report says, though this is a less significant factor for those over age 65 because of Medicare access….”

And from the report itself:

“With respect to income inequality, it is widely believed that such inequalities are higher in the United States than in other high-income countries, in part because the United States does less to redistribute wealth among its citizens…. Poverty rates also appear to be higher in the United States than in most of the other countries….

“This combination of factors could result in higher mortality rates among people in the lower socioeconomic brackets in the United States than in other countries, pulling down U.S. life expectancy levels in general…. In particular, there is a clear pattern among U.S. white males that fits the hypothesis….On the other hand, the pattern for U.S. women is somewhat different: mortality rates are higher than in most Northern and Western European countries among those who are highly educated as well as among the least educated….

“It is difficult to draw a precise conclusion as to the size of the role of inequality in relative levels and trends in U.S. mortality above age 50.”

This country has made a lot of progress against smoking. Obesity remains a major problem, though there are some signs it’s leveling off. And as the report notes, the link between obesity and mortality isn’t yet clear. Inequality’s role also seems unclear.

So beyond reducing smoking further, the single best strategy for extending American lives would appear to be extending universal health-insurance coverage below the age of 65.

http://economix.blogs.nytimes.com/2011/01/25/why-dont-americans-live-longer/

National Research Council of the National Academies:
“Explaining Divergent Levels of Longevity in High-Income Countries”
http://www.nap.edu/catalog.php?record_id=13089

Comment: 

By Don McCanne, MD

We frequently look at the lower life expectancy in the United States, in comparison to other wealthy nations, as a sign of the relatively poor performance of the U.S. health care system. We conclude that we would benefit if we established a reasonably comprehensive national health program that included everyone. Opponents contend that our system is outstanding and that reform is not necessary; individuals need only to take better care of themselves.

This new report by the National Research Council does not provide all of the answers, but it does provide very useful information. Two detrimental factors in which individuals do play some role are smoking and obesity.

On smoking, there is good news. Our high incidence of deaths from lung cancer and chronic pulmonary disease are related to the very high rates of smoking from a few decades ago. In the recent couple of decades, smoking cessation programs have been very successful, so much so that we can predict a significant increase in life expectancy as the non-smoking generation ages. Score one for those who blame individuals for our higher death rates, but also score ten for those who support the multitude of public health programs that have been so effective in reducing smoking behavior.

Obesity is a more difficult problem. Certainly a sedentary life style and poor eating habits contribute, so individuals can bear some blame, but other complex factors play even more important roles. Genetic factors, which are very important, we have no control over. Computers, televisions, work-at-home arrangements all reduce physical exertion. Community design and transportation have reduced self-propelled locomotion (i.e., walking). The food industry has not been particularly helpful, marketing excesses of nutritionally unbalanced foods, though there are signs that an awareness has set in and that product selection should improve. It’s easy to say that everyone should exercise more and eat less, but it is going to require intensive public policy and public health measures – more intensive than with the smoking cessation programs – to alter the obesity-inducing milieu.

Socioeconomic inequality in the United States certainly plays a role in our shorter life expectancy statistics. Considerable heated debate takes place over whether that is a cause or a symptom of factors leading to premature deaths. That debate is misdirected since socioeconomic inequality is deplorable for far more reasons than just our health outcomes. We do need national policies to raise the lot of those who are falling hopelessly behind. Although there is much to do, we can begin by reversing the income transfer that has been taking place from the productive workforce (hard-earned income) to the very wealthy (largely unearned income). Simple progressive tax policies can ensure that everyone has a living income, without impacting in the least the life styles of the wealthy.

You really need to read the 200 page report to understand what is known and what is not known about why we have lower life expectancies than should be expected for a wealthy nation. Regardless of those who would distract us by blaming personal failure for increased mortality, one conclusion of the report really stands out:

“The lack of universal access to health care in the United States undoubtedly increases mortality and reduces life expectancy. It is a smaller factor above age 65 than at younger ages because of Medicare.”

We know how to fix that.

PNHP comments on Hsiao draft report "Achieving Affordable Universal Health Care in Vermont" 1/19/11

January 21, 2011
William Hsiao, Ph.D.
124 Mt. Auburn Street, Suite 410 South
Cambridge, MA 02138

Dear Dr. Hsiao,

Thank you for this opportunity to comment on your draft report, and for generously volunteering your time and international expertise to this project.

PNHP agrees that the most effective, evidence-based approach to addressing the health care crisis facing Vermont is the adoption of a single payer system, and applauds the work of your team in preparing two models of single payer – with different benefit packages and governance structures – for the Vermont legislature to consider.

We particularly appreciate your recommendation, based on interviews with all the stakeholders, for an Independent Board to determine budgets and payments to providers, to address concerns – real or imagined – about the transparency and accountability of the single payer.  That is a valuable contribution to the design of a single payer system for Vermont.

We briefly outline some questions and concerns, below, with the goal of strengthening the single payer model in Option 1 and Option 3 and giving it greater ability to control costs. 

We also have concerns about the fiscal analysis of the model, also below, mostly related to what we believe is an underestimate of the potential administrative savings and savings from effective cost-containment with single payer budgeting, and an overestimate of the potential savings from ACO’s.  Overall we believe that the projected savings from single payer are in the right range (25 percent of projected health spending 2015-2024), however.

Strengthening the Single Payer, Strengthening Cost Control

1. Medicare and Medicaid should be fully incorporated into the single payer to maximize administrative savings, strengthen cost control, and provide seniors and low-income residents with the superior benefits package of the single payer as well as seamless, continuous coverage.  Additional Medicaid benefits (e.g. transportation costs) may continue to be provided separately.

2. With Medicare and Medicaid fully incorporated into the single payer, it will be possible to globally budget hospitals, nursing homes, and other delivery facilities, a measure we strongly recommend both to slash administrative costs at the hospital level and to vastly strengthen cost control.  In order to contain costs, it is important to do health planning, particularly with new technology, which is expanding in Vermont more rapidly than hospitals’ physical plant.  Thus we recommend that hospitals and other institutions have separate capital and operating budgets.

3. In order to effectively control costs Vermont needs to prohibit participation in the program by investor-owned, for-profit delivery systems.  There is solid evidence that investor ownership raises costs and lowers quality of care in nursing homes, hospitals, dialysis clinics, and other facilities.

4. Long-term care is an essential benefit for an aging population.  The additional cost of coverage for nursing home care may be reduced by charging an income-based fee for the housing portion of nursing home care, but not for the clinical portion.

5. Other benefit improvements we suggest are:
  – use of the “comprehensive” benefit package as the starting point
  – coverage of all residents of Vermont (subject to a residency requirement, not citizenship status)
  – elimination of all co-pays and cost-sharing (reduces administrative costs and is not necessary for cost control under single payer system with enforceable budgets)

6. While we appreciate the need for time to prepare for a new way of financing care, we suggest that the program be implemented sooner, in 2012, rather than wait until 2015.  We believe that the evidence from Taiwan shows that faster implementation, if there is the political will, is possible.

Comments on the fiscal analysis:  Single Payer “Bends the Cost Curve”

1. The evidence from savings from administrative waste is very strong and savings from this category are a minimum of 10 percent if the single payer is correctly structured (that is, Medicare and Medicaid are included and hospitals are globally budgeted) and as high as 15 percent or more of total health expenditures. 

2. The evidence of savings from using a non-profit delivery system is also very strong; for-profit hospitals are an average of 19 percent more costly than non-profits.  There is a large body of evidence showing that investor-owned, for-profit facilities such as dialysis clinics are more costly and have lower quality than non-profits that should be added to the report and fiscal modeling (see references at  www.pnhp.org/resources/evidence-based-talking-points).

3. In addition to the one-time savings from slashing administrative waste, if the single payer is strengthened it is able to “bend the cost curve” and reduce the rate of health inflation in Vermont going forward (e.g. with enforceable global budgets for physician care and hospitals as well as total health spending; bulk purchasing of drugs and supplies; and negotiated fees).  This is the real source of the majority of savings over time from a single payer plan, and projections of future health spending should reflect this.  This finding is well supported by the international evidence from Taiwan and elsewhere.

4. In contrast, we believe that the evidence for ACOs saving money is weak (much of it has not been published in peer-reviewed journals; even CMS does not agree on what an ACO looks like and is only pursuing pilot projects) and there is just as much reason to believe that the consolidation of providers and increased management costs necessitated by the ACO requirement will raise costs as lower them.  In fact, dramatically raising administrative costs is precisely what has happened in the British NHS as it has tried ACO-like schemes.

5. We thus strongly recommend a more critical evaluation of the literature on ACOs in the report and reducing the estimate of the potential savings from ACOs.  We believe that the savings from effective cost-control as a result of the single payer will more than make up for the savings currently attributed to ACOs. 

6. While outsourcing claims processing to the lowest bidder may be more appealing politically and to insurers, we are skeptical of the claim that it will save any more money.

7. Finally, while we understand the justification for the payroll tax on the employer side, we believe that the payroll tax on the employee side should be replaced with a small income tax or surtax on very wealthy families (top 5 percent) or a small tax on unearned income.  Income inequality is a major contributor to ill health in its own right, and income inequality has increased dramatically in the U.S. over the past 30 years.  A small tax on unearned income (or surtax on those with very high unearned incomes) would be a small step towards reducing this disparity.

We would be happy to review these points with your team or to arrange meetings with PNHP policy experts.

Thank you again for your outstanding contribution to fundamental health care reform in Vermont. 

Sincerely yours,

Deborah Richter, MD
Chair, Vermont chapter, PNHP

Ida Hellander, MD
Executive Director, PNHP

Comments by Himmelstein and Woolhandler on Hsiao draft report "Achieving Affordable Universal Health Care in Vermont"

By Drs. Steffie Woolhandler and David Himmelstein

Submitted on Mon, Jan 24, 2011

Dear Dr. Hsiao,

1- We are convinced that hospital global budgeting would generate substantial additional administrative savings.   This conviction is based both on strong anecdotal evidence and some systematic studies.  Canadian hospitals do little of the internal cost tracking needed to attribute costs and charges to individual patients.  Anecdotally, this allows a typical Canadian hospital to employ fewer than 5 billing personnel, vs. 50 or more for a U.S. hospital.  Some years ago we learned that Toronto General had about a dozen people in its billing department whose main task was to send bills to Americans who wandered across the border.  At that time, the MGH had 352 FTE billing personnel.  We’re told that the current number at the MGH is closer to 1000.  This is reflected in the 10 percentage point difference in administration’s proportion of hospital costs between the U.S. and Canada, far larger than the roughly 2% that you estimate could be saved under your options 1 or 3 (http://www.masscare.org/wp-content/uploads/2007/05/PNHPAdminCosts.pdf).  Our studies of the number of administrative personnel employed in U.S., Canadian and German hospitals yield similar estimates of potential savings through global budgeting, and indicate that a unified per-patient billing system (as in Germany) is far less administratively streamlined (http://ajph.aphapublications.org/cgi/content/abstract/86/2/172 and Himmelstein, D. U., et al., “The Health Care Labor Force: U. S., Canada, and Western Germany,” unpublished contractor report prepared for the Office of Technology Assessment, U.S. Congress, Washington, DC, Mar. 19, 1993.).  In the U.K., hospitals also beefed up their administrative staffs when the internal market was promulgated, and the director of the Karolinska Hospital in Stockholm told David that the advent of per-patient payments had caused at least a doubling in that hospital’s administrative costs.

2- We’re very concerned about your failure to recommend that hospital capital budgets be allocated separately from their operating revenues.  Deriving hospital capital largely from the surpluses they accumulate out of their operating budgets means that profitability determines investment, negating any real possibility for health planning.  Allowing hospitals to divert unspent operating funds to capital investment also provides incentives for hospitals to amplify profitable services such as elective orthopedic and cardiac procedures, and shrink needed but unprofitable ones such as psychiatry and primary care.  We’re similarly concerned about the plan to allow ACOs to keep any surplus they don’t spend on their patients.  Such incentives will guarantee cherry picking and the neglect of important but unmeasured care.  Regulatory efforts and quality measurement are no match for the cleverness of those who will game the system.

3- Your endorsement of P-4-P is unsupported by any reasonable evidence.  The extensive British experience indicates that you get more of what you pay for, but with substantial undesired side effects on aspects of care that are not incentivized.  Recent studies from the MGH indicate that P-4-P targets are far harder to achieve when caring for low income, minority or mentally ill patients. Moreover, interesting data from behavioral economics suggests that such schemes may well worsen performance of complex tasks (see the video at: http://www.youtube.com/watch?v=u6XAPnuFjJc for an entertaining introduction to this literature from writer Daniel Pink).

4- Microsimulation models inaccurately predict changes in utilization that result from system-wide changes in the comprehensiveness of coverage because they assume  no supply limit.  Given the shortage of primary care physicians in much of Vermont it is implausible that the more comprehensive benefit package would cause much increase in primary care visits.  Similarly, unless hospital capacity were greatly expanded, dropping financial barriers to hospitalization would not be likely to cause a large increase in inpatient care.  The proof of this lies in data from Canada.  In Quebec, there was virtually no change in aggregate utilization of physician care with the elimination of financial barriers in 1971.  The poor and sick saw doctors more frequently, while the wealthy and healthy waited a bit longer for appointments and saw their doctors a bit less often (http://www.nejm.org/doi/pdf/10.1056/NEJM197311292892206).  Similarly, Saskatchewan saw little decrease in aggregate physician visits when co-payments for outpatient care were added, and not much increase when they were subsequently dropped (http://www.jstor.org/pss/3764080).  Bob Evans has noted that physicians almost always work the same number of hours, regardless of the MD/Population ratio, and the Dartmouth data make a convincing case that this is so.  Hence, we’d suggest that your estimates of the cost of comprehensive benefits are too high.

5- While we find much to like in your Model 1 with comprehensive benefits, even that plan cannot be properly labeled “single payer” since it would retain (at least initially) Medicare and Medicaid (and apparently Medigap plans as well).  We’d suggest calling this plan (and Model 3) “Oligopayer” options.  If (as we understand that you advocate) Medicare and Medicaid were folded in at a later date and Medigap eliminated, only at this more advanced stage would the system properly be termed single payer.

6- Finally, we are unaware of evidence to support your claim that contracting out claims payment etc. to a private insurer will produce savings, and would urge you to review the evidence to the contrary.  The initial Saskatchewan experience (reviewed in: Horne JM, Beck RG.   Further Evidence on Public versus Private Administration of Health Insurance.  Journal of Public Health Policy 1981) led the Hall Commission that recommended nationwide adoption of the single payer approach to conclude:  “Hence the decision which Canadians have to make is whether they wish to pay $1,027 million in 1971 for a programme administered by the insurance industry, or $837 million for a programme administered by government agencies.”  At present, Canadian public payers average about 1% overhead, far lower than any of the private contracted payers that you cite.  Moreover, it seems likely that after the initial bidding process, barriers to entry for competitors will be steep since the initial winning bidder will have a decisive advantage in having built the payment infrastructure (computer programs, provider rosters etc.).  Moreover, a private firm would have strong incentives to increase the complexity and cost of administration, and hence boost its revenues.

Thanks in advance for your consideration.  We’d be happy to discuss these issues with you further if you wish.

Why don’t Americans live longer?

Why Don’t Americans Live Longer?

By David Leonhardt
The New York Times
January 25, 2011

The National Academy of Sciences has just released a fascinating report on life expectancy in rich countries around the world. The researchers who wrote the report — public-health experts, demographers, economists and others, from around the world — have tried to figure out why Americans don’t live as long as people in many other countries.

From a summary of the report:

“Over the last 25 years, life expectancy at age 50 in the U.S. has been rising, but at a slower pace than in many other high-income countries, such as Japan and Australia. This difference is particularly notable given that the U.S. spends more on health care than any other nation….

“Three to five decades ago, smoking was much more widespread in the U.S. than in Europe or Japan, and the health consequences are still playing out in today’s mortality rates, the report says. Smoking appears to be responsible for a good deal of the differences in life expectancy, especially for women….

“Obesity’s contribution to lagging life expectancies in the U.S. also appears to be significant, the report says. While there is still uncertainty in the literature about the magnitude of the relationship between obesity and mortality, it may account for a fifth to a third of the shortfall in longevity in the U.S. compared to other nations, the report says….

“Lack of universal access to health care in the U.S. also has increased mortality and reduced life expectancy, the report says, though this is a less significant factor for those over age 65 because of Medicare access….”

And from the report itself:

“With respect to income inequality, it is widely believed that such inequalities are higher in the United States than in other high-income countries, in part because the United States does less to redistribute wealth among its citizens…. Poverty rates also appear to be higher in the United States than in most of the other countries….

“This combination of factors could result in higher mortality rates among people in the lower socioeconomic brackets in the United States than in other countries, pulling down U.S. life expectancy levels in general…. In particular, there is a clear pattern among U.S. white males that fits the hypothesis….On the other hand, the pattern for U.S. women is somewhat different: mortality rates are higher than in most Northern and Western European countries among those who are highly educated as well as among the least educated….

“It is difficult to draw a precise conclusion as to the size of the role of inequality in relative levels and trends in U.S. mortality above age 50.”

This country has made a lot of progress against smoking. Obesity remains a major problem, though there are some signs it’s leveling off. And as the report notes, the link between obesity and mortality isn’t yet clear. Inequality’s role also seems unclear.

So beyond reducing smoking further, the single best strategy for extending American lives would appear to be extending universal health-insurance coverage below the age of 65.

http://economix.blogs.nytimes.com/2011/01/25/why-dont-americans-live-longer/

National Research Council of the National Academies:
“Explaining Divergent Levels of Longevity in High-Income Countries”
http://www.nap.edu/catalog.php?record_id=13089

We frequently look at the lower life expectancy in the United States, in comparison to other wealthy nations, as a sign of the relatively poor performance of the U.S. health care system. We conclude that we would benefit if we established a reasonably comprehensive national health program that included everyone. Opponents contend that our system is outstanding and that reform is not necessary; individuals need only to take better care of themselves.

This new report by the National Research Council does not provide all of the answers, but it does provide very useful information. Two detrimental factors in which individuals do play some role are smoking and obesity.

On smoking, there is good news. Our high incidence of deaths from lung cancer and chronic pulmonary disease are related to the very high rates of smoking from a few decades ago. In the recent couple of decades, smoking cessation programs have been very successful, so much so that we can predict a significant increase in life expectancy as the non-smoking generation ages. Score one for those who blame individuals for our higher death rates, but also score ten for those who support the multitude of public health programs that have been so effective in reducing smoking behavior.

Obesity is a more difficult problem. Certainly a sedentary life style and poor eating habits contribute, so individuals can bear some blame, but other complex factors play even more important roles. Genetic factors, which are very important, we have no control over. Computers, televisions, work-at-home arrangements all reduce physical exertion. Community design and transportation have reduced self-propelled locomotion (i.e., walking). The food industry has not been particularly helpful, marketing excesses of nutritionally unbalanced foods, though there are signs that an awareness has set in and that product selection should improve. It’s easy to say that everyone should exercise more and eat less, but it is going to require intensive public policy and public health measures – more intensive than with the smoking cessation programs – to alter the obesity-inducing milieu.

Socioeconomic inequality in the United States certainly plays a role in our shorter life expectancy statistics. Considerable heated debate takes place over whether that is a cause or a symptom of factors leading to premature deaths. That debate is misdirected since socioeconomic inequality is deplorable for far more reasons than just our health outcomes. We do need national policies to raise the lot of those who are falling hopelessly behind. Although there is much to do, we can begin by reversing the income transfer that has been taking place from the productive workforce (hard-earned income) to the very wealthy (largely unearned income). Simple progressive tax policies can ensure that everyone has a living income, without impacting in the least the life styles of the wealthy.

You really need to read the 200 page report to understand what is known and what is not known about why we have lower life expectancies than should be expected for a wealthy nation. Regardless of those who would distract us by blaming personal failure for increased mortality, one conclusion of the report really stands out:

“The lack of universal access to health care in the United States undoubtedly increases mortality and reduces life expectancy. It is a smaller factor above age 65 than at younger ages because of Medicare.”

We know how to fix that.

'How everybody exists' in D.C. doesn’t have to be

By Wendell Potter
The Huffington Post, Jan. 25, 2011

If you want to know how things really get done in Washington — or don’t get done, depending on the desires of America’s corporate executives — all you have to do is read a couple of paragraphs in a Jan. 23 Philadelphia Inquirer story.

Reporter Joe DiStefano quotes a vice president at APCO Worldwide — one of DC’s most powerful and influential PR firms — in response to questions about my book, “Deadly Spin.” Throughout the book I disclose the previously secretive work APCO did for the health insurance industry to manipulate public opinion on health care reform, in part by trying to scare people away from a movie, Michael Moore’s 2007 documentary “Sicko.”

The surprising gem in the Inquirer piece was that APCO VP Bill Pierce essentially agreed with me. He acknowledged that interest-funded pressure groups “are all over the place” in Washington. “That’s how everybody exists here,” Pierce said.

He’s right. That is indeed how the influence peddlers and spinmeisters exist (although a much more accurate word is thrive) in Washington.

Credit Where Credit is Due

Here’s the context. Pierce — an old (and probably now former) friend from my nearly two decades inside the insurance industry — was quoted by DiStefano as saying that I erred when I wrote that APCO set up and operated a fake grassroots front group, Health Care America, to discredit Moore and his movie because insurance company executives were terrified that “Sicko” would convince even more Americans that the government should play a much greater role in the U.S. health care system.

The trend was already going against the industry: In the spring of 2007, a few weeks before Sicko’s U.S. premier, the insurance industry’s pollsters told the executives that for the first time ever, more than half of all Americans were so disillusioned with the way private insurers controlled the health care system that they wanted more government involvement.

My error, according to Pierce, is not in pointing out that APCO was doing the dirty work of the industry through its phony front group — but that I failed to acknowledge the role that other big special interests played in funding Health Care America, as well. (Pierce was listed on the now-defunct group’s press releases as Health Care America’s media contact. If you called the number on the press release for Pierce, you would have reached him at his desk at APCO.)

DiStefano is at least the second reporter to hear Pierce complain that I did the public a disservice by not giving sufficient credit to other big special interests who paid APCO to create and run Health Care America. In November of last year he told PR industry watchdog Jack O’Dwyer the same thing.

In response, I wrote a blog post on Nov. 22 detailing the history and work of the front group. Here’s an excerpt:

O’Dwyer blogged last Tuesday that, ‘Just about every known evil practice that PR has ever engaged in is described in Deadly Spin.’ He noted that I had mentioned APCO — the second biggest firm in the O’Dwyer ranking, with $100.3 million in fees in 2009 — several times in the book. APCO and AHIP must be paying a media monitoring service to alert them immediately when I am mentioned in the media, as they did for Michael Moore and “Sicko” three years ago. Within hours, APCO Senior Vice President William Pierce sent O’Dwyer an email to challenge my credibility because of my failure to disclose Health Care America’s original incarnation. He’s right — partially. I should have pointed out in the book that APCO repurposed Health Care America for the insurance industry and other special interests who were concerned that “Sicko” might lead to reforms that would threaten their profits, too. I would have disclosed it if I had known about it. Unlike PR people who practice the dark arts of PR, I had no intention of misleading anyone.

Textbook Playbook

Had Pierce been more forthcoming, he might have shared with DiStefano the PR plan APCO prepared for America’s Health Insurance Plans (AHIP), the insurance industry’s big lobbying group, to discredit “Sicko” and set the stage for the industry’s campaign to shape health care reform legislation.

Since he didn’t, I will.

Here it is, courtesy of Bill Moyers, who disclosed  portions of the APCO/AHIP plan on the July 10, 2009, edition of Bill Moyers Journal, and posted it on his website. As you can see, the plan shows how APCO planned to use Health Care America and other organizations that APCO could press into service in the industry’s campaign against “Sicko.” If you’ve ever wanted to know how to create a PR plan to discredit an enemy and manipulate public opinion, you should take a look at this one. It’s a classic.

Back to Pierce’s comments to DiStefano. Here’s the full quote:

‘Pharma, hospitals, doctors backed Health Care America, not insurers,’ Pierce said. He doesn’t see why Potter thinks such groups are a threat to democracy: In Washington, interest-funded pressure groups ‘are all over the place,’ and many are backed by liberals. ‘That’s how everybody exists here.’

Pierce and I agree on this last point. Pierce admitted in a few words that one of the core truths of my book is indeed true: the near-total control exerted by corporate special interests over the democratic process in America is simply, and in the most literal way possible, business as usual.

The irony seems to be lost on Pierce, however. What’s the big deal, he asks?

Endangered Democracy

The big deal is that this dynamic threatens the very foundations of our democracy. It puts the interests of corporations, and the institutional shareholders that own them, above the interests of individual citizens — you and me. It concentrates power in the hands of a few “business leaders” rather than in the people who vote and the people those voters elect to represent them. It gives the loudest voice not to those with the best ideas but to those who can afford the most expensive lobbyists.

In the end, the true will of the people — such as the widely popular but still elusive policy of providing universal access to affordable, quality health care, as do the countries featured in “Sicko” — will continue to be thwarted until this is no longer “how everybody exists” in Washington.

http://www.huffingtonpost.com/wendell-potter/how-everybody-exists-does_b_813532.html

John Goodman: "real" insurance means sick pay more

The Case for Health Insurance

By John Goodman
John Goodman’s Health Policy Blog
January 26, 2011

I’m one of the very few health policy wonks you know (maybe the only one) who believes everyone should have access to health insurance the same way they currently have access to life, disability and homeowner’s insurance. In fact, I often refer to my blog as about the only health policy blog on the Internet that believes real health insurance is a legitimate business.

Wait a minute, Goodman. How can you say that? What about the Commonwealth Fund and Families USA? Don’t they believe everyone should have health insurance? What about everyone in Congress who supported ObamaCare? What about the president himself? Aren’t they all promoting the business of health insurance?

The short answer to all those questions is “no.” Real insurance involves a pooling of risks. The insurer must make sure each new entrant to the pool pays a premium that reflects the expected costs that entrant brings to the pool. Otherwise, the insurer won’t be able to pay claims. The business of insurance is the business of pricing and managing risk.

The organizations and people noted above don’t believe that “pricing and managing risk” is a legitimate activity. In fact, they went a long way toward completely outlawing the practice in the health reform bill. The only legitimate purpose of insurance, in their view, is to collect money and pay bills. For public insurance, this means collecting taxes and paying expenses. Their view of acceptable private insurance is to copy government insurance — a sort of private sector socialism.

Okay, Goodman, let’s accept that distinction for the moment. Doesn’t pricing risk mean charging me a premium that reflects my health status? The less healthy I am, the more I have to pay. Why should I want to buy insurance from a company that does that?

Because if your insurer doesn’t do that, a lot of bad things will happen.

Remember the phrase, “You’re in good hands with Allstate”? It was the voiceover at the scene of an auto accident where there has been catastrophic damage. The ad speaks volumes about what happens in real insurance markets. Basically, insurance is unimportant to you until things go very wrong. It’s at that point that you want good service.

Contrast Allstate’s ad with the kind of ads federal employees are subjected to during the fall open season for choosing a health insurance plan. What you never see in Washington are ads saying, “You are in good hands with [Aetna, Cigna, UnitedHealth, etc.] if you get [AIDS, cancer, heart disease, etc.].” Instead, the typical open season ad pictures young families with healthy children and no apparent health problems. The not-so-subtle message is: “You’ll be in good hands with us if you look like the people in these photos.”

Why is the health insurance market so different from auto insurance? Answer: health insurers are not allowed to charge federal employees premiums that reflect their health status.

Since the health overhaul legislation plans to make the federal employee health benefit system the model for health insurance exchanges nationwide, it’s instructive to stop and consider the incentives the health plans in these systems have. As explained in a previous analysis, if insurers have to take all applicants for the same premium, they will obviously try to attract the healthy (on whom they will make profits) and avoid the sick (on whom they will incur losses). After enrollment, their incentive is to overprovide to the healthy (to keep the ones they have and attract more of them) and to underprovide to the sick (to encourage them to leave and discourage enrollment by others just like them). If a TV ad could summarize how this health insurance market works, it would say, “You’re in good hands with us, unless you really need us — then we hope you will go somewhere else.”

And the reason this works is because people really can go somewhere else if they get sick — paying no extra premium.

So the incentives of the healthy employees are: Find plans that have lots of services for healthy people — knowing that if they get sick, they can always enroll in some other plan. The incentives for employees with a serious health problem (or more likely, a family member with a health problem) are to seek out plans that are the best at treating costly illness. But, as in a game of musical chairs, no insurer wants to be chosen.

In such a world, comparative effectiveness research, FDA rulings on drugs, end-of-life counseling and so many other controversial issues of late become very relevant. Insurance companies can’t just dump their sickest patients out on the street. They need cover. They need reasons not to pay for the latest cancer drug or the latest expensive test. Given the slightest encouragement, denial is in their self-interest.

Okay, Goodman. This is all very persuasive. But if my premium reflects my health status, what happens to people who are too poor or too sick to be able to afford those premiums? And what happens if a healthy person gets really sick (high medical costs) and wants to switch insurers?

These are good questions. I will answer them in a future Health Alert.

http://healthblog.ncpa.org/the-case-for-health-insurance/

Comments

By Don, McCanne, MD (Originally published here)

In pooling risk, the decision to assign premiums based on an individual’s risk is purely arbitrary, albeit it is convenient for those marketing the traditional business model of insurance – “real” health insurance, as John Goodman calls it.

The ultimate pooling of risk would be one national pool that includes everyone. Yet average medical costs for a worker’s family of four is now over $18,000 (Milliman), when median household income is $50,000. A middle-income family can no longer afford an equally-allocated premium plus out-of-pocket costs for that risk pool, much less a premium that is adjusted upward for higher risk.

Many of of us who do believe that everyone should have access to health care free of significant financial barriers understand that the traditional concept of “real” insurance no longer works. If individuals with health problems are priced out of risk pools, then how can they possibly pay premiums for the pools that concentrate high-risk individuals? And don’t say that you merely have to set up state-run high-risk pools. Not only have they already been proven to be ineffective in seriously addressing this problem, they would still have to be funded by us anyway, through the tax system. If we moved most high-risk individuals into these pools, that would consume a major portion of our national health expenditures (i.e., much of the 20 percent of people who consume 80 percent of health care).

In fact, think of our largest risk pool – the collective pools of employer-sponsored plans. These are largely composed of the healthy workforce and their young healthy families (the 80 percent of people who use only 20 percent of health care). Yet these low-cost pools that benefit from favorable selection (opposite of adverse selection) are already straining the budgets of employers and their employees. Isn’t it kind of silly to pool together these massive numbers of healthy people, while leaving out most of those with greater needs, and pretend that somehow we have provided the nation with “real” insurance? That serves the insurance industry well, but not the people.

Since average-income individuals can no longer afford their equally-allocated portion of our national health expenditures, funding will have to be progressive, based on income. The least adminis
tratively complex and a less expensive method of doing that would be to establish a single risk pool, and fund it through progressive tax policies.

If our goal is seeing that everyone gets the care they need, then we really do need to discard the antiquated business model of “real insurance” and adopt a single payer system – an improved Medicare that covers everyone.

John Goodman: “real” insurance means sick pay more

The Case for Health Insurance

By John Goodman
John Goodman’s Health Policy Blog
January 26, 2011

I’m one of the very few health policy wonks you know (maybe the only one) who believes everyone should have access to health insurance the same way they currently have access to life, disability and homeowner’s insurance. In fact, I often refer to my blog as about the only health policy blog on the Internet that believes real health insurance is a legitimate business.

Wait a minute, Goodman. How can you say that? What about the Commonwealth Fund and Families USA? Don’t they believe everyone should have health insurance? What about everyone in Congress who supported ObamaCare? What about the president himself? Aren’t they all promoting the business of health insurance?

The short answer to all those questions is “no.” Real insurance involves a pooling of risks. The insurer must make sure each new entrant to the pool pays a premium that reflects the expected costs that entrant brings to the pool. Otherwise, the insurer won’t be able to pay claims. The business of insurance is the business of pricing and managing risk.

The organizations and people noted above don’t believe that “pricing and managing risk” is a legitimate activity. In fact, they went a long way toward completely outlawing the practice in the health reform bill. The only legitimate purpose of insurance, in their view, is to collect money and pay bills. For public insurance, this means collecting taxes and paying expenses. Their view of acceptable private insurance is to copy government insurance — a sort of private sector socialism.

Okay, Goodman, let’s accept that distinction for the moment. Doesn’t pricing risk mean charging me a premium that reflects my health status? The less healthy I am, the more I have to pay. Why should I want to buy insurance from a company that does that?

Because if your insurer doesn’t do that, a lot of bad things will happen.

Remember the phrase, “You’re in good hands with Allstate”? It was the voiceover at the scene of an auto accident where there has been catastrophic damage. The ad speaks volumes about what happens in real insurance markets. Basically, insurance is unimportant to you until things go very wrong. It’s at that point that you want good service.

Contrast Allstate’s ad with the kind of ads federal employees are subjected to during the fall open season for choosing a health insurance plan. What you never see in Washington are ads saying, “You are in good hands with [Aetna, Cigna, UnitedHealth, etc.] if you get [AIDS, cancer, heart disease, etc.].” Instead, the typical open season ad pictures young families with healthy children and no apparent health problems. The not-so-subtle message is: “You’ll be in good hands with us if you look like the people in these photos.”

Why is the health insurance market so different from auto insurance? Answer: health insurers are not allowed to charge federal employees premiums that reflect their health status.

Since the health overhaul legislation plans to make the federal employee health benefit system the model for health insurance exchanges nationwide, it’s instructive to stop and consider the incentives the health plans in these systems have. As explained in a previous analysis, if insurers have to take all applicants for the same premium, they will obviously try to attract the healthy (on whom they will make profits) and avoid the sick (on whom they will incur losses). After enrollment, their incentive is to overprovide to the healthy (to keep the ones they have and attract more of them) and to underprovide to the sick (to encourage them to leave and discourage enrollment by others just like them). If a TV ad could summarize how this health insurance market works, it would say, “You’re in good hands with us, unless you really need us — then we hope you will go somewhere else.”

And the reason this works is because people really can go somewhere else if they get sick — paying no extra premium.

So the incentives of the healthy employees are: Find plans that have lots of services for healthy people — knowing that if they get sick, they can always enroll in some other plan. The incentives for employees with a serious health problem (or more likely, a family member with a health problem) are to seek out plans that are the best at treating costly illness. But, as in a game of musical chairs, no insurer wants to be chosen.

In such a world, comparative effectiveness research, FDA rulings on drugs, end-of-life counseling and so many other controversial issues of late become very relevant. Insurance companies can’t just dump their sickest patients out on the street. They need cover. They need reasons not to pay for the latest cancer drug or the latest expensive test. Given the slightest encouragement, denial is in their self-interest.

Okay, Goodman. This is all very persuasive. But if my premium reflects my health status, what happens to people who are too poor or too sick to be able to afford those premiums? And what happens if a healthy person gets really sick (high medical costs) and wants to switch insurers?

These are good questions. I will answer them in a future Health Alert.

http://healthblog.ncpa.org/the-case-for-health-insurance/

In pooling risk, the decision to assign premiums based on an individual’s risk is purely arbitrary, albeit it is convenient for those marketing the traditional business model of insurance – “real” health insurance, as John Goodman calls it.

The ultimate pooling of risk would be one national pool that includes everyone. Yet average medical costs for a worker’s family of four is now over $18,000 (Milliman), when median household income is $50,000. A middle-income family can no longer afford an equally-allocated premium plus out-of-pocket costs for that risk pool, much less a premium that is adjusted upward for higher risk.

Many of of us who do believe that everyone should have access to health care free of significant financial barriers understand that the traditional concept of “real” insurance no longer works. If individuals with health problems are priced out of risk pools, then how can they possibly pay premiums for the pools that concentrate high-risk individuals? And don’t say that you merely have to set up state-run high-risk pools. Not only have they already been proven to be ineffective in seriously addressing this problem, they would still have to be funded by us anyway, through the tax system. If we moved most high-risk individuals into these pools, that would consume a major portion of our national health expenditures (i.e., much of the 20 percent of people who consume 80 percent of health care).

In fact, think of our largest risk pool – the collective pools of employer-sponsored plans. These are largely composed of the healthy workforce and their young healthy families (the 80 percent of people who use only 20 percent of health care). Yet these low-cost pools that benefit from favorable selection (opposite of adverse selection) are already straining the budgets of employers and their employees. Isn’t it kind of silly to pool together these massive numbers of healthy people, while leaving out most of those with greater needs, and pretend that somehow we have provided the nation with “real” insurance? That serves the insurance industry well, but not the people.

Since average-income individuals can no longer afford their equally-allocated portion of our national health expenditures, funding will have to be progressive, based on income. The least administratively complex and a less expensive method of doing that would be to establish a single risk pool, and fund it through progressive tax policies.

If our goal is seeing that everyone gets the care they need, then we really do need to discard the antiquated business model of “real insurance” and adopt a single payer system – an improved Medicare that covers everyone.

(Comment originally published here)

Merger of Harvard Pilgrim Health Care and Tufts Health Plan

2 big health plans may merge

By Robert Weisman and Kay Lazar
The Boston Globe
January 25, 2011

Harvard Pilgrim Health Care and Tufts Health Plan are close to signing a memorandum of understanding that would combine their operations in four New England states and make them a stronger competitor to the market leader, Blue Cross Blue Shield of Massachusetts, in their home state. (Update: the memorandum of understanding was signed today.)

Consumer advocates said it is unclear how the insurers’ subscribers might be affected by the union, which would leave Massachusetts with only two major health companies.

“There has been tremendous value in having three strong locally based health plans in terms of choices for consumers,” said Nancy C. Turnbull, associate dean at the Harvard School of Public Health and a former deputy insurance commissioner. “But on the other hand, this could create a consolidated plan that could create a stronger competitor to Blue Cross and it could create a plan that has stronger leverage than either of them individually in negotiating with providers.”

Partly in reaction to the pressure to switch from fee-for-service to global payments, several Massachusetts hospitals have combined operations, while others say they are seeking buyers.

http://www.boston.com/business/healthcare/articles/2011/01/25/tufts_harvard_pilgrim_explore_merger/?page=full

Comment: 

By Don McCanne, MD

Choice. Wasn’t that the clarion call during the campaign for health care reform? We could have our choice of keeping the health plan we have, or choosing from a market of plans in the health insurance exchanges. Since Massachusetts had a head start in establishing the model of reform selected for the nation, let’s see what choice has meant to them.

Has health plan competition in the marketplace kept Massachusetts’ health care costs under control? No. They have the highest health care costs in the nation, and costs continue to rise.

Well that didn’t work. So now Massachusetts has begun the process of reducing the competition to two major health plans. That creates an oligopoly, which suppresses competition. Out with the market theory that competition reduces prices. In with the market theory that concentration provides the health plans with leverage to extract greater price concessions from the providers of health care. Of course, choice is a casualty of concentrated markets.

How do the providers fight back? Hospitals are already merging, in an effort to establish market dominance. Physicians are evaluating the concept of accountable care organizations (ACOs) as called for in the Patient Protection and Affordable care Act. Although the intent of the law is that ACOs would control costs (after all, they’re supposed to be accountable), physicians and their health provider partners will certainly use them to leverage their end of price negotiations (i.e., fight for higher prices, not lower).

Fundamental to competition is that when you have winners, you must have losers. That might be appropriate in sporting events, but it is an ethical breach to establish a health care financing system that automatically moves a significant portion of our health care providers into the column of losers. We need a financing system that makes patients winners by providing them access to a health care delivery system that strives for optimal care through cooperation, rather than competition.

That is partly what a single payer system is all about. Using global budgeting and negotiation, the public administrator works with the providers – all providers – to pay legitimate costs and provide fair margins.

Under such a system, competition becomes moot. Eliminating private health plans obviously eliminates health plan competition. If consolidation of health providers improves efficiency, quality and access, then there is no reason to be concerned about a lack of competition there either. Even without consolidation, appropriately compensated providers still can fully engage themselves in serving their patients, unencumbered with the distraction of having to compete.

Merger of Harvard Pilgrim Health Care and Tufts Health Plan

2 big health plans may merge

By Robert Weisman and Kay Lazar
The Boston Globe
January 25, 2011

Harvard Pilgrim Health Care and Tufts Health Plan are close to signing a memorandum of understanding that would combine their operations in four New England states and make them a stronger competitor to the market leader, Blue Cross Blue Shield of Massachusetts, in their home state. (Update: the memorandum of understanding was signed today.)

Consumer advocates said it is unclear how the insurers’ subscribers might be affected by the union, which would leave Massachusetts with only two major health companies.

“There has been tremendous value in having three strong locally based health plans in terms of choices for consumers,” said Nancy C. Turnbull, associate dean at the Harvard School of Public Health and a former deputy insurance commissioner. “But on the other hand, this could create a consolidated plan that could create a stronger competitor to Blue Cross and it could create a plan that has stronger leverage than either of them individually in negotiating with providers.”

Partly in reaction to the pressure to switch from fee-for-service to global payments, several Massachusetts hospitals have combined operations, while others say they are seeking buyers.

http://www.boston.com/business/healthcare/articles/2011/01/25/tufts_harvard_pilgrim_explore_merger/?page=full

Choice. Wasn’t that the clarion call during the campaign for health care reform? We could have our choice of keeping the health plan we have, or choosing from a market of plans in the health insurance exchanges. Since Massachusetts had a head start in establishing the model of reform selected for the nation, let’s see what choice has meant to them.

Has health plan competition in the marketplace kept Massachusetts’ health care costs under control? No. They have the highest health care costs in the nation, and costs continue to rise.

Well that didn’t work. So now Massachusetts has begun the process of reducing the competition to two major health plans. That creates an oligopoly, which suppresses competition. Out with the market theory that competition reduces prices. In with the market theory that concentration provides the health plans with leverage to extract greater price concessions from the providers of health care. Of course, choice is a casualty of concentrated markets.

How do the providers fight back? Hospitals are already merging, in an effort to establish market dominance. Physicians are evaluating the concept of accountable care organizations (ACOs) as called for in the Patient Protection and Affordable care Act. Although the intent of the law is that ACOs would control costs (after all, they’re supposed to be accountable), physicians and their health provider partners will certainly use them to leverage their end of price negotiations (i.e., fight for higher prices, not lower).

Fundamental to competition is that when you have winners, you must have losers. That might be appropriate in sporting events, but it is an ethical breach to establish a health care financing system that automatically moves a significant portion of our health care providers into the column of losers. We need a financing system that makes patients winners by providing them access to a health care delivery system that strives for optimal care through cooperation, rather than competition.

That is partly what a single payer system is all about. Using global budgeting and negotiation, the public administrator works with the providers – all providers – to pay legitimate costs and provide fair margins.

Under such a system, competition becomes moot. Eliminating private health plans obviously eliminates health plan competition. If consolidation of health providers improves efficiency, quality and access, then there is no reason to be concerned about a lack of competition there either. Even without consolidation, appropriately compensated providers still can fully engage themselves in serving their patients, unencumbered with the distraction of having to compete.

Funding for health care law next big battle

By Robert Reich
San Francisco Chronicle
Sunday, January 23, 2011

Forget the symbolic vote to repeal health care. Republicans don’t have the votes to override President Obama’s sure veto.

The real move happens later, when Republicans try to cut the money needed to implement the law’s requirement that all Americans buy health insurance.

On its face, it’s a smart tactic. The individual mandate is the linchpin of the heath care law because it spreads the risks. Without the participation of younger or healthier people, private insurers won’t be able to take on older or sicker customers with pre-existing medical conditions, or maintain coverage indefinitely for people who become seriously ill. The result would be to unravel the health care law, which presumably is what many Republicans seek.

The mandate is also the least popular aspect of the law. According to a December 9-12 ABC News/Washington Post survey, 60 percent of the public opposes it. While most want to prevent insurers from dropping coverage when customers become seriously ill, they don’t like the idea of the government requiring them to buy coverage. The mandate not only offends libertarian sensibilities, but it also worries some moderates and liberals who fear private insurers will charge too much because of insufficient competition in the industry.

And the mandate is most vulnerable to legal challenge. In the first major ruling on the new law, announced Dec. 13, Judge Henry E. Hudson of the federal district court in Richmond, Va., struck it down, calling the mandate an “unbridled exercise of federal police powers” and an overreach of the Constitution’s Commerce Clause. The U.S. government is appealing that decision.

There’s a lesson for Democrats in all this.

The federal government wouldn’t be nearly as vulnerable to these political and legal obstacles had the health care law been built upon the framework of Social Security or Medicare – public insurance financed by payroll taxes.

Not only are these programs enormously popular (“Don’t take away my Medicare!” was a rallying cry among some conservative populists during the debates over the health care law), but they also rest on a more widely accepted relationship between the individual, the government and the market.

Americans are accustomed to paying for public insurance through their payroll taxes. Such payments aren’t viewed as federal mandates that encroach upon individual freedoms, or as payoffs to private companies likely to make even more money from mandatory purchases of their products, but as well-deserved entitlements.

Indeed, the biggest problem with Social Security and Medicare is they’re so popular that politicians have had a hard time trimming their benefits to match payroll-tax revenues.

For 60 years, the battle over health care reform has been waged over these two ways of spreading costs and risks: either through payroll taxes and public insurance, or mandated purchases from private insurers.

For most of those six decades, Democrats advocated the former. Harry Truman’s initial plan for adding health insurance to Social Security was defeated, but Lyndon Johnson’s Medicare succeeded. Apart from George W. Bush’s drug benefit, which was also based on this Democratic framework, Republicans have been on the side of mandated purchases from private insurers.

In 1974, Richard Nixon’s proposed Comprehensive Health Insurance Plan would have required private employers to provide their employees with comprehensive health insurance coverage purchased from private insurers. (An employer mandate is tantamount to an individual mandate in that employees are forced to pay it indirectly, via lower wages.) Sen. Edward Kennedy simultaneously proposed universal coverage financed through Social Security taxes, essentially copying Medicare. Neither plan succeeded, but Nixon’s framework redefined the idea of national health insurance from then onward.

Obama and a majority of Democrats in the last Congress opted for the Republican model even though many Democrats preferred a single-payer system – Medicare for all – or at the very least a public option. Most polls showed that the public favored such an option. But the White House hoped for Republican support and wanted to ward off opposition from health insurers and pharmaceutical companies by promising them some 30 million additional customers.

The current Republican attack on mandatory coverage shows that Democrats who wanted a single-payer system should have stuck to their guns.

Perhaps they’ll have another chance. If the Republican attack is successful, single-payer will be the only alternative. And it’s the system Americans seem to prefer – payroll taxes and public insurance.

© Robert Reich

Robert Reich, former U.S. secretary of labor, is professor of public policy at UC Berkeley and the author of the new book “Aftershock: The Next Economy and America’s Future.” He blogs at www.robertreich.org.

Read more: http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2011/01/22/INQ81HANI5.DTL#ixzz1C3tyGAoF

Physicians for a National Health Program Tour Oregon to Promote Single Payer Health Care, February 2011

The Oregon Chapter of Physicians for a National Health Program (PNHP) and Mad As Hell Doctors (MAHD) will follow up on their landmark 2009 national tour and 2010 California tours with spirited rallies in Linn and Lincoln Counties during February. Their program will feature music by bluegrass singer and composer Bob Wickline of Fox Island, Washington; documentary videos by Paul Hochfeld M.D.; testimony by physicians and nurses; and “Mad As Heck Minutes” by audience members on camera and on screen.

 The doctors and nurses will start in Albany on Sunday, February 13, 6:30-8 p.m. at the Two Rivers Market, then go to Eugene for a parade starting at 5 p.m. and rally at 6 p.m. (place tba), hit the beach at Florence on Tuesday, Feb. 15, 6-8 p.m. at the Siuslaw Public Library, then Newport on Wednesday, Feb. 16, 7-9 p.m., at the Newport Visual Arts Center 2nd floor conference room, 777 NW Beach Drive (across from the Nye Beach Turnaround). Then it’s on to Lincoln City on Thursday, Feb. 17, 6:30 p.m., at the Lincoln City Cultural Center.2150 NE Oar Place.

 PNHP is a group of physicians, nurses, ancillary health providers, and other concerned citizens advocating for an improved and expanded Medicare program to provide financially sustainable universal health coverage for all Americans. In September 2009, PNHP doctors traveled 6,000 miles through America’s heartland from Portland, OR to Washington, D.C., stopping at over 40 venues in 22 states. After appearances on the Ed Schultz Show (MSNBC), Keith Olberman (MSNBC), Democracy Now! and interviews on dozens of other media outlets, the group is continuing its unique approach and activist flair to advocate for Single Risk Pool, Improved Medicare-for-all. 

 PNHP contends that the Patient Protection and Affordable Care Act (P-PACA) does too little to protect the health and livelihood of patients and their families. P-PACA serves to further entrench the current medical-industrial complex with an unsustainable cost spiral within our health care system.PNHP further contends that, while the Oregon Health Policy Board, a result of House Bill 2009, has proposed critical improvements in Oregon’s health care system, these improvements will be achievable only under a Single Risk Pool, Improved Medicare-for-all plan.

 PNHP is hitting the road again over the next several months to carry its message throughout Oregon. More information is available at www.pnhp.org/states/oregon and www.madashelldoctors.com. 

You can also interact with 11,000 friends on www.facebook.com/MadDrs.  

Mike Huntington, Physicians for a National Health Program, (541) 745-5635, mchuntington@comcast.net