Letters
Seattle Times, Jan. 19, 2011
U.S. Secretary of Commerce Gary Locke’s defense of the new health-care law had the usual fatal flaw: He still allows it to feed a callous health-insurance middleman [“Repealing new health-care law will make America less competitive,” Opinion, Jan. 15].
The law itself recognizes the immoral abuses of the health-insurance industry. It then immediately gives the industry hundreds of billions of taxpayer dollars every year to continue to deny care and bankrupt Americans.
Meanwhile, single-payer insurance systems have been proven to cost half as much as we spend. These single-payer insurance systems also cover everyone, eliminating bankruptcies. Our own government statistics prove single-payer insurance systems are the best at controlling costs. All of Locke’s numbers pale in comparison with the $400 billion we would save each year by simply eliminating the health-insurance middleman.
Give all of this, it seems Locke is defending entrenched political donors, not a health-care law. Until we get a single-payer insurance system, we will never see an affordable health-care act.
William McQuaid
Seattle
William Hsiao's single payer proposal for Vermont
Statement by William C. Hsiao
Vermont State Legislature
January 19, 2011
Act 128 calls upon our team to develop three options. The Legislature requires that we evaluate a state government-administered and publicly-financed single-payer health benefits system. This system, which we refer to as Option 1, would provide all Vermonters with a uniform benefits package. Within those parameters, we looked at costs of both a “comprehensive” benefits package and a leaner, “essential” benefits package, which I will define and discuss later. The second option is a state government-administered, public option that would allow Vermonters to choose between public and private insurance coverage. Option 2 is designed to allow for and promote competition between the public and private plans, while keeping in place the current multiple payer system. Act 128 allows our team to develop a third option that we design after analyzing all aspects of Vermont’s health care and assessing the positions of key stakeholders across the State of Vermont. We call Option 3 a public/private single-payer system. It provides an “essential” benefits package, is administered by an independent board with diverse representation, and it employs a competitively-selected third party to manage provider relations and claims adjudication and processing.
In analyzing the three options, we determined that all will yield significant savings. However, our research and analysis indicate that the single-payer options will have a more dramatic impact on reducing cost than the public option because they incorporate a uniform benefits package and reduce much of the administrative structure needed to compensate multiple payers. Therefore, we estimate that Option 1 will produce savings of 24.3% of total health expenditure between 2015 and 2024. Option 2 will produce savings of 16.1% of total health expenditure between 2015 and 2024. Finally, Option 3 will produce savings of 25.3% of total health expenditure between 2015 and 2024. Option 3 produces additional savings as compared to Option 1 because it incorporates a public/private partnership in governance and administration.
In 2015, the first full year of implementation, PPACA would reduce the number of uninsured by 18,000 people; however 32,000 Vermont residents will remain uninsured. Ultimately in 2019, PPACA will reduce the number of uninsured by 22,000 in 2019. PPACA will likely add an additional $240 million of federal funds in 2015 to the State of Vermont, which will eventually rise to $420 million in 2019. All of these dollar values are expressed in 2010 dollars.
In comparison with option 1 and 3, Option 2 would still leave approximately 30,000 Vermonters uninsured. Option 2 would not expand the current benefits to cover some dental and vision care nor bring up the benefits for those who are currently under-insured.
The comprehensive benefit package under option 1 covers all health services with minimum cost sharing. As a result, it costs more and requires more funds to finance it. Under a payroll contribution scheme of financing, employers and workers will have to pay more than what they would pay if no reform takes place. This comprehensive benefit option would also increase the total health spending in Vermont which would make this option less feasible.
The essential benefit package under option 1 and 3 have leaner benefits and they can be financed through payroll contributions without increasing the amount that most employers and workers would have to pay as compared to if no reform takes place. It would reduce the total health spending in Vermont slightly in 2015 when the proposed reforms are implemented.
Statement (10 pages):
http://WWW.leg.state.VT.us/jfo/healthcare/FINAL%20VT%20Hsiao%20Written%20Statment%20for%20Jan1911_1.pdf
Full report – William Hsiao, Steven Kappel and Jonathan Gruber (138 pages):
http://www.leg.state.vt.us/jfo/healthcare/FINAL%20VT%20Draft%20Hsiao%20Report.pdf
Comment:
By Don McCanne, MD
Although advocates of the pure single payer model will find some problems with this report on a reform proposal for Vermont, there is very good news in this analysis. The report emphatically confirms the superiority of the single payer model in ensuring that everyone is included while containing health care costs.
In an analysis of the impact of the Patient Protection and Affordable Care Act (PPACA), the authors demonstrated that far too many would still be left without insurance, and it would have a negligible impact in controlling health care costs. As we have said all along, the financing system in PPACA is grossly inadequate and needs to be replaced.
The authors’ Option 2 is essentially PPACA with a “public option” added – a public insurance plan that competes with the private plans. Their analysis shows that it would have only a very modest impact on reducing costs, and an almost negligible impact on reducing the numbers of uninsured. Thus the bluster in support of the public option was misdirected. That energy should have been redirected to supporting single payer instead.
Options 1B and 3 are almost identical. They are both single payer models that totally replace the private insurance plans. They have an “Essential Benefits Package” with an actuarial value of about 87 percent which is close to the typical employer-sponsored plans before they began introducing high deductibles. Their analyses shows that these plans would cover everyone without any increase in spending since the single payer efficiencies would be enough to pay for those currently uninsured or under-insured. So this is the really good news – single payer works (though read on).
The primary difference in 1B and 3 is that 1B is publicly administered whereas 3 is administered by an independent board that contracts with a competitively-selected third party to manage provider relations and claims adjudication and processing. The authors state a preference for Option 3 claiming that it saves a little bit more money by requiring potential managers to compete for the contract. That is highly dubious and more likely was inserted to appease the market ideology of a sector of the twenty some odd contributors to this study. Considering this, I think that we can extrapolate the fact that the authors would also endorse Option 1B, since it is otherwise identical.
Option 1A is like 1B except that it provides a “Comprehensive Benefits Package” – virtually all health care services and products – achieving approximately an actuarial ratio of 97% for medical and mental health services, 90% for drugs and vision care, and 85% for dental, nursing homes and home care. It would cost more than Option 1B, but not that much more. It was not selected by the authors since one of the goals of study was to cover everyone without increasing spending over current levels. In a single payer system the benefits should be comprehensive.
One very serious deficiency is that they decided to leave in place Medicare and Medicaid, primarily because of existing barriers to move them into a single payer system. Thus their proposal is not a single payer system. Leaving these programs in place sacrifices some of the important single payer efficiencies.
They also tout accountable care organizations (ACO), suggesting that capitation should apply to primary care and salaries should apply to specialists. Yet by questions that they pose, they recognize that ACOs are not well defined. For instance, how can they effectively manage the care of a patient that PPACA grants the right to move in and out of the ACO at any and all times?
Within the next couple of days, we’ll have a clearer concept
of where the single payer community should be on this report. Tentatively, it seems that it deserves our support, but support that is qualified by strong advocacy to make it right by such measures as including comprehensive benefits, and rolling in and eliminating Medicare and Medicaid.
William Hsiao’s single payer proposal for Vermont
Statement by William C. Hsiao
Vermont State Legislature
January 19, 2011Act 128 calls upon our team to develop three options. The Legislature requires that we evaluate a state government-administered and publicly-financed single-payer health benefits system. This system, which we refer to as Option 1, would provide all Vermonters with a uniform benefits package. Within those parameters, we looked at costs of both a “comprehensive” benefits package and a leaner, “essential” benefits package, which I will define and discuss later. The second option is a state government-administered, public option that would allow Vermonters to choose between public and private insurance coverage. Option 2 is designed to allow for and promote competition between the public and private plans, while keeping in place the current multiple payer system. Act 128 allows our team to develop a third option that we design after analyzing all aspects of Vermont’s health care and assessing the positions of key stakeholders across the State of Vermont. We call Option 3 a public/private single-payer system. It provides an “essential” benefits package, is administered by an independent board with diverse representation, and it employs a competitively-selected third party to manage provider relations and claims adjudication and processing.
In analyzing the three options, we determined that all will yield significant savings. However, our research and analysis indicate that the single-payer options will have a more dramatic impact on reducing cost than the public option because they incorporate a uniform benefits package and reduce much of the administrative structure needed to compensate multiple payers. Therefore, we estimate that Option 1 will produce savings of 24.3% of total health expenditure between 2015 and 2024. Option 2 will produce savings of 16.1% of total health expenditure between 2015 and 2024. Finally, Option 3 will produce savings of 25.3% of total health expenditure between 2015 and 2024. Option 3 produces additional savings as compared to Option 1 because it incorporates a public/private partnership in governance and administration.
In 2015, the first full year of implementation, PPACA would reduce the number of uninsured by 18,000 people; however 32,000 Vermont residents will remain uninsured. Ultimately in 2019, PPACA will reduce the number of uninsured by 22,000 in 2019. PPACA will likely add an additional $240 million of federal funds in 2015 to the State of Vermont, which will eventually rise to $420 million in 2019. All of these dollar values are expressed in 2010 dollars.
In comparison with option 1 and 3, Option 2 would still leave approximately 30,000 Vermonters uninsured. Option 2 would not expand the current benefits to cover some dental and vision care nor bring up the benefits for those who are currently under-insured.
The comprehensive benefit package under option 1 covers all health services with minimum cost sharing. As a result, it costs more and requires more funds to finance it. Under a payroll contribution scheme of financing, employers and workers will have to pay more than what they would pay if no reform takes place. This comprehensive benefit option would also increase the total health spending in Vermont which would make this option less feasible.
The essential benefit package under option 1 and 3 have leaner benefits and they can be financed through payroll contributions without increasing the amount that most employers and workers would have to pay as compared to if no reform takes place. It would reduce the total health spending in Vermont slightly in 2015 when the proposed reforms are implemented.
Statement (10 pages):
http://WWW.leg.state.VT.us/jfo/healthcare/FINAL%20VT%20Hsiao%20Written%20Statment%20for%20Jan1911_1.pdfFull report – William Hsiao, Steven Kappel and Jonathan Gruber (138 pages):
http://www.leg.state.vt.us/jfo/healthcare/FINAL%20VT%20Draft%20Hsiao%20Report.pdf
Although advocates of the pure single payer model will find some problems with this report on a reform proposal for Vermont, there is very good news in this analysis. The report emphatically confirms the superiority of the single payer model in ensuring that everyone is included while containing health care costs.
In an analysis of the impact of the Patient Protection and Affordable Care Act (PPACA), the authors demonstrated that far too many would still be left without insurance, and it would have a negligible impact in controlling health care costs. As we have said all along, the financing system in PPACA is grossly inadequate and needs to be replaced.
The authors’ Option 2 is essentially PPACA with a “public option” added – a public insurance plan that competes with the private plans. Their analysis shows that it would have only a very modest impact on reducing costs, and an almost negligible impact on reducing the numbers of uninsured. Thus the bluster in support of the public option was misdirected. That energy should have been redirected to supporting single payer instead.
Options 1B and 3 are almost identical. They are both single payer models that totally replace the private insurance plans. They have an “Essential Benefits Package” with an actuarial value of about 87 percent which is close to the typical employer-sponsored plans before they began introducing high deductibles. Their analyses shows that these plans would cover everyone without any increase in spending since the single payer efficiencies would be enough to pay for those currently uninsured or under-insured. So this is the really good news – single payer works (though read on).
The primary difference in 1B and 3 is that 1B is publicly administered whereas 3 is administered by an independent board that contracts with a competitively-selected third party to manage provider relations and claims adjudication and processing. The authors state a preference for Option 3 claiming that it saves a little bit more money by requiring potential managers to compete for the contract. That is highly dubious and more likely was inserted to appease the market ideology of a sector of the twenty some odd contributors to this study. Considering this, I think that we can extrapolate the fact that the authors would also endorse Option 1B, since it is otherwise identical.
Option 1A is like 1B except that it provides a “Comprehensive Benefits Package” – virtually all health care services and products – achieving approximately an actuarial ratio of 97% for medical and mental health services, 90% for drugs and vision care, and 85% for dental, nursing homes and home care. It would cost more than Option 1B, but not that much more. It was not selected by the authors since one of the goals of study was to cover everyone without increasing spending over current levels. In a single payer system the benefits should be comprehensive.
One very serious deficiency is that they decided to leave in place Medicare and Medicaid, primarily because of existing barriers to move them into a single payer system. Thus their proposal is not a single payer system. Leaving these programs in place sacrifices some of the important single payer efficiencies.
They also tout accountable care organizations (ACO), suggesting that capitation should apply to primary care and salaries should apply to specialists. Yet by questions that they pose, they recognize that ACOs are not well defined. For instance, how can they effectively manage the care of a patient that PPACA grants the right to move in and out of the ACO at any and all times?
Within the next couple of days, we’ll have a clearer concept of where the single payer community should be on this report. Tentatively, it seems that it deserves our support, but support that is qualified by strong advocacy to make it right by such measures as including comprehensive benefits, and rolling in and eliminating Medicare and Medicaid.
IOM's "essential benefits" may serve interests of private insurers
Health care lobby mum on repeal
By Kate Nocera
Politico
January 18, 2011
It’s at meetings like the Institute of Medicine’s Committee on the Determination of Essential Health Benefits where these groups (AHIP and others) can begin to voice their concerns. The committee convened for three days last week to hear from experts, lobbyists and special advocacy groups. The IOM will soon make recommendations to the Department of Health and Human Services on what defines an “essential benefit” that insurers must cover if they want to be listed on the exchanges that are coming in 2014.
Carmella Bocchino, AHIP executive vice president of clinical affairs and strategic planning, asked HHS not to load specific benefits into the bill, so the 10 broad categories of benefits would remain as they are and the market would decide what type of coverage is needed. The group also asked HHS not to include the 2,000 state mandates as part of an essential benefit package. Each state directs insurance providers on what must be covered in the policies they sell. The inclusion of every state mandate in the health care reform law would significantly drive up consumer costs and mandates for all states, which does not necessarily make sense, AHIP argues.
http://www.politico.com/news/stories/0111/47711.html
IOM meeting on essential benefits:
http://iom.edu/Activities/HealthServices/EssentialHealthBenefits/2011-JAN-12/Agenda.aspx
Comment:
By Don McCanne, MD
The Institute of Medicine (IOM) will be making recommendations to HHS on the definition of required essential benefits for the health plans that are to be offered through the state insurance exchanges. Several experts testifying before IOM’s Committee have called for flexibility in the definition (testimonies provided at IOM link above).
We should all be concerned that the insurance industry intends to use this approach to “let the market decide what type of coverage is needed.” Although the health reform legislation closed large loopholes in insurance coverage, it is clear that the industry fully intends to use innovations in essential benefit design to continue to profit by depriving patients of essential health care.
It was a terrible mistake to design health care financing reform based on the existing model of private insurance plans. No matter how much the private insurers are regulated, they will always find a way to place their own interests first.
It is not too late to stop this nonsense and do it right – establish our own publicly-administered and publicly-financed single payer national health program, an improved Medicare for all.
UPDATE ON SINGLE PAYER: Interview with Margaret Flowers, MD
By Joan Brunwasser
OpEdNews, Jan. 16, 2011
My guest is Dr. Margaret Flowers, congressional fellow of Physicians for a National Health Program [PNHP]. Welcome back to OpEdNews, Margaret. Republican lawmakers, fresh from their November victory, are pledging to move immediately in the new Congress to dismantle the health care law that President Obama gave so much attention to. What’s your take on that?
Thank you for inviting me back, Joan. As you know, Physicians for a National Health Program does not support the new health law. Overall we find that it does more harm than good by further privatizing our health care and failing to address the fundamental problems of rising health care costs and lack of access to care for tens of millions of people. That said, we find the Republican plans to dismantle the health law reprehensible given that they are willing to remove what coverage was gained under the law and offer no effective alternative to our growing health care crisis.
The Republican calls to repeal the law are mere political posturing and will not succeed. In fact the health industries, which contributed more heavily to Republican campaigns in the last election cycle than to Democrats, do not want the full law repealed. The Republicans will more likely succeed in defunding portions of the bill and relaxing regulation of the health insurance industry. This will escalate our health care crisis.
The health law passed in 2010 has already begun to unravel as the Department of Health and Human Services has had to issue multiple waivers excusing businesses and insurance companies from complying with provisions in the law that they refused to meet. A large part of the increase in coverage under the law was based on an expansion of Medicaid, however, states are facing severe budget deficits which will prevent them from implementing the expansion. Republican efforts will likely accelerate the unraveling.
This is why PNHP and the many other organizations which advocate for single payer/improved Medicare for All continue to push forward in educating and building the grassroots voice for single payer. We recognize that our health care problems have not yet been appropriately addressed or solved.
There are millions of us out there who share your concern about the current health care crisis. But this is a little tricky. Those of us who feel that the law passed was less than stellar need to fight back against its repeal, its unraveling or being whittled away altogether by Republicans or strained state budgets. At the same time, we need to be agitating for something that will really do the job. That’s a little complicated. And voters and the public in general have had a notoriously short attention span. How do you channel that very real public distress to bring about meaningful and positive change?
As you are aware, civil unrest in this nation is growing. It is an expression of the very real public distress that you mention. Although information about this unrest is largely censored from the mainstream media, we see that non-union workers and anti-poverty movements are growing as are more organized actions such as the prison protests in Georgia, nurses’ strikes and the veteran-led antiwar civil resistance. This type of unrest is to be expected if we look at what happens historically in nations which experience such severe wealth inequalities as we have in the United States.
Some of the civil unrest is turning to violence. In the absence of constructive and nonviolent avenues for social change and as unemployment, lack of access to health care, homelessness and poverty grow, the level of violence may increase. This is why, now more than ever, we must educate, organize and engage in actions that change the balance of power away from corporate interests and to the needs of people.
There are three important principles that will guide effective action. First, our movements, whatever the issue, must be independent of political parties. The Republican and Democratic parties are both controlled by concentrated corporate power. There are some differences between those parties but overall they serve corporate power and not the people. We must be willing to hold all legislators accountable to act on behalf of people even if that means that they lose a few elections until the shift occurs. And independence also includes the media. We will have to make our own media because mainstream media is also controlled by corporate interests.
Second, we must be clear about what we ask for and that is where education comes in. We have the solutions to all of our problems. For health care it is a national single payer health system. For unemployment and the environment, it is investment in green jobs and ending oil and coal dependence. For the economy, it is developing sustainable local economies and ending Wall Street bailouts. And so on. We must educate the public through local events and independent media about these solutions.
And third, we must be uncompromising in our demands. We are too often willing to accept partial or non-solutions to our problems because we are told that what we want is politically infeasible. When we look at health care, we are constantly told that single payer is not politically feasible. We have heard this for decades. However, the legislation that passes which is politically feasible fails to be feasible from a practical standpoint. It simply doesn’t work. The number of un-insured continues to grow and soaring health care costs are destroying our families and businesses. At some point, we have to realize that we determine what is politically feasible because we hold the power of the vote. We must learn to use that power.
Of course, these are difficult times and many of us are struggling. However, each of us can contribute in some way. We can weaken corporate power by supporting local goods and services. We can educate ourselves and those around us. We can donate to non-profits. We can expose injustice that we see and work with others in our community to end it. We can treat each other with love and respect so that we model what we want to see for others. And for those who are able, we must join together and engage in acts of strategic non-violent resistance.
It is important to realize that work for peace and for social and economic justice is all related. The various movements need to join together in our actions to create a healthy, prosperous and just country. For me, this means that we must organize large acts of non-violent resistance together that focus on weakening corporate power and letting legislators know that business as usual cannot continue. This is why I joined the veterans in their action against war at the White House in December. I believe as we continue to educate, organize and act, more people will join us in any way they can.
Wow, Margaret! This is a lovely, well fleshed-out plan of action, with something for everyone. What can you tell us about specific efforts going on now at the state level for single payer? We don’t hear much about it through the corporate media so it feels like nothing is happening.
Yes, Joan. There is a lot happening at the state level when it comes to single payer. Currently, twenty states have single payer health bills in some phase of the legislative process.
As you may know, California has passed a state single payer bill twice in 2006 and 2008. I just returned from a large health professional student-led march, rally and lobby day at the state capital in Sacramento. The California single payer coalition is continuing to move forward to pass single payer and have it signed by the new Governor. California faces such a serious budget crisis that I was told the legislature will be basing their cuts on what will result in the least number of lives lost.
We are particularly enthusiastic this year about Vermon
t. They are poised to pass a single payer health bill this legislative session. The state hired Dr. William Hsaio from Harvard to design their health system. He has designed health systems for five countries, the most recent being the single payer system in Taiwan. The new governor of Vermont, Peter Shumlin, ran on a strong single payer platform. And, of course, Vermont has Senator Sanders, who has been a long time proponent of single payer.
Even with all of the stars seeming to be aligned, it is going to be a difficult process to get single payer passed in Vermont. The forces who oppose this, primarily the corporations who profit from the status quo, will be putting tremendous resources into that state to stop single payer. For that reason, many of the organizations that support single payer are working to assist the state single payer movement. Single payer advocates from across the nation are volunteering or helping to raise funds for Vermont.
I encourage your readers to visit www.vermontforsinglepayer.org to learn more about the efforts there and to support them.
Legislation will also be introduced at the national level again in both the House and Senate this year. It is important to work at both the state and national levels because we cannot predict where we will be successful first. Of course, the ultimate goal is a national single payer health program so that all people living in our country will have access to care and so that we can control our health care costs at the national level. Health care costs are a significant cause of our national debt.
Agreed. Tell us about the national deficit and the commission and efforts to cut social insurances like Medicare and Medicaid. How does that fit into the mix?
You are probably aware that the President appointed a commission to look at our national deficit last April. This commission, the National Commission for Fiscal Responsibility and Refom, was composed of 18 people, 14 of whom were fiscal hawks. The commission received support and staff from the Pete Peterson Foundation which has advocated for cuts to our social insurance programs for decades. It was interesting that the President created this commission despite opposition coming from within the Democratic party.
During the summer and fall, there was a considerable effort by the Peterson Foundation and in the media to convince people in America that Social Security and Medicare/Medicaid were to blame for the deficit and that they would need to be changed by either raising the age of eligibility or otherwise placing more of the cost onto the individual.
Members of the single payer community testified before the commission (read my testimony here), educated staffers in Congress and built a public education campaign called Handsoffourmedicare.org to counter the misinformation coming from the deficit commission and the media.
The commission was required to vote on recommendations to reduce the deficit by December 1st. They missed the deadline and were not able to gain enough votes to pass a package of recommendations. However, many believe that their proposed actions will turn up in legislation being put together in the coming year.
It is commonly accepted that the rising cost of health care is a fundamental cause of our national deficit, as well as the wars and financial catastrophe. Several members of the commission rightly said that we must deal with the cost of health care in order to effectively resolve the deficit.
Unfortunately, while the commission has made the correct diagnosis, they are ordering the wrong treatment. The commission proposed some initial cuts to Medicare including the Medicare funds that help to pay for the training of doctors, and proposed that more drastic measures be taken if the initial steps are not effective. Of course the initial steps will not be effective because they miss the cause of Medicare’s difficulties.
Medicare and Medicaid are not the causes of our national deficit, they are the victims of a broken health system. As our overall health care costs rise, so do the costs of Medicare and Medicaid. The most effective way to control our health care costs would be to expand and improve Medicare and put everybody in the country on Medicare instead of using hundreds of different health insurances as we do now.
The administrative savings alone of a single payer national health program would be around $400 billion. There are other ways that single payer/Medicare for All controls health care costs such as giving hospitals and other medical institutions a global budget and negotiating for the prices of pharmaceuticals, medical devices and services.
We will need to watch carefully to make sure that Congress does not chip away at Medicare and Medicaid over the next few years. These social insurance programs have been effective in improving the health of the populations they serve and on lifting people out of poverty. It is imperative that we preserve and protect them as we continue to push for improved Medicare for all.
Thanks for bringing us up to date on single payer, Margaret. It was a pleasure talking with you again.
Joan Brunwasser is a co-founder of Citizens for Election Reform (CER) which since 2005 existed for the sole purpose of raising the public awareness of the critical need for election reform.
http://www.opednews.com/articles/Update-on-Single-Payer-fro-by-Joan-Brunwasser-110116-521.html
Health bill would allow waivers in 2014
By NEAL P. GOSWAMI
Bennington Banner, 01/18/2011
BENNINGTON – Vermont’s congressional delegation joined Gov. Peter Shumlin Tuesday to announce legislation that would allow states to seek federal health care waivers in 2014, and the flexibility to craft their own state-level health care plans.
Landmark health care reform legislation signed into law last year by President Barack Obama provides states the option of seeking a federal waiver to opt out of some requirements of the bill as long as certain standards are maintained. That provision was sought by U.S. Sen. Bernie Sanders, a Vermont independent. But the law currently does not allow those waivers until 2017.
Campaign promise
Shumlin, a Democrat sworn in to office earlier this month, promised during the campaign that he would seek a single-payer health care system for the state. He said acquiring the needed federal waivers would be the easy part of implementing such a system. Vermont’s congressional delegation is hoping to prove him right.
Sanders joined U.S. Sen. Patrick Leahy and Rep. Peter Welch, both Democrats, at a Statehouse press conference Tuesday morning to announce the “State Leadership in Healthcare Act,” which would allow states to move forward with state-level plans three years sooner.
“At a time when 50 million Americans lack health insurance and when the cost of health care continues to soar, it is my strong hope that Vermont will lead the nation in a new direction through a Medicare-for-all single-payer approach. The goal is clear – quality,
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cost-effective health care for all Vermonters,” Sanders said. “This is essential not only for the well-being of all Vermonters but for job creation. We must do all we can to lower the crushing costs of health care that are now devastating Vermont businesses and their employees.”
Sanders plans to introduce the bill in the Senate for himself and Leahy. Welch will introduce the bill in the House.
Last year’s health care changes extend access to health insurance to about 32 million more Americans. But Shumlin and the state’s congressional delegation said Tuesday that states should be allowed to make additional improvements on their own to help better control costs.
Allowing waivers in 2014 will keep states from spending money on health insurance exchanges, which are required for all states by 2014. A state receiving a waiver to implement its own system would likely dismantle the exchange, anyway.
A waiver would allow states to collect federal funding – including Medicaid, Medicare and the Children’s Health Insurance Program – to finance state-level pilot health care systems. Those plans must be as comprehensive and affordable as the federal model and cover as many people, however. Waivers will not be granted for plans that offer lower quality or less affordable coverage, according to the Vermont officials.
The bill also calls for HHS to create an application that includes required waivers.
Shumlin said the legislation will deliver federal money required to implement a state-level plan that covers all Vermont residents in a more timely manner. “We want to do it better and faster than the federal law contemplates. We want to control costs and cover everyone,” Shumlin said. “I am so pleased that our congressional delegation supports us in this effort, and I thank them for introducing this important legislation.”
The announcement of the legislation comes as the GOP-led U.S. House prepares to vote this week on repealing the federal health care law. While the measure is expected to clear the House, it will almost certainly come to a halt in the Senate, which remains under the control of Democrats.
Leahy said repeal efforts are a step backward. Allowing states to obtain waivers sooner will help better the federal legislation, he said. “While some in Washington are trying to turn the clock back on health reform, Vermont instead is moving forward. This state waiver bill will give Vermont and other states the choice to go above and beyond what the federal health care law does by devising their own reforms,” he said. “Vermont has always been a leader in health care quality and access, and this bill will give our state the flexibility we want to offer Vermonters the best care and coverage while controlling costs.”
Welch, in a telephone interview, said the proposed changes to federal law will allow Vermont to move forward the way it best sees fit. “We’ve got to get our arms around the costs and single-payer flexibility would give the governor and the state the ability to do the job,” he said. He noted, however, that other states could develop their own plans, which might be very different from what Shumlin hopes to implement.
“If another state wanted to pursue it through another way that works for them, they could,” Welch said. “We believe there is a way to get support from among Republicans who may be against single-payer. The waiver is not promoting single payer, it’s promoting flexibility,” he added.
While “leadership is coming from Vermont,” other states are also interested in obtaining a waiver, Welch said, including “red” states. “I’ve been talking regularly to Gov. Shumlin and he’s said some pretty conservative governors are interested in having some flexibility,” Welch said.
Cooperation is also expected from the White House, Welch said. “[HHS] Secretary [Kathleen] Sebelius is the one we’ve had contact with and she’s a former governor herself and has indicated significant interest in this. I think we’ll find cooperation from the White House in this,” Welch said.
Tuesday’s press conference precedes a report expected to be delivered to lawmakers today by Dr. William Hsiao, a Harvard University economist. Hsiao was hired by the state to design three separate universal health care plans for the state, including a single-payer plan, according to the law passed last year that calls for the health system options.
“This is just the beginning of this process, and there are other waivers we will need to get it done. If we work together, I am convinced we can persuade the federal government they should not stand in our way,” Shumlin said.
Contact Neal P. Goswami at ngoswami@benningtonbanner.com
Wendell Potter speaks in Bloomington, Ind
By Michela Tindera
Indiana Daily Student, Jan. 17, 2011
More than 415 people filled the Buskirk-Chumley Theater on Sunday as Wendell Potter, former head of corporate communications at health insurance giant CIGNA, attempted to blow the whistle on corporate insurance.
After resigning from his post at CIGNA in May 2008, he began tireless efforts to protest the immoralities of corporate public relations.
By publishing his first book, “Deadly Spin: An Insurance Company Insider Speaks Out on How Corporate PR is killing Health Care and Deceiving Americans” and going on tour, Potter has attempted to shed light on the health care industry.
The book signing and speech by Potter as well as a screening of the related 2007 Michael Moore documentary “Sicko,” which was also a critique of the injustices of the health insurance industry, was sponsored by Hoosiers for a Commonsense Health Care Plan.
Considering his 20 years of experience in corporate public relations, first with Humana and then with CIGNA, it may have been difficult to imagine that Potter’s next career move would be to become what Time Magazine calls “the ideal whistleblower” in the campaign against the injustices of the health insurance industry.
“I didn’t think I’d get this involved,” Potter said. “It was very scary, but I decided if I ever had the chance to make a difference, I wanted to.”
Yet it was a personal decision following events during the course of a couple years that made him want to turn in his papers.
“There were three strikes that occurred to me before I decided to resign,” Potter said.
The first strike was the release of “Sicko.” It was part of Potter’s job to discredit this film in order to maintain a positive reputation for CIGNA.
“It was especially daunting to me to disprove because I realized Michael Moore had gotten it right,” Potter said in his speech.
Shortly after, on a visit to his hometown in Tennessee, he came upon a makeshift clinic in nearby Wise County, Va., where hundreds of people were lined up in front of a barn to receive health care.
The death of a CIGNA policyholder was the final strike against the health insurance industry for Potter.
It was also Potter’s job to deal with “squeaky wheels,” or policyholders with complaints. One such family was that of 17-year-old Nataline Sarkisyan in late 2007.
Sarkisyan was a patient in need of a liver who was eligible for transplant, according to doctors at University of California, Los Angeles. Yet Sarkisyan was deemed ineligible by a CIGNA employee who claimed the surgery would be experimental.
While her surgery was eventually allowed after her family and their lawyers generated enough bad press, CIGNA’s approval came too late. Sarkisyan died within hours of the news from CIGNA.
“That did it for me,” Potter said. “I could not in good conscience continue working.”
Potter said the main reason for the injustices committed by health insurances giants is their greater concern for meeting the expectations of Wall Street shareholders and analysts like Goldman Sachs than the needs of actual patients.
While a health care act repeal may be underway, Potter said this attempt is a smokescreen to allow health insurance companies to strip out consumer protections that would be beneficial.
“It’s a shame that corporations have so much political power,” Bloomington City Council representative Isabel Piedmont-Smith said after Potter’s speech.
However, the health insurance industry is a proponent of some provisions of health care reform, such as the requirement that nearly everyone buy health insurance by 2014 or be severely fined.
“If people were well-informed and not victimized by the industry, it’d be a no-brainer,” said Chris Stacks, Indianapolis physician and member of HCHP. “Health insurance companies do not add any value to the transaction. There’s no point to pay 25 percent to a middleman.”
Potter recommended college students stay informed and get involved to make necessary changes. Students can call congressmen, write letters to the editor of their local newspapers, and stay informed on current events.
“This is important for all of us,” Potter said. “Young people need coverage as they get older. They need to think ahead.”
http://www.idsnews.com/news/story.aspx?id=79230
‘Sicko’ showing draws crowd, emotions
By Kelsey Holder
Indiana Daily Student, Jan. 18, 2011
Advocates of American health care reform filled the chairs of the Buskirk-Chumley Theater on Sunday.
They silenced themselves as IU Jacobs School of Music Sylvia McNair sang an a cappella version of “Down to the River to Pray.”
“As I went down in the river to pray / Studying about that good ol’ way / And who shall wear the robe and crown? / Good Lord, show me the way.”
McNair and guitarist David Gulyas treated the advocates with four other songs: “Blowin’ in the Wind,” Harold Arlen’s “Over the Rainbow,” “Greensleeves” and “Let There Be Peace on Earth.”
“We let them choose the songs they’d be sharing,” said Dr. Rob Stone, director of Hoosiers for a Commonsense Health Plan. “They chose well.”
Bloomington residents and other locals were there to watch Michael Moore’s 2007 documentary “Sicko” and speak with the whistle-blower Wendell Potter about his insight to health insurance companies in America.
Potter stopped by the Buskirk-Chumley Theater during his book tour of the newly released “Deadly Spin: An Insurance Company Insider Speaks Out on How Corporate PR Is Killing Health Care and Deceiving Americans.”
“We thought showing ‘Sicko’ would nicely complement the book tour,” Rob Stone’s wife and fellow advocate Karen Green Stone said.
Rob and Karen housed Potter during his weekend visit and organized the free event sponsored by Hoosiers for a Commonsense Health Plan.
John and Rosalie Neel are members of Hoosiers for a Commonsense and ushered the event.
“We’ve never seen ‘Sicko,’” Rosalie said. “We’re very excited.”
The couple, along with other ushers, wore shirts that quoted Dr. Martin Luther King Jr.:
“Of all the forms of inequality, injustice in health care is the most shocking and inhumane.”
The fronts of the shirts read “Medicare for All.”
“We’re on Medicare,” John said. “We get the quality that everyone should get.”
Although they receive full benefits from Medicare, they still firmly believe in the Hoosiers for a Commonsense mission.
“We went to our first meeting about a year and a half ago because of an ad in the paper,” John said. “We’ve been going ever since. One meeting is all it takes.”
As the Buskirk-Chumley house filled to more than 415 people, the largest attendance yet of Potter’s book tour, the anxiousness for the 3 p.m. showing of “Sicko” grew.
“The movie ‘Sicko’ itself is a wake-up call,” Potter said. “It is both emotionally affecting and effective. Michael Moore achieved his objective.”
Potter screened the film twice before its release in 2007, while he still held the PR executive position for CIGNA.
“I thought, ‘Oh my, I can’t believe he made a movie this accurate,’” he said. “I knew it’d be a challenge to discredit it.”
Potter confirmed the authenticity of the documentary, admitting that it uncovers a side of health care that most choose not to see.
“The arts have a significant role to play in communicating and reaching people,” he said. “You can reach people on an emotional level. The movie ‘Sicko’ does that.”
http://www.idsnews.com/news/story.aspx?id=79226
Doran: A health care bubble about to burst
By Terry Doran
VTDigger.com, January 15, 2011
Editor’s note: This op-ed is by Terry Doran, a resident of Montpelier. His wife, is Dr. Deborah Richter, a single-payer advocate.
When we talk about health care reform, what are we really talking about?
Reform says there is something to correct. What is it?
There are a lot of answers. The quality of care. The delivery of care. The cost of health insurance. The wildly discrepant charges by doctors and hospitals. Those are some, and they break down into narrower and narrower topics, all of which could do with some correction, perhaps.
By now few, if any of us, believe the costs of health care are sustainable much longer. There are clear signs we are in huge trouble. This is widely, clearly understood.
We seem to be living in a health care bubble about to burst. The alarm grows more urgent year by year, and yet nothing close to the scope of the problem is attempted. Vermont has tried tiny corrections with tiny discernible effects, not all of them good. What now?
Could it be that it goes much deeper, this problem? Everyone knows there are selfish interests who want corrective change kept to between none and the minimum.
It looks like what is needed is a kind of religious conversion. We’ve allowed something to happen in health care because we had faith and now that faith has been thoroughly discredited.
It goes like this:
Our health care is an admixture of a market-model (health care stores for individual buyers with enough money) and a public good (health care services financially supported by society).
In Vermont most health care professionals and the services, hospitals, etc., act as though health care is a public good, which is the same thing as saying its primary reason for being is to benefit the public as a whole.
Our faith, delirious you could argue, was to believe that a market model could solve – mysteriously, magically – any problem thrown in its way. You can decide if this was true in big banking and Detroit auto manufacturing.
There is now a mountain of evidence that our awkward coupling of the health care stores idea to the health care services idea is a really bad idea. It doesn’t work.
One good reason for this is that a public good isn’t limited to one segment of the population, however you define that group. It excludes no one. A market-model does. It excludes some, the some usually being those without enough money.
Our deepest problem is to understand a public good, how it works and why, and what it can mean for health care. We don’t exclude some youngsters from public education; we don’t exclude some families from fire and police protection; we don’t exclude some drivers from full use of roads and highways.
Characteristic of all these, and other public goods, is that they are collectively funded by us all for us all. The implied agreement is that individually we know we are unlikely to be able to pay for a school, fire department, police force, or a road without the help of everyone else.
Health care is exactly the same, except that we have mostly fallen into the trap of looking at it as an individual purchase and not a public good. When we use it, we tend to think we’re up for paying for it, or our insurance is. But in fact the very existence of the services (a hospital, a nurse, a doctor) we intend to buy from depend on collective financing.
At this moment Vermont stands at a unique point in time. It’s the only state on the cusp of adopting a health care system that is coordinated to benefit the whole of the Vermont public. Our legislature has asked a highly-regarded health economist, William Hsiao of Harvard, and his working group to design three systems to study and perhaps legislate from.
We won’t know what the designs look like until Wednesday morning. But if what eventuates does not move us clearly and in a step-wise manner toward health care as a public good, then our unique moment will have been lost. And the next sound you hear could be the sound of a bubble bursting.
http://vtdigger.org/2011/01/15/doran-a-health-care-bubble-about-to-burst/
Doctor urges single-payer health plan
Advocate invokes King during talk
By Nancy C. Rodriguez
Louisville Courier-Journal, Jan. 15, 2011
President Barack Obama’s landmark health care law was significant, “but it is not enough and it will not solve our problem,” a national advocate for single-payer health insurance told an audience Saturday at the Urban League of Louisville.
The legislation still leaves 23 million Americans uninsured and without access to quality health care, said Dr. Claudia Fegan, past president of Physicians for a National Health Program.
“This is about justice,” she said. “Heath care should be a right to which everyone is entitled.”
Fegan was the guest speaker at an event that was sponsored by Physicians for a National Health Program-Kentucky and Kentuckians for Single Payer Health Care and tied to Dr. Martin Luther King Jr.’s birthday. It was called “Remembering Dr. King’s Cry for Justice in Health Care” and was attended by about 60 people, including Louisville Mayor Greg Fischer, Louisville Urban League executive director Ben Richmond and U.S. Rep. John Yarmuth, D-3rd District.
“I want everyone in our community, and particularly in the South and minorities, to know we can do a better job of providing health care to all our citizens,” said Dr. Garrett Adams, president and Kentucky coordinator for Physicians for a National Health Program.
During her talk, Fegan — who practices primary care internal medicine at the Woodlawn Health Center of Cook County in Chicago — said African Americans are more likely to be uninsured and suffer from higher rates of cancer, heart disease, diabetes and HIV.
“This is our issue. … This is our reality,” said Fegan, who called the fight for better health care the civil-rights struggle of the 21st century.
A single-payer health care system would involve the government or a government-run organization collecting all health care fees and paying out all health care costs.
Fegan said she knows some are reluctant to criticize Obama’s health care law because they support the president. “I think Dr. King would say it’s important to tell the truth. Remember, he said, ‘The time is always right to do the right thing,’” she said.
She said a single-payer plan would lead to better access to quality health care for all Americans. “There are no easy solutions. We have to be willing to fight and continue to fight,” said Fegan, who ended her talk by leading a chant of, “Everybody in, and nobody out.”
Fegan’s comments came just days before the U.S. House of Representatives is expected to vote to repeal the health care law. The repeal vote would fulfill a campaign promise of Republicans who won control of the House in the November elections. The measure is expected to stall in the Senate, where Democrats remain in control.
Obama has said he would veto a repeal if Congress passes it.
Democrats argue that the health care law, which was signed last year, will expand coverage to millions of uninsured Americans and help rein in soaring medical costs. Republicans argue that the coverage mandated in the legislation is unconstitutional and that penalties for employers who don’t provide coverage discourage hiring.
Yarmuth said the health care law was “an important first step,” but he acknowledged that “it was not what I wanted to see. I’m a single-payer guy.”
He said health care is a moral issue. “It’s not a question of politics; it’s not a question of economics,” he said. “It’s a question of morality.”
Only Washington has cure for fear of major medical bills
Health care costs are devastating the U.S. middle class in ways not seen in countries that have universal care.
By RICHARD C. DILLIHUNT, M.D.
The Portland (Maine) Press Herald, Jan. 1, 2011
PORTLAND – Fear is a distressing emotion aroused by an impending danger. This simple four-letter word commands attention in a myriad of daily circumstances in the lives of men. Fear can paralyze any person or nation — thank goodness FDR saw this coming.
Perhaps the first expression of fear in primates is the Moro reflex, in which the infant, when startled, instinctively throws out his arms, spreads his fingers and then grasps for his mother.
Creatures below man rely upon fear for survival; see the spider roll up in a ball, the lobster in reverse gear or the chipmunk disappear into a hole seemingly too small for escape.
In medical practice, fear is a constant visitor to patients, and the allaying of apprehensions assumes a dominant role in the doctor-patient relationship. A hidden, quiet, highly personal part, it’s nonetheless a crucial factor in the strategic approach to management of the medical problem at hand.
As an aside, this is one of several reasons why attempts at involvement of political forces in patient care are unsuccessful — even laughable when brought to bear awkwardly, as we have seen during recent health care debates. As my dad said, “If you want to comment on that, go first to medical school.” So I did.
With the skyrocketing of health care costs continuing, it has become evident that this is contributing deeply to our decrepit economy, and to the overall national health (or lack of it).
Newspaper and magazine articles as well as books are written about this morass, but lurking in the background is a complex element of our situation that hasn’t surfaced as a significant factor.
Yes, it’s fear itself. When this box is opened, a vast seascape is exposed, and one wonders how this subject has remained under cover.
The mechanics and importance of fear in this setting deserve a look.
The insurance industry is afraid of losing its control over Washington by restriction of campaign donations; the pharmaceutical industry fears price control, and the legal profession fears tort reform.
The medical profession is shaking at the thought of losing reimbursement for services rendered and hospitals fear competition among themselves, while politicians fear loss of campaign funding, completing a circle reminding one of buffalo under siege.
More importantly, outside the circle, fear is entrapping a huge category of health care recipients — our vast middle class who have absorbed repeated blows by armies of providers bellying up to the troughs, feasting on a source of great riches that has a decidedly detrimental effect on America’s economy.
Let’s explore this matter to illuminate our health care system — especially how it compares to other countries. Ours is much more expensive, has no price controls, penalizes business the most and allows bankruptcy due to inability to pay.
In a large number of middle-class patients receiving major care, a second fear is manifest under our system.
This is the fear of economic consequences and secondary personal humiliation occurring weeks later when the bills arrive. Insurance coverage, health savings accounts, deductibles and personal savings accounts are inadequate. The bills are so astronomical that fear again appears — and rules.
This is fear of economic consequences with personal humiliation, a situation not seen in nations with universal health care. It’s perhaps best depicted by a fictitious example:
John Recipient, age 50, has a complicated gastrectomy requiring prolonged hospitalization. After health insurance payments he still owes $75,000 to the hospital and physicians. His disability insurance covers only his basic needs.
He borrows from his aged parents and his 401(k), his wife returns to work, his employer suffers from hard times and John has no job. His daughter cancels plans to attend Yale and two family cars go without payment for two months, requiring the sale of one to pay for the other.
Credit cards are maxed out, his mortgage is in arrears with ultimate foreclosure at a huge loss, and his youngest son needs braces.
Along the line a deep-seated throbbing, even palpable fear, has developed, along with loss of self-respect and despair. Bankruptcy is filed, and a middle-American family lies in economic ruin.
This does not happen in Canada or other industrialized countries with universal health care. It happens right here. Nothing Karl Rove can say will make this story go away. No tea party will correct this social injustice. We are struck another blow in trying to emerge from depression.
Hello, Washington, do you hear the people? We are anxious for change. Please, no more tweaks.
Richard C. Dillihunt, M.D., of Portland is a retired surgeon.
IOM’s “essential benefits” may serve interests of private insurers
Health care lobby mum on repeal
By Kate Nocera
Politico
January 18, 2011It’s at meetings like the Institute of Medicine’s Committee on the Determination of Essential Health Benefits where these groups (AHIP and others) can begin to voice their concerns. The committee convened for three days last week to hear from experts, lobbyists and special advocacy groups. The IOM will soon make recommendations to the Department of Health and Human Services on what defines an “essential benefit” that insurers must cover if they want to be listed on the exchanges that are coming in 2014.
Carmella Bocchino, AHIP executive vice president of clinical affairs and strategic planning, asked HHS not to load specific benefits into the bill, so the 10 broad categories of benefits would remain as they are and the market would decide what type of coverage is needed. The group also asked HHS not to include the 2,000 state mandates as part of an essential benefit package. Each state directs insurance providers on what must be covered in the policies they sell. The inclusion of every state mandate in the health care reform law would significantly drive up consumer costs and mandates for all states, which does not necessarily make sense, AHIP argues.
http://www.politico.com/news/stories/0111/47711.html
IOM meeting on essential benefits:
http://iom.edu/Activities/HealthServices/EssentialHealthBenefits/2011-JAN-12/Agenda.aspx
The Institute of Medicine (IOM) will be making recommendations to HHS on the definition of required essential benefits for the health plans that are to be offered through the state insurance exchanges. Several experts testifying before IOM’s Committee have called for flexibility in the definition (testimonies provided at IOM link above).
We should all be concerned that the insurance industry intends to use this approach to “let the market decide what type of coverage is needed.” Although the health reform legislation closed large loopholes in insurance coverage, it is clear that the industry fully intends to use innovations in essential benefit design to continue to profit by depriving patients of essential health care.
It was a terrible mistake to design health care financing reform based on the existing model of private insurance plans. No matter how much the private insurers are regulated, they will always find a way to place their own interests first.
It is not too late to stop this nonsense and do it right – establish our own publicly-administered and publicly-financed single payer national health program, an improved Medicare for all.
Wishful thinking on health costs?
Wishful Thinking on Health Costs
By David Leonhardt
The New York Times
January 13, 2011
Opponents of the health law sometimes like to suggest that cutting health costs would be easy, if only we’d be willing to try common-sense ideas. But that’s wishful thinking. The law does include most of the common-sense ideas supported by health economists ranging from Mark McClellan (the former Bush administration official) to David Cutler (a former Clinton and Obama adviser). There’s just no getting around the fact that reducing the growth rate of health costs will be difficult.
Comment:
By Don McCanne, MD
So many noted policy experts have trumpeted the supposed fact that the health reform law contains essentially all of the cost containment ideas known that now this concept is being accepted unchallenged. This ignores the fact that the most effective model of cost containment was rejected at the very beginning of the reform process.
Numerous microsimulation studies plus the experience of several nations has demonstrated that a single payer system (e.g., an improved Medicare for all) actually bends the cost curve down when contrasted with the fragmented, multi-payer system that we have in the United States.
These same microsimulation studies show that building on our current system, which is precisely what the current law does, is the most expensive model of reform, primarily because it retains the profound administrative inefficiencies that are a major contributor to our very high costs. Setting medical loss ratios recovers only a negligible portion of the administrative waste which permeates our system. The many other efficiencies of a single payer system, such as reducing the administrative burden on the health care delivery system, would recover much of this waste.
Another factor that is not receiving the attention that it should is that the current law can never result in truly universal coverage – tens of millions will remain uninsured. A single payer system not only costs less and slows the growth of health costs into the future, it also automatically covers everyone. Moreover, it uses progressive tax policies to ensure that funding is equitable, making health care affordable for everyone.
The popularity of Medicare is understandable, since it provides us with health security in our later years. But the projected spending increases in this high-risk pool are of concern. We could fix that problem immediately by diluting the costly Medicare pool with the couple hundred million of us who are relatively healthy.
We’re already paying for the Medicare pool anyway, so why shouldn’t we all have the advantage of an efficient health care financing system that eliminates the profound waste of our costly, dysfunctional, fragmented system of a multitude of private and public payers? An improved Medicare for all is the only practical solution to our problem of intolerable cost increases.