PNHP

Healthcare For All Ohioans Would Promote Economic Prosperity

Healthcare For All Ohioans Would Promote Economic Prosperity

by Margaret Brinich
The Lakewood (Ohio) Observer, Nov. 16, 2010

Charles Shaughnessy interviewed April Stoltz on the Health Care For All Ohioans Act (HCFAOA)

Q. April, your picture was on the front page of the Huffington Post last week. What were you protesting so soon after the mid-term elections? Your sign read “Healthcare …” but it was cut off in the picture.

A. Actually, that was an AP image from a “Medicare for All” protest that occurred in Cleveland in October of 2009. The sign said “Healthcare is a Human Right”. The picture is old, but the debate continues. There are nineteen states with single payer healthcare initiatives at various stages. The non-profit organization SPAN Ohio is working to promote a Medicare-for-All style plan known as the Health Care for All Ohioans Act (HCFAOA). SPAN stands for Single-Payer Action Network.

Q. Most people have health insurance and they’re generally satisfied with it. Why rock the boat?

A. Premiums will continue to rise. More and more Ohioans will be priced out of the health care market. It’s not only a health care crisis, but a major contributor to the economic crisis. Lack of health insurance leads to lack of health care and a less-healthy working population. Ohio needs jobs. If Ohio had a comprehensive health care plan covering all citizens and the costs were known, prospective employers would be encouraged to start up new businesses or move businesses into Ohio. It’s in our economic self-interest.

Q. Is it possible to extend health care to everyone without raising the collective cost?

A. Absolutely. The premiums being paid today by individuals, employers, and taxpayers, and the co-pays being paid for medical service could pay for comparable coverage for all. The savings would come from a number of efficiencies. Administrative costs would decline significantly if there were one Medicare-type system in place of a number of private insurance carriers. There would be no need for multi-million dollar executive salaries. No shareholder dividends to pay out quarterly. No marketing budget. Equipment costs for million-dollar imaging machines would be reduced. Today there are too many MRI machines in some areas, sitting idle, while other parts of the state have a shortage. Emergency departments would no longer be a substitute for a doctor’s office. Ohio’s population of about 13 million would mean prescription prices could be negotiated downward significantly. As a local example, health insurance savings for the Lakewood School System would exceed $7 million annually with the passage of the Health Care for All Ohioans Act. Elimination of waste is not possible with the Federal plan, as insurance companies are left to their own devices with no caps on premiums.

Access to medical care for all, including preventive care programs, would lead to a healthier, more productive population. Aside from a better quality of life for all, employees could choose a job or profession based on true interest rather than availability of employer-provided health care coverage. It’s been shown for many years that European and Asian countries have enjoyed a higher level of medical care for less cost than in the United States. SPAN Ohio is showing the PBS special “Sick Around the World ” Thursday November 18th at 7:00 p.m. at the Shaker Heights Community Bldg. at 3450 Lee Rd. It’s free and parking is free.

Q. What about all the workers engaged in claims processing at doctor’s offices and insurance companies who would lose their jobs?

A. Fewer workers would be needed to process claims in a Medicare-type single-payer system, but extending coverage would increase the number of workers needed to run the state plan. Those who wouldn’t be needed would be protected by a provision of Ohio’s proposed plan. They would be paid their previous income, up to $60,000 annually, for up to two years, while training for new jobs or until they took other jobs.

Q. It seems that many people get upset over discussions of health care issues. Can you explain that?

A. I don’t know what others are thinking, but poling show 85% of the population is in favor of no pre-existing condition restrictions and in favor of extending coverage for children and young adults up to age 26. The biggest complaint about the Federal plan is that many provisions don’t take effect until 2014 and that it still leaves the insurance companies in the drivers seat raising costs and cutting coverage.

Q. You have said health care access has become especially important due to the current economic crisis. Please explain.

A. Ohioans know we must have attractive conditions to bring in new job opportunities and that includes having a healthier work force and known health care costs for employers. Ohio is a leader in agricultural production, manufacturing, exports to other countries, and the development and manufacture of climate-friendly sources of energy, yet we’re suffering in a few measures, notably high unemployment. Fiscal responsibility is not a partisan issue. The Healthcare for All Ohioans Act (HCFAOA) could make an impact on our state budget and would promote economic prosperity by creating an entrepreneur-friendly environment.

Q. What local entities support this effort?

A. Endorsers of the campaign sponsored by the Single-Payer Action Network Ohio (SPAN Ohio) to pass the Health Care For All Ohioans Act (HCFAOA) include health care professionals, unions, faith-based organizations, businesses, and government bodies throughout the state.  Local support comes from Ohio Senator Michael Skindell, Ohio State Reps. Nickie Antonio and Michael Foley, Cleveland City Council and Lakewood City Council.

April Stoltz retired early from the U.S. Post Office and has good health insurance coverage, but works for health care for all, as a “civilized and responsible” access solution. She volunteers for Single-Payer Action Network Ohio (SPAN Ohio).  www.spanohio.org

Charles Shaughnessy is a long-time resident of Lakewood, Ohio and currently serves as Treasurer of the Lakewood Democratic Club. www.lakewooddemocrats.com

http://lakewoodobserver.com/read/6/23/healthcare-for-all-ohioans-would-promote-economic-prosperity

Jan Schakowsky and Rivlin/Domenici on the deficit

Schakowsky Alternative to Simpson-Bowles Deficit Reduction Plan

Congresswoman Jan Schakowsky
November 16, 2010

Today Rep. Jan Schakowsky (D-IL), a member of the bipartisan National Commission on Fiscal Responsibility and Reform, offered a comprehensive proposal to reduce the federal deficit without making middle class Americans foot the bill.  Schakowsky’s plan is an alternative to the Simpson-Bowles plan and would reduce the deficit by $427.75 billion in 2015, surpassing President Obama’s $250 billion target. Critically, the Schakowsky plan accomplishes deficit reduction without making cuts to essential federal expenditures that benefit the middle class.

http://schakowsky.house.gov/index.php?option=com_content&view=article&id=2777:schakowsky-alternative-to-simpson-bowles-deficit-reduction-plan&catid=21:2010-press-releases&Itemid=58

And…

Reviving the Economy, Cutting Spending and Debt, and Creating a Simple, Pro-Growth Tax System

By The Debt Reduction Task Force, Senator Pete Domenici and Dr. Alice Rivlin, Co-Chairs
Bipartisan Policy Center
November 2010

Strengthen Medicare for the Long Term: Transition to a Premium Support Option

Like today, Medicare enrollees will be in the traditional fee-for-service program unless they choose a private plan. However, if federal spending per enrollee for the benefits specified in legislation rises faster than GDP growth plus one percent, beneficiaries will have to pay an additional premium to cover the difference. They can avoid that additional premium, however, and potentially get higher quality health care, if they choose a private health plan offered on a new Medicare Exchange. The expectation is that increased competition among plans fostered by the Medicare Exchange, and increased beneficiary interest in these plans, will keep costs from rising rapidly and result in higher quality, more cost-effective health care.

This proposal will limit growth in federal support for Medicare per beneficiary to one percentage point per year higher than a five-year moving average of GDP growth. If Medicare spending per enrollee for the benefits specified in legislation rises at a faster rate, enrollees will have the option of paying an additional premium to cover the difference and remaining in the traditional Medicare program, or selecting a private insurance plan from the Medicare Exchange.

While the proposed premium support option resembles the current structure of Medicare Advantage, there are differences. Competition among plans will be enhanced by creating a federal Medicare Exchange, which will facilitate beneficiary choice and enrollment and increase the competitiveness of the market, leading to lower premiums.

This proposal will provide incentives for Medicare Exchange plans to develop products that will save beneficiaries money. Today, if a Medicare Advantage plan has very low costs, it cannot pay a rebate to enrollees; instead, it must increase benefits. Under this proposal, Medicare Exchange plans can offer beneficiaries relief from rising Medicare premiums. The Task Force plan might also increase political support – by Medicare beneficiaries, their children, and those approaching Medicare eligibility – for federal policies that promote cost containment in health care.

Asking beneficiaries to pay more for their Medicare coverage (or shift to a lower-cost plan) mirrors what has happened in private insurance over the past decade, with increases in patient cost-sharing to keep premium growth from exceeding income growth by too large a margin. Employers have generally opted to increase patient cost-sharing rather than increase the percentage of the premium that employees contribute. The former keeps employees enrolled in the plan and encourages more judicious use of health services.

http://bipartisanpolicy.org/system/assets/drupal/FINAL%20DRTF%20REPORT%2011.16.10.pdf

The co-chairmen of President Obama’s deficit commission advanced a proposal that disappointed those of us who believe that the government has an important role in promoting a healthy and secure future for all of us. Erskine Bowles and Alan Simpson recommend reducing the deficit by cutting back on important social programs such as Medicare and Social Security, while failing to recommend tapping obvious potential revenue sources in our upside-down economy. Two members of their committee, Jan Schakowsky and Alice Rivlin, have now released alternative proposals.

Alice Rivlin is also co-chair, along with Pete Dominici, of The Debt Reduction Task Force from the Bipartisan Policy Center (BPC), an organization founded by Howard Baker, Tom Daschle, Bob Dole, and George Mitchell. Frankly, their report is also disappointing for basically the same reasons. It is very heavy on program reductions (though some are appropriate) and very light on seeking new revenues.

Discussed here is only one feature of the BPC recommendation: converting Medicare to a premium support program. This had been mentioned only cryptically in the Bowles/Simpson report, but more details are provided in the Rivlin/Domenici report (excepts above).

Premium support was a proposal advanced a dozen years ago by John Breaux, Bill Thomas, Bill Frist, and Bobby Jindal that barely failed to receive a super-majority vote in their Bipartisan Medicare Commission, and is now being trotted out again. It is a proposal to convert Medicare from a defined benefit to a defined contribution.

Premium support places a limit on the amount that the government contributes toward the Medicare beneficiaries’ premiums, exposing individuals to the increasing costs of health care. It then uses the leverage of higher individual premiums to encourage “voluntary” purchase of less expensive private plans in the marketplace.

Since private plans have much higher administrative costs, they can achieve lower premiums only by reducing benefits or increasing out-of-pocket costs for the beneficiaries, making coverage worse than under the traditional Medicare program. Instead of overpaying private plans as with the current Medicare Advantage program, the premium support underpays the private plans but allows them to obtain the balance from the Medicare beneficiaries. It is a plan to privatize Medicare that can have only disastrous consequences for Medicare beneficiaries.

In sharp contrast is the proposal of Jan Schakowsky. She would balance revenues and expenditures with the goal of reducing the deficit, as opposed to the unstated goals of Bowles/Simpson and Rivlin/Domenici to reduce government. Her recommended reductions in spending are carefully targeted to programs that many in America believe should be reduced anyway. Her proposed increased revenues not only would help wipe out the deficit, but they also would provide corrections to the current massive income transfer from middle-income workers to the very wealthy – one of the greatest social injustices in modern history.

Other than improving the way we would purchase pharmaceuticals, she has little to say about Medicare. Her position is that of protecting what we do have. We can go her one better on that. We can improve Medicare and then provide it for everyone. That frankly won’t reduce the deficit much, but it would provide us with much greater value for our health care taxes.

What more could we ask for out of our government than sustainable budgets that provide us with real value?

ACTION ALERT: The heavy hitters are out in force, and they intend to dismantle as much of government as they can, in the name of “fiscally responsible hard choices.” It is imperative that President Obama and members of the Senate receive our clear and unrelenting message that we must both protect and improve our public programs dedicated to social justice. The House alone cannot take those away from us if we have the President and the Senate on our side.

Physician-Congressman Andy Harris wants his health care, but forget yours

GOP frosh: Where's my health care?

By Glenn Thrush
Politico
November 16, 2010

A conservative Maryland physician elected to Congress on an anti-Obamacare platform surprised fellow freshmen at a Monday orientation session by demanding to know why his government-subsidized health care plan takes a month to kick in.

Republican Andy Harris, an anesthesiologist who defeated freshman Democrat Frank Kratovil on Maryland’s Eastern Shore, reacted incredulously when informed that federal law mandated that his government-subsidized health care policy would take effect on Feb. 1 – 28 days after his Jan. 3rd swearing-in.

Harris, a Maryland state senator who works at Johns Hopkins in Baltimore and several hospitals on the Eastern Shore, also told the audience, “This is the only employer I’ve ever worked for where you don’t get coverage the first day you are employed,” his spokeswoman Anna Nix told Politico.

Harris said in an Oct. 30 statement, “In Washington, I will never vote to raise taxes, I will fight to repeal health-care reform, and I will work to balance the budget.”

http://www.politico.com/news/stories/1110/45181.html

Comment:

By Don McCanne, MD

Freshman Congressman Andy Harris, a physician, certainly understands the importance of health insurance. He is incensed that the government would make him wait until the month following the onset of his employment for his insurance benefits to begin, even though that is standard in both the public and private sectors. Actually he does not have to face a lapse in insurance coverage since another government program, COBRA, guarantees that he will be able to extend his previous insurance through the month of January.

But what about our citizens who are uninsured? The 30 million or so who would become insured under the Patient Protection and Affordable Care Act? He says he will “fight to repeal health care reform.” And we already know that the proposals that he and his Republican colleagues support instead would insure only about 3 million people.

He, a physician, demands his taxpayer-financed health care at the same time that he fought to become a government steward and will use that position to deny tens of millions of Americans their health care. A physician!

No. A real politically-empowered physician would use that power to see that financial barriers to health care would be removed for everyone.

Our medical school admissions committees need to set the bar higher. All applicants accepted should meet the standard of possessing common decency. Too bad Andy Harris snuck through.

Progressive Groups: Salem to See Single-Payer Health Care Bill in 2011

By James Pitkin
Willamette Week, November 15th, 2010

After President Obama and Democrats in Congess failed to even put universal single-payer health care on the table, progressive groups say they’ll bring a bill to the Oregon Legislature in 2011 that would establish that option in the state.

The announcement from Health Care for All-Oregon, Jobs with Justice, Physicians for a National Health Program and the Oregon League of Women Voters says state Rep. Michael Dembrow (D-Northeast Portland) will introduce the bill.

Dembrow has yet to return a phone call seeking comment. And the measure would be a tough sell in a a House evenly split and a Senate where Democrats have only a 16-14 advantage. But the groups that drafted the bill say it would provide comprehensive health benefits for every Oregon resident without co-payments or deductibles. Insurance companies would be forbidden from competing directly but could still provide benefits not covered under the plan.

Critics have blasted the national health-care bill because it lacks any meaningful cost controls and does not cover all Americans. But states have been encouraged by the feds to experiment with their own programs. And any state that passes single-payer health care has the potential to see a huge economic revival once businesses realize they’ll no longer be saddled with paying for employees’ spiraling health costs.

Read a draft of the proposed bill here.

http://blogs.wweek.com/news/2010/11/15/progressive-groups-salem-to-see-single-payer-bill-in-2011/

Drew Altman on hard choices for Medicare

Health Care Takes a Hit in New Commission Plan

By Drew Altman
The Fiscal Times
November 12, 2010

Three national commissions are hammering out recommendations for reducing the debt and reining in entitlement spending, putting two giant health programs that serve the elderly, disabled and low-income Americans, Medicaid and Medicare, as well as Social Security, in the crosshairs of a new policy debate.

The discussion of these issues is framed almost always in terms of “hard choices” to reduce spending, increase taxes, or both. In general, Democrats will resist cuts in these programs and Republicans will resist any new taxes.

But these choices are also hard on legitimate policy grounds, especially when it comes to Medicare.  And the most important reason they are hard is that so many seniors and disabled people on Medicare have low incomes and already pay a significant share of those incomes for their health care today.  It will be difficult if not impossible to ask the majority of beneficiaries ––to pay more or make do with less.  That has been the missing element in the entitlement/deficit reduction debate: Warren Buffet is not the typical Medicare beneficiary.  Instead the prototype is an older woman with multiple chronic illnesses living on an income of less than $25,000 who spends more than 15 percent of her income on health care.  It is the people on these programs and the realities of their lives that have been left out of the discussion.

http://www.thefiscaltimes.com/Issues/Health-Care/2010/11/12/Health-Care-Takes-a-Hit-in-New-Commission-Plan.aspx

Comment: 

By Don McCanne, MD

Medicare is already an inadequate program for our seniors and for individuals with long term disabilities. The commissioners are making an egregious mistake in framing the problem as a budget deficit that needs “hard choices” to reduce federal spending by shifting more costs to Medicare beneficiaries.

Medicare does need to be improved, not by cutting benefits, but rather by expanding benefits and by eliminating financial barriers to care. Then Medicare would be a much more suitable program, not only for current beneficiaries, but for everyone else as well.

It is true that the federal budget spending would increase, but the federal budget deficit would be reduced by financing Medicare through equitable taxes, and wasn’t this supposed to be all about reducing the federal budget deficit in the first place? Further, our entire national health expenditures, public and private, finally would be brought under control. As both patients and taxpayers, we couldn’t ask for a better deal.

Privatizing health care is risky for all of us

By Danielle Martin and Irfan Dhalla
The Globe and Mail, Toronto, Nov. 12, 2010

In poll after poll, Canadians reaffirm their commitment to a health-care system in which access is based on need rather than wealth. So it stands to reason that opening up medicare to a private second tier would be bad for people who have no choice but to rely on the public system. With a relatively fixed number of health-care providers, wait times in the public system would increase as staff were recruited to the private sector. From Australia to Zimbabwe, this scenario has unfolded repeatedly around the world.

But, deep down, some of us wonder: If I had the money to buy my way to the front of the line, wouldn’t I be better off in a two-tier system?

The answer, perhaps surprisingly, is probably not. Private health care would be almost as bad for the wealthy as for the poor, as long as the public system provides high-quality care (and most Canadians who use the system rate it highly).

The reason is, there’s such a thing as too much health care – too many tests, too many interventions and too many pills. The emergence of for-profit health care in Canada would produce just this situation – not enough health care for some, and too much health care for others.

This is exactly what happens in the United States, where people with private health insurance find themselves subjected to the risks of unwarranted procedures. The U.S., for example, has the highest rate of invasive cardiac procedures in the world – 45 per cent more than the next highest country. Yet, all these additional procedures have not bought Americans better heart health. Worse still, each invasive cardiac procedure carries a small but real risk of a serious complication – stroke, a torn coronary artery or even death.

Similarly, in a two-tier system, the wealthy would be bombarded with advice to get “checked out,” and many would end up receiving unwarranted screening tests such as CT scans, which produce enough radiation to increase the risk of cancer.

Even if there were a well-developed private health-care system in Canada, the wealthy would still need to use the public system for many forms of health care – trauma care, for example – because the private system would focus on elective and outpatient care. The erosion of political support for medicare probably would result in worse public care for everyone.

A two-tier system also would be bad for business. In a world where wealth buys faster access to more health care, corporations would be expected to pay for their employees to jump to the front of the line. Some Canadian businesses do this already, purchasing too much health care – executive physicals, for example – for their most-favoured employees. The cost of providing too much health care for a large proportion of the work force would be enormous.

Bank CEOs understand this already. Charles Baillie, the former CEO of TD Bank, said a few years ago: “I choose to talk about health care as a banker – as a corporate leader – because I believe it’s high time that we in the private sector went on record to make the case that Canada’s health-care system is an economic asset, not a burden, one that today, more than ever, our country dare not lose.”

Danielle Martin is a family physician at Women’s College Hospital in Toronto; Irfan Dhalla is a general internist at St. Michael’s Hospital. Both serve on the board of Canadian Doctors for Medicare.

http://www.theglobeandmail.com/news/national/time-to-lead/healthcare/privatizing-health-care-is-risky-for-all-of-us/article1795709/

I’m Over 100, and I’m Still Fighting for Health Care Reform

By Genie Ahders
The Faster Times, Nov 12, 2010

President Obama was wrong. The recent mid-term election proved that this is how the American people felt. He tried to compromise too much. That was obvious when it came to health care reform. I can still see him walking into a meeting on health care legislation with Big Pharm and insurance company executives, literally by his side, and with his back to single payer advocates. He turned his back on the American people. And the deal was done. It was all finished. But it can’t be finished for those of us who support the only method of health care reform that will be fair to everyone — the single payer system.

Every industrialized nation, with whom we compete in the world economy, has some form of universal health care. Are they all wrong? There is so much misinformation out there about the single payer option. Canada is often used as an example of the problems with a single payer, yet no one dies in Canada due to a lack of health insurance. But over a hundred a day die here from a lack of health insurance. In response to the myth about rationing of health care, Public Citizen points out that our health care is already rationed by private health insurance companies. By eliminating their administrative costs and profits we could be saving billions and billions of dollars.

Why can’t we have a system that takes profit out of the health care? Let us begin at the beginning. This is a concept I first wrote about years ago, insuring children from birth. Howard Dean instituted this type of program in Vermont with the understanding that not only do you raise healthier children but they are less of a burden on society later on. The children have improved eyesight and hearing, do better in school, are less likely to go to prison.

The ramifications are obvious to most of us. Our country is in dire straits and we need money. That money is already being given away to the very profitable health industries. I’m still hoping for the day, so vivid in my mind, that the president will consult will all the people on this issue and health care reform will be true reform.

http://thefastertimes.com/lifeafter100/2010/11/12/im-over-100-and-im-still-fighting-for-health-care-reform/

Drew Altman on hard choices for Medicare

Health Care Takes a Hit in New Commission Plan

By Drew Altman
The Fiscal Times
November 12, 2010

Three national commissions are hammering out recommendations for reducing the debt and reining in entitlement spending, putting two giant health programs that serve the elderly, disabled and low-income Americans, Medicaid and Medicare, as well as Social Security, in the crosshairs of a new policy debate.

The discussion of these issues is framed almost always in terms of “hard choices” to reduce spending, increase taxes, or both. In general, Democrats will resist cuts in these programs and Republicans will resist any new taxes.

But these choices are also hard on legitimate policy grounds, especially when it comes to Medicare.  And the most important reason they are hard is that so many seniors and disabled people on Medicare have low incomes and already pay a significant share of those incomes for their health care today.  It will be difficult if not impossible to ask the majority of beneficiaries ––to pay more or make do with less.  That has been the missing element in the entitlement/deficit reduction debate: Warren Buffet is not the typical Medicare beneficiary.  Instead the prototype is an older woman with multiple chronic illnesses living on an income of less than $25,000 who spends more than 15 percent of her income on health care.  It is the people on these programs and the realities of their lives that have been left out of the discussion.

http://www.thefiscaltimes.com/Issues/Health-Care/2010/11/12/Health-Care-Takes-a-Hit-in-New-Commission-Plan.aspx

Medicare is already an inadequate program for our seniors and for individuals with long term disabilities. The commissioners are making an egregious mistake in framing the problem as a budget deficit that needs “hard choices” to reduce federal spending by shifting more costs to Medicare beneficiaries.

Medicare does need to be improved, not by cutting benefits, but rather by expanding benefits and by eliminating financial barriers to care. Then Medicare would be a much more suitable program, not only for current beneficiaries, but for everyone else as well.

It is true that the federal budget spending would increase, but the federal budget deficit would be reduced by financing Medicare through equitable taxes, and wasn’t this supposed to be all about reducing the federal budget deficit in the first place? Further, our entire national health expenditures, public and private, finally would be brought under control. As both patients and taxpayers, we couldn’t ask for a better deal.

Kevin Drum explains the budget deficit

Is the Deficit Commission Serious?

By Kevin Drum
Mother Jones
November 10, 2010

So this report matters (the “chairman’s mark” of the deficit commission report), even though it’s really nothing more than the opinion of Alan Simpson and Erskine Bowles. So here’s what I think of it, all contained in one handy chart from the Congressional Budget Office:

(If the chart is not transmitted by this email, it can be accessed at the link below.)

Here’s what the chart means:

*  Discretionary spending (the light blue bottom chunk) isn’t a long-term deficit problem. It takes up about 10% of GDP forever. What’s more, pretending that it can be capped is just game playing: anything one Congress can do, another can undo. So if you want to recommend a few discretionary cuts, that’s fine. Beyond that, though, the discretionary budget should be left to Congress since it can be cut or expanded easily via the ordinary political process. That’s why it’s called “discretionary.”

*  Social Security (the dark blue middle chunk) isn’t a long-term deficit problem. It goes up very slightly between now and 2030 and then flattens out forever. If Republicans were willing to get serious and knock off their puerile anti-tax jihad, it could be fixed easily with a combination of tiny tax increases and tiny benefit cuts phased in over 20 years that the public would barely notice. It deserves about a week of deliberation.

*  Medicare, and healthcare in general, is a huge problem. It is, in fact, our only real long-term spending problem.

To put this more succinctly: any serious long-term deficit plan will spend about 1% of its time on the discretionary budget, 1% on Social Security, and 98% on healthcare. Any proposal that doesn’t maintain approximately that ratio shouldn’t be considered serious. The Simpson-Bowles plan, conversely, goes into loving detail about cuts to the discretionary budget and Social Security but turns suddenly vague and cramped when it gets to Medicare. That’s not serious.

There are other reasons the Simpson-Bowles plan isn’t serious. Capping revenue at 21% of GDP, for example. The plain fact is that over the next few decades Social Security will need a little more money and healthcare will need a lot more. That will be true even if we implement the greatest healthcare cost containment plan in the world. Pretending that we can nonetheless cap revenues at 2000 levels isn’t serious.

And their tax proposal? As part of a deficit reduction plan they want to cut taxes on the rich and make the federal tax system more regressive? That’s not serious either.

Bottom line: this document isn’t really aimed at deficit reduction. It’s aimed at keeping government small. There’s nothing wrong with that if you’re a conservative think tank and that’s what you’re dedicated to selling. But it should be called by its right name. This document is a paean to cutting the federal government, not cutting the federal deficit.

http://motherjones.com/kevin-drum/2010/11/deficit-commission-serious

Comment: 

By Don McCanne, MD

After reading Kevin Drum’s explanation of the federal deficit, it becomes even more obvious that all we have to do is improve Medicare, provide it for everyone, and then use its power as a monopsony serving the public good to bring the growth of health care costs to a manageable level. Compared to this, the other budget issues are a piece of cake. 

Repeal and Replace?

Not so fast. An insurance-company defector explains why the most controversial provision of the health-care law will survive.

By Wendell Potter
Newsweek, Nov. 5, 2010

Conservatives who voted for congressional candidates because they pledged to repeal and replace the health-care-reform law are in for a rude awakening. Once those newly elected members of Congress have a little talk with the insurance industry’s lobbyists and executives, they will back off from that pledge. They will go through the motions, of course. They’ll hold hearings and take to the floor of both Houses to rail against the new law, and they’ll probably even introduce a bill to repeal it with much fanfare — but it will all be for show. That’s because health insurers, one of Republican candidates’ biggest and most reliable benefactors — the industry contributed three times as much money to Republicans as to Democrats since January — can’t survive without it.

Despite all the attacks on “Obamacare,” the new law props up the employer-based system that insurers and large corporations benefit from so greatly. It also guarantees that private insurers will get billions of dollars in new revenue. And the insurers won’t have to share a penny of that windfall with a government-run public option the president once said was necessary “to keep insurers honest.”

I know what the insurers are thinking because, not long ago, I was on their side. I am sorry to admit it, but over nearly two decades I had a hand in planning the industry’s PR and public-policy strategies to either kill or shape any health-care reform proposal that might hinder profits. I was part of the strategic-communications team that planned and carried out the successful attack on the Clinton plan in the 1990s as well as the one that killed the patients’ bill of rights a few years later. I left my job handling communications for Cigna in 2008 because I didn’t have the stomach to be part of yet another spin campaign to cheat Americans out of the reform they needed.

For months before I left my job, I worked closely with my counterparts at the other big insurers to develop the list of must-haves our well-connected army of lobbyists would take to Capitol Hill when lawmakers began drafting reform legislation. Despite their public statements to the contrary, insurance companies really liked much of what was in both House and Senate versions of the bill — big chunks of which they actually wrote behind the scenes — especially the requirement that all Americans buy insurance if they’re not eligible for an existing public program like Medic-aid or Medicare.

During the reform debate, the industry’s deception-based PR strategy had two active fronts. One was a highly visible charm offensive designed to create an image of the industry as an advocate for reform and a good-faith partner with the president and lawmakers in achieving it. The second was a secret fearmongering campaign using shadowy “AstroTurf” groups and business and political allies as shills to disseminate misinformation and lies — like the one about the creation of “death panels” — with the sole intent of killing any reform that might hurt the bottom line.

Although I was ashamed of many of the things I did during my career, I didn’t plan to speak out about the industry’s devious practices until I saw Karen Ignagni, president of America’s Health Insurance Plans, tell President Obama at the end of his March 2009 White House Forum on Health Reform, “You have our commitment to play, to contribute, and to help pass health-care reform this year.” Then I knew the industry’s disingenuous charm offensive had begun. Soon after that I read that, Aetna chairman and CEO Ron Williams, the driving force behind the industry’s effort to get the individual mandate enacted, had met with the president half a dozen times. I knew Williams was trying to persuade the president to drop his insistence on the public option and to embrace the individual mandate. Sure enough, Williams got his wish.

It is ironic, of course, that the requirement to purchase insurance has become the centerpiece of Republicans’ condemnation of the new law and their court challenge of its constitutionality. Insurers have no reason to worry, however, because they fare very well when the Republicans are in charge. Their profits soared — as did the number of Americans who are uninsured and underinsured — during the Bush years and Republican control of Congress.

The real reason insurers want the GOP leading Congress again is not to repeal “Obamacare,” but to try to gut some of the provisions of the law that protect consumers from the abuses of the industry, such as refusing to cover kids with preexisting conditions, canceling policyholders’ coverage when they get sick, and setting annual and lifetime limits on how much they’ll pay for medical care. Insurers also hate the provision that requires them to spend at least 80 percent of premium revenues on medical care, as well as the one that calls for eliminating the billions of dollars that the government has been overpaying them for years to participate in private Medicare plans. (Be on the lookout for a death panel-like fearmongering campaign to scare people into thinking, erroneously, that Granny and Pawpaw will lose their government health care if Congress doesn’t restore those “cuts” to Medicare.)

Insurers are not waiting for all their new members of Congress to be sworn in to get what they want. They and their big-business allies are already pressuring the Obama administration to waive or delay the implementation of provisions they don’t like, all the while working behind the scenes not only to protect the individual mandate but to have the government enforce it with much greater gusto. The one thing the industry didn’t like about the mandate provision was that the penalties for not buying their overpriced products won’t inflict nearly enough financial pain.

Retiring Sen. Judd Gregg (R-N.H.), who once had been a part of the repeal-and-replace brigade, provoked the wrath of conservative pundits shortly before the midterm elections when he said, in a moment of unguarded candor, that repealing the law was not realistic. Instead, he said, the GOP should focus on “retooling” it. You can be certain that insurance-industry lobbyists will be helping their newly expanded congressional caucus determine what needs retooling. As my former Cigna colleague Bill Hoagland, the company’s top lobbyist, told the Associated Press a few days ago: “If you ended up repealing [the individual mandate], the whole thing blows up. It doesn’t work. The cost would explode.” In other words, feel free to repeal those pesky consumer protections, but keep your hands off our mandate.

Potter is a senior analyst at The Center for Public Integrity. This piece is based on his book “Deadly Spin,” published this week by Bloomsbury Press.

http://www.newsweek.com/search.html?q=wendell+potter

Gov.-elect Shumlin: ‘I am convinced that Vermont has an opportunity to pass a single-payer health care system’

Green Mountain Daily, Nov. 10, 2010
 
The following is an excerpt from an interview with Gov.-elect Peter Shumlin of Vermont conducted by a blogger at Green Mountain Daily (GMD).
 
GMD: You made some big commitments on health care, and I think you’ve got a strong reservoir of trust in the progressive community on that issue. But what should reformers expectations really be over the first term?
 
Gov.-elect Peter Shumlin: Well, we’re going to get Dr. [William] Hsiao’s work back shortly. I’m going to start assembling in the next few weeks a team of people – I abhor ribbon commissions because they just sit on shelves collecting dust. What I do like is a group of really informed people that can sit around and chart an ambitious course. I’ll be putting that group together. I am convinced that Vermont has an opportunity to pass a single-payer health care system that does three things. First, that contains costs so that we’re not spending a million dollars a day than we were before. Second, where health care follows the individual and is not a requirement of the employer. And third, where health care is a right, not a privilege. They’re the sort of principles that I go into this with.
 
Now, I got a lot of criticism during the campaign by Brian [Dubie, the GOP candidate] and frankly a lot of the Democrats over the primary saying, “He’s overpromising more than can be delivered.” And what I’ve said about this health care vision is this is not a promise, it’s a plan. My promise is that I will work as hard as I can over the next two years to make this happen as quickly as I can. I understand the obstacles. Some people see the federal waivers. My own view is that the federal waivers are the easy part. I think the hard part is designing a system that actually works, and bringing together the players and getting them to agree to change, and making it fast enough so that we don’t bankrupt the state, see more and more people lose their health insurance because they cant afford it, keeping the middle class from continually being [inaudible], and most importantly, keep our providers alive. You know, we’re in crisis. We’re losing our primary care providers in Vermont. We’re losing many of our health care providers. Our hospitals are on the brink because of this crazy reimbursement system. Because all the money we’re spending chasing money around, and because of a lack of technology and efficiency in the system. So – it’s a very ambitious goal, I get that, but I’m going to work as diligently as I can with as many people as we can and get it done.
 
I think that – let’s put it this way: part of the economic opportunity I’m talking about in terms of infrastructure is cracking this nut. If we can be the state where health insurance follows the individual, where it’s affordable, and where everybody’s covered. And where we’re sharing, using technology to reduce costs. Getting rid of the waste – the percentage for insurance companies and bureaucracy – we beat the other 49 states to jobs, because that is the single biggest challenge. Small business, middle class families – how do we afford the health care increases, 10 percent, 20 percent, 30 percent a year? It’s just not sustainable.
 
GMD: As far as the waivers go, you’ve got some of this wave around the country of Republican governors that got in. I was just hearing Rick Perry in Texas – arch-conservative – saying the same sort of thing, you know, they want waivers for Medicare so they can do their own thing. Obviously their own thing is going to be very different, but do you see some potential for maybe getting together on that?
 
Shumlin: I do. I’ve already talked to [Health and Human Services Secretary Kathleen] Sebelius about this. I had the pleasure of having a conversation with the president of the United States, told him I was going to be looking for three waivers. You know, we just – all I’m saying is I don’t think the waivers are the biggest challenge. The biggest challenge is designing a system, getting consensus on a system, and passing it.
 
full: http://greenmountaindaily.com/diary/7115/governorelect-shumlin-the-hopefully-first-of-many-gmd-interview

Kevin Drum explains the budget deficit

Is the Deficit Commission Serious?

By Kevin Drum
Mother Jones
November 10, 2010

So this report matters (the “chairman’s mark” of the deficit commission report), even though it’s really nothing more than the opinion of Alan Simpson and Erskine Bowles. So here’s what I think of it, all contained in one handy chart from the Congressional Budget Office:

(If the chart is not transmitted by this email, it can be accessed at the link below.)

Here’s what the chart means:

*  Discretionary spending (the light blue bottom chunk) isn’t a long-term deficit problem. It takes up about 10% of GDP forever. What’s more, pretending that it can be capped is just game playing: anything one Congress can do, another can undo. So if you want to recommend a few discretionary cuts, that’s fine. Beyond that, though, the discretionary budget should be left to Congress since it can be cut or expanded easily via the ordinary political process. That’s why it’s called “discretionary.”

*  Social Security (the dark blue middle chunk) isn’t a long-term deficit problem. It goes up very slightly between now and 2030 and then flattens out forever. If Republicans were willing to get serious and knock off their puerile anti-tax jihad, it could be fixed easily with a combination of tiny tax increases and tiny benefit cuts phased in over 20 years that the public would barely notice. It deserves about a week of deliberation.

*  Medicare, and healthcare in general, is a huge problem. It is, in fact, our only real long-term spending problem.

To put this more succinctly: any serious long-term deficit plan will spend about 1% of its time on the discretionary budget, 1% on Social Security, and 98% on healthcare. Any proposal that doesn’t maintain approximately that ratio shouldn’t be considered serious. The Simpson-Bowles plan, conversely, goes into loving detail about cuts to the discretionary budget and Social Security but turns suddenly vague and cramped when it gets to Medicare. That’s not serious.

There are other reasons the Simpson-Bowles plan isn’t serious. Capping revenue at 21% of GDP, for example. The plain fact is that over the next few decades Social Security will need a little more money and healthcare will need a lot more. That will be true even if we implement the greatest healthcare cost containment plan in the world. Pretending that we can nonetheless cap revenues at 2000 levels isn’t serious.

And their tax proposal? As part of a deficit reduction plan they want to cut taxes on the rich and make the federal tax system more regressive? That’s not serious either.

Bottom line: this document isn’t really aimed at deficit reduction. It’s aimed at keeping government small. There’s nothing wrong with that if you’re a conservative think tank and that’s what you’re dedicated to selling. But it should be called by its right name. This document is a paean to cutting the federal government, not cutting the federal deficit.

http://motherjones.com/kevin-drum/2010/11/deficit-commission-serious

After reading Kevin Drum’s explanation of the federal deficit, it becomes even more obvious that all we have to do is improve Medicare, provide it for everyone, and then use its power as a monopsony serving the public good to bring the growth of health care costs to a manageable level. Compared to this, the other budget issues are a piece of cake.