Resource – Page 697

Possibilities for Medicare For All?

By Saul Friedman
Time Goes By blog, Oct. 23, 2010

Who would have guessed that one of the most right-wing Republicans in the Senate would predict that the American people, sooner rather than later, will see the passage of single-payer, universal health care such as Medicare for All?

I hasten to add that this prediction from Senator Tom Coburn of Oklahoma, would not be to his liking; indeed he’d probably fight to his last breath to prevent such a proposal from becoming law.

Coburn, a physician, is known as “Dr. No” because of all the nominations and legislation he has obstructed with his lone objection, the latest being the emergency aid to the earthquake victims in Haiti. He’s also the M.D. who suggested we pray that the late Senator Robert Byrd (D, WV), would be too ill to cast a crucial vote on health reform, which Coburn opposed. (Byrd voted and the health reforms passed.)

Now that the Affordable Care Act is law, Coburn predicted in a speech earlier this month to the Republican Women’s Club of Tulsa, “There will be no insurance industry left in three years. That is by design. You’re going to make insurance unaffordable for everyone — which is what they want. Because if there’s no private insurance left, what’s left? Government-centered, government-run. Single-payer health care.”

The reforms, he said, will mean “the beginning of the end of America” unless they are killed by repeal, or the courts.

He didn’t explain who is the “they” who want insurance to be unaffordable. The Obama administration has criticized companies that have sharply raised premiums and asked them to desist. And the law’s requirement that individuals must buy insurance (the so-called individual mandate), subsidized by the government, is expected to add millions of new customers to the insurers’ rolls.

As far as I know, no one in the Obama White House is plotting to extend the health reforms into Medicare for All, which is too bad. But Coburn may be right without knowing why; the greed and stupidity of the insurance and drug industries could kill the reforms and bring on true universal health care if they continue their rapacious conduct.

That’s a strong possibility, according to a more rational and traditional conservative, Professor Paul J. Feldstein, of the University of California and an expert in Health Care Management in the school of business who has written text books on health economics. He was interviewed for the journal, Nursing Economics, by Peter I. Buerhaus, on the faculty of Vanderbilt University.

As Buerhaus wrote, he conducted the interview (may need free registration) because, while the health reforms “did not include language to transition toward a single-payer system, this does not preclude that over time, and depending on how the legislation is implemented, a single-payer system might eventually be adopted as many people and advocacy groups desire.”

The description “single-payer” can be confusing, and Feldstein defined it: “When a government is the only payer of health services. It does not mean that the government owns the health provider, like the U.S. owns VA hospitals. An example is Canada, where the government is the only payer for all the basic medical services provided to its citizens.”

Feldstein is not necessarily a fan of such systems; he’s a believer in the market, but he favors some regulation and restraints. When he was asked if the health reforms could lead to the adoption of a single-payer system, Feldstein said:

“I can see a scenario where there is very little cost containment and little pressure to keep insurance premiums from rising substantially. And if there is a weak mandate for individuals to purchase health insurance, then the resulting adverse selection [enrolling too many sick people] is likely to cause insurers to increase their premiums. People will become dissatisfied…and may become more supportive of a government funded public insurance option…

“Eventually, if many individuals purchase public insurance we could end up with a single-payer system or something close to one. We already pay the health care for tens of millions of people with the Medicaid and Medicare programs, and you can just pretty much put a public insurance option together with these programs into one system.”

He acknowledged that a single-payer system would cover more Americans, spend less money per patient and save on the vast administrative costs now spent on the fragmented private health insurance establishment. But Feldstein said a single-payer system would include budget restraints that could retard advances in technology and lead to rationing, inefficiencies and a reduction in preventive care because of the greater demands for acute and urgent care.

Dr. Don McCanne, of Physicians for a National Health Program (PNHP), praised Feldstein for “a more intellectual” and “sincere” discourse on the singe-payer issue. But “it is distorted by exaggerated potential adverse consequences of single-payers,” he said, “by his failure to include certain inescapable benefits.”

Dr. Quentin Young, Barack Obama’s physician in Chicago before he became president [PNHP note: Obama was actually the patient of Dr. Young’s colleague, Dr. David Scheiner, at their clinic], agrees that the new health reforms could lead to a single-payer system, if it is undermined by its critics, challenges in the courts and “destabilizing pressures” from the insurance industry. Indeed, he adds, “the law may unravel sooner than many suspect.”

Young, a founding member of PHNP, warned that if the Affordable Care Act collapses, “Single-payer Medicare for all needs to be ready to fill the gap.”

And in the meantime, he hoped Obama would reject cuts in Medicare that may be suggested by his deficit commission. “Medicare should be strengthened by improving it and extending it to everyone,” he said.

There are two bills calling for Medicare for All, one (HR 676) that has been introduced by Representative John Conyers (D. Mich), the second longest serving member of the House. Information on his bill may be found at the healthcarenow website.

The second bill, introduced by Senator Bernie Sanders, (I, Vt.), is the American Health Act, S. 703, which calls for state based single-payer systems that combine all current programs such as Medicare and Medicaid. You can study this proposal at govtrack.

When Young was Obama’s doctor, Obama favored Medicare For All, as do many Democratic lawmakers who have co-sponsored the Conyers and Sanders bills. Obama now says he would favor Medicare for All, “if we were starting from scratch.”

Well, why not start? Maybe in the second term, if there is one.

Pulitzer Prize-winning journalist Saul Friedman writes the weekly Gray Matters column which appears here each Saturday.

http://www.timegoesby.net/weblog/2010/10/gray-matters-possibilities-for-medicare-for-all.html

Why Republicans Are Always Worried That Their Pet Corporations Might Face Real Free Market Competition

Whenever corporate executives begin talking about how they support "free markets" and "competition," check to see if you still have your wallet.

By Michael Moore
Alternet, October 21, 2010

I have a rule of thumb that’s served me well my whole life: whenever corporate executives begin talking about how they support “free markets” and “competition,” check to see if you still have your wallet.

That’s because no one — not Karl Marx, not Fidel Castro, not your niece who owns the only lemonade stand on the block — hates competition more than corporations. The whole goal of a corporation is to crush all the competition. When corporate executives start pushing for “free market policies,” what they mean is a government that lets them become a monopoly.

Don’t believe me? Well, count how many corporate CEOs (and Republican politicians) stand up and cheer for the Obama administration this week:

The Justice Department sued Blue Cross Blue Shield of Michigan on Monday, asserting that the company, the state’s dominant health insurer, had violated antitrust laws and secured a huge competitive advantage by forcing hospitals to charge higher prices to Blue Cross’s rivals.

The civil case appears to have broad implications because many local insurance markets, like those in Michigan, are highly concentrated, and Blue Cross and Blue Shield plans often have the largest shares of those markets. […]

Blue Cross and Blue Shield, like most insurers, contracts with hospitals, doctors, labs and other providers for services. The lawsuit took direct aim at contract clauses stipulating that no insurance companies could obtain better rates from the providers than Blue Cross. Some of these contract provisions, known as “most favored nation” clauses, require hospitals to charge other insurers a specified percentage more than they charge Blue Cross — in some cases, 30 to 40 percent more, the lawsuit said.

As the New York Times reports, Blue Cross Blue Shield insures 60% of Michiganders — including me and everyone in my office. They have nine times more customers than the state’s next largest insurer.

And they’re just doing what businesses do, even non-profits like Blue Shield: use all their power to eliminate the competition. In fact, if Daniel J. Loepp, Blue Cross’s CEO, didn’t do that, he’d be kicked out and someone who did would replace him. (I’d hate to see that happen — he always seems like a real gentlemen when he writes every year to tell us they’re hiking our premiums 27%.)

So this is the future we face with health care in the U.S., even with Obama’s new bill: endless battles between the federal government and health insurance corporations as the companies use all their ingenuity to give us fewer choices and higher prices…at least until we get President Palin, who’ll stop fighting the biggest insurance companies and start helping them kill their competition. Which she’ll do while giving tons of speeches about the need for competition and free markets.

Is there any solution for Michigan? Yes, and it’s just across the river in Canada: they have single-payer health insurance. Of course, at this point we pretty much do too. The difference is that our single-payer is run by a corporation. Theirs is run by the government — or to put it another way, democratically.

P.S. Blue Cross Blue Shield is fantastic at making secret agreements with hospitals, but not so great at actually getting people health care: the U.S. is now ranked 49th worldwide in life expectancy. Look out, French Polynesia, we’re coming for you next!

Massachusetts doctors snub state’s health reform as model for country, pick single-payer system instead

FOR IMMEDIATE RELEASE
Oct. 22, 2010

Contact:
Rachel Nardin, M.D., chair of neurology, Cambridge Hospital; president, Massachusetts Physicians for a National Health Program

Patricia Downs Berger, M.D., retired internist; co-chair, Mass-Care: The Massachusetts Campaign for Single Payer Health Care

Benjamin Day, executive director, Mass-Care: The Massachusetts Campaign for Single Payer Health Care

BOSTON – For the first time the Massachusetts Medical Society has asked doctors what they think about health reform in its annual “Physician Workforce Survey” of 1,000 practicing physicians in the state, and the results may strike some as surprising.

A plurality of the physician respondents, 34 percent, picked single-payer health reform as their preferred model of reform, followed by 32 percent who favored a private-public insurance mix with a public option buy-in. Seventeen percent voted for the pre-reform status quo, including the permissibility of insurers offering low-premium, high-deductible health plans.

Remarkably, only 14 percent of Massachusetts doctors would recommend their own state’s model as a model for the nation. A small number of respondents, 3 percent, chose an unspecified “other.”

In other words, the doctors with the most on-the-ground experience with the Massachusetts plan, after which the Obama administration’s new health law is patterned, regard it as one of the least desirable alternatives for financing care.

The findings contrast with an earlier survey of Massachusetts physicians’ opinions on health reform funded by the Blue Cross Blue Shield of Massachusetts Foundation and the Robert Wood Johnson Foundation. That survey, published in the New England Journal of Medicine in October 2009, found that three-fourths of doctors in the state support the Massachusetts reform law. However, the survey did not allow respondents to express their preference for alternative models of health reform.

Dr. Rachel Nardin, chair of neurology at Cambridge Hospital and president of the Massachusetts chapter of Physicians for a National Health Program, said: “Massachusetts physicians realize that the state’s health reform has failed to make health care affordable and accessible, and won’t work for the nation. These findings show the high support for single-payer Medicare for all by physicians on the front lines of reform.”

While many in the country look to Massachusetts as a role model for the country, Dr. Patricia Downs Berger, co-chair of Mass-Care, the single-payer advocacy coalition in Massachusetts, and a member of the Massachusetts Medical Society, notes, “Physicians in Massachusetts, particularly after health reform, know from experience that the current health care system is not sustainable and is not addressing the deep inequalities and high costs faced by patients, and they are calling for a more fundamental change.”

A survey published in the Annals of Internal Medicine in April 2008 showed that 59 percent of U.S. physicians support government action to establish national health insurance, an increase of 10 percentage points over similar findings five years before.

Link to the 2010 Physician Workforce Survey (relevant pages: 86-90):
http://www.massmed.org/AM/Template.cfm?Section=Research_Reports_and_Studies2&TEMPLATE=/CM/HTMLDisplay.cfm&ContentID=36167

Link to 2009 Blue Cross Blue Shield survey of Massachusetts physicians:
http://healthpolicyandreform.nejm.org/?p=2133&query=home

http://www.hsph.harvard.edu/news/press-releases/2009-releases/three-fourths-of-mass-physicians-health-reform-law.html

Link to April 2008 survey in the Annals of Internal Medicine:
https://pnhp.org/docsurvey/annals_physician_support.pdf

The National Health Program Reader

Edited by Ida Hellander, M.D. and Matthew Petty

Edition 3.3, Updated on October 21, 2011

Section I: PNHP’s Proposal for Single-Payer National Health Insurance

Physicians’ Proposal for Single-Payer National Health Insurance (JAMA, 2003)
Frequently Asked Questions

Section II: The Evidence-Based Case for Single Payer National Health Insurance

Topic A: Patients need single payer

Talking Point 1: Nearly two-thirds of all bankruptcies are caused by medical bills; three-quarters of those bankrupted had health insurance at the time they got sick or injured.
Himmelstein, D.U., Thorne, D., Warren, E., Woolhandler, S. (2009). “Medical Bankruptcy in the United States, 2007: Results of a National Study.” Am J Med, 122, 741-746.
Himmelstein, D.U., Thorne, D., Warren, E., Woolhandler, S. (2009). “Medical Bankruptcy Q&A.”
Talking Point 2: The uninsured do not receive all the medical care they need: 45,000 die annually. One-third of uninsured adults have a chronic illness and don’t receive needed care.
Wilper, A., et. al. (2009). “Health Insurance and Mortality in U.S. Adults.” Am J Public Health, 99, 2289-2295.
Press Release for Wilper, A., et. al. (2008). “A National Study of Chronic Disease Prevalence and Access to Care in Uninsured U.S. Adults.” Arch Intern Med, 149, 170-176.

Topic B: We can afford single payer

Talking Point 3: Administrative costs consume 31 percent of health spending, most of it unnecessary. The U.S. could save enough on administrative costs (almost $400 billion in 2009) with a single-payer system to cover the uninsured.
Woolhandler, S., Campbell, T., & Himmelstein, D.U. (2003). “Costs of Health Care Administration in the U.S. and Canada.” N Engl J Med, 349, 768-775.
Talking Point 4: Taxes already pay for more than 60 percent of US health spending, and business pays less than 20 percent. Americans pay the highest health care taxes in the world; we pay for national health insurance, but we don’t get it.
Woolhandler, S. & Himmelstein, D.U. (2002). “Paying for National Health Insurance – And Not Getting It.” Health Affairs 21(4), 88-98.
Talking Point 5: The U.S. spends more per capita on health care than other nations.
OECD Health Data 2011 (excerpted charts)

Topic C: Single payer ensures high quality health care

Talking Point 6: Single-payer national health insurance is the best way to ensure high-quality health care.
Schiff, G.D., Bindman, A.B., & Brennan, T.A. (1994). “A Better Quality Alternative: Single-Payer National Health System Reform.” J Am Med Assoc, 272, 803-808.
Talking Point 7: Other countries have high quality care with lower levels of amenable mortality.
Nolte, E. & McKee, M. (2011). “Variations in Amenable Mortality – Trends in 16 High-Income Nations.” Health Policy.
Talking Point 8: Competition among investor-owned, for-profit entities – including hospitals, HMOs, hospice care, and nursing homes – increases costs and degrades quality.
Woolhandler, S. & Himmelstein, D.U. (2007). “Competition in a publicly funded healthcare system.” Brit Med J, 335, 1126-1129.
Himmelstein, D. & Woolhandler, S. (2004). “The high costs of for-profit care.” Can Med Assoc J, 170, 1814-1815.
Devereaux, P.J., et. al. (2004). “Payments for care at private for-profit and private not-for-profit hospitals: a systematic review and meta-analysis.” Can Med Assoc J, 170, 1817-1824.
Devereaux, P.J., et. al. (2002). “A systematic review and meta-analysis of studies comparing mortality rates of private for-profit and private not-for-profit hospitals.” Can Med Assoc J, 166, 1399-1406.
Himmelstein, D.U., Woolhandler, S., Hellander, I., & Wolfe, S.M. (1999). “Quality of Care in Investor-Owned vs. Not-for-Profit HMOs.” J Am Med Assoc, 282, 159-163.
Perry, J.E. & Stone, R.C. (2011). “In the Business of Dying: Questioning the Commercialization of Hospice.” J Law Med Ethics, Summer, 224-234.
Comondore, V.R., et. al. (2009). “Quality of care in for-profit and not-for-profit nursing homes: systematic review and meta-analysis.” Brit Med J, 339.

Topic D: Single payer is good for physicians

Talking Point 9: Single payer removes corporate barriers to physicians’ ability to practice medicine.
Grumbach, K. & Bodenheimer, T. (1990). “Reins or Fences? A Physicians’ View of Cost Containment.” Health Affairs, Winter, 120-126.
Hayes, G.J., Hayes, S.C., & Dystra, T. (1993). “Physicians Who Have Practiced in Both the United States and Canada Compare the Systems.” Am J Public Health, 83, 1544-1548.
Talking Point 10: Medical malpractice systems can be harnessed to ensure better quality in single-payer systems. The cost and quantity of medical malpractice suits are decreasing.
Schiff, G. (2003). “Medical Malpractice. Health Care Quality and Health Care Reform,” Forum Report #4. PNHP NY Metro.
Canadian Health Services Research Foundation. (2006). “Mythbusters: Medical malpractice suits plague Canada.”
Adelman, S.H. & Westerlund, L. (2004). “The Swedish Patient Compensation System: A viable alternative to the U.S. tort system?” Bull Am Coll Surg 89(1), 25-30.
Talking Point 11: It is a myth that doctors practicing under national health insurance are compensated significantly worse than their American colleagues.
How does national health insurance affect physicians’ income?” PNHP document.
Duffin, J. “The Impact of Single-Payer Health Care on Physician Income in Canada, 1850-2005.” Am J Public Health, 101(7), 1198-1208.

Topic E: How other countries do it: international health systems

Talking Point 12: Every other industrialized, capitalist country has some form of non-profit national health care.
Hellander, I. “International Health Systems for Single Payer Advocates.” PNHP Documents.
Reid, T.R. (2008). “PBS Frontline Interview with T.R. Reid, Fall 2008.”
Case Study: Canada
Lasser, K., Himmelstein, D.U., & Woolhandler, S. (2006). “Access to Care, Health Status, and Health Disparities in the United States and Canada: Results of a Cross-National Population-Based Survey.” Am J Public Health, 96, 1300-1307.
Guyatt G.H., et al. (2007). “A systematic review of studies comparing health outcomes in Canada and the United States.” Open Medicine, 1, E27-36.
Katz, S.J., Cardiff, K., Pascall, M., Barer, M.L., & Evans, R.G. (2002). “Phantoms in the Snow: Canadians’ Use of Health Care Services in the United States.” Health Affairs, 21(3), 19-31.
Case Study: Taiwan
Underwood, A. (2009). “Health Care Abroad: Taiwan.” The New York Times Prescriptions Blog, Nov. 3.
Cheng, T.M. (2009). “Lessons from Taiwan’s Universal National Health Insurance: A Conversation With Taiwan’s Health Minister Ching-Chuan Yeh.” Health Affairs, 28(4), 1035-1044.

Topic F: Alternative reform proposals

Talking Point 13: Alternative proposals for “universal coverage” do not work. State health reforms over the past two decades have failed to reduce the number of uninsured.
Himmelstein, D.U. & Woolhandler, S. (2010). “Obama’s Reform: Not Cure for What Ails Us.” Brit Med J, 340, c1778.
Angell, M. (2008). “Health Reform You Shouldn’t Believe In.” The American Prospect, April 21.
Woolhandler, S., Day, B., & Himmelstein, D.U. (2008). “State Health Reform Flatlines.” Int J Health Serv, 38, 585-592.
Himmelstein, D.U., Thorne, D., & Woolhandler, S. (2011). “Medical Bankruptcy in Massachusetts: Has Health Reform Made a Difference?” Am J Med, 124, 224-228.

Topic G: Controlling health care costs

Talking Point 14: Computerized medical records and chronic disease management do not save money.
Himmelstein, D.U., Wright, A., & Woolhandler, S. (2010). “Hospital Computing and the Costs and Quality of Care: A National Study.” Am J Med, 123(1), 40-46.
Geyman, J. (2007). “Disease Management: Panacea, Another False Hope, or Something in Between?” Ann Fam Med, 5, 257-260.
Talking Point 15: Immigrants and emergency department visits by the uninsured are not the cause of high and rising health care costs.
Mohanty, S., et. al. (2005). “Health Care Expenditures of Immigrants in the United States: A Nationally Representative Analysis.” Am J Public Health, 95, 1431-1438.
Tyrance, P.H., Himmelstein, D.U., & Woolhandler, S. (1996). “US Emergency Department Costs: No Emergency.” Am J Public Health, 95, 1527-1531.
Talking Point 16: Co-pays and deductibles are not necessary to control costs and reduce unnecessary care.
Goodell, S. & Swartz, K. (2010). “Cost-sharing: Effects on spending and outcomes.” Robert Wood Johnson Foundation. The Synthesis Project, Policy Brief No. 20.
Talking Point 17: Drug companies spend more on marketing (31 percent) and profits (20 percent) than on R & D (13 percent). Lower drug prices would not jeopardize drug innovation, much of which is, in fact, publicly-funded.
Light, D.W. & Warburton, R.N. (2005). “Extraordinary Claims Require Extraordinary Evidence.” J Health Econ, 24, 1030-1033.
Light, D.W. & Lexchin, J. (2005). “Foreign Free Riders and the High Price of U.S. Medicines.” Brit Med J, 331, 958-60.

Topic H: The public supports single payer, “Medicare for all”

Talking Point 18: A majority of physicians (59 percent), and an even higher proportion of Americans (two-thirds), support national health insurance or “Medicare for all.”
Carroll, A.E. & Ackerman, R.T. (2008). “Support for National Health Insurance among U.S. Physicians: 5 Years Later.” Ann Intern Med, 148, 566.
PNHP. (2007). “PNHP Backgrounder: Recent Public Polls on Single Payer.”
Single payer endorsers (HR 676, unions, etc.)

Section III: Tools for Activists

Finding your niche in activism
Building the movement with public speaking
PNHP PowerPoints
Media tips
Congressional visit “how to” kit
Handouts for talks
Key Features of Single-Payer National Health Insurance
Frequently Asked Questions
The case for an Improved Medicare for All
PNHP Research
Background Fact Sheet
Financing single-payer national health insurance: Myths and facts

Find more resources for activists at www.pnhp.org/action/activism

Health food for thought

By Evan Tuchinsky
Paradise (Calif.) Post, Oct. 19, 2010

Last week I took an assignment from another newspaper to cover the Mad As Hell Doctors’ appearance in Chico. The advocates for a single-payer system were completing a tour of California, and the capacity crowd at Harlan Adams Theater was the biggest they drew. They found a very receptive audience.

The panel – four physicians from the Pacific Northwest, joined by a local doctor and two local nurses – raised some thought-provoking points about healthcare reform. If you’re unhappy about the Patient Protection and Affordable Care Act, you’re in good company, and you have something in common with these crusading physicians who find reasons for displeasure on both sides of the debate.

They’re mad about disinformation like “death panels” and “socialized medicine,” which clouds the discussion. They’re also mad that the single-payer option wasn’t even considered by the White House and Congress, leaving us with a compromise bill with fundamental flaws.

They see single-payer insurance as critical.

“Single payer” tends to get lumped in with “nationalized medicine” even though there is a key distinction: Insurance would come from the public sector, but care would come from the private sector. Despite the oft-heard crises of “keep your government out of my healthcare,” MAHD speakers argue that the majority of healthcare money flows from the government right now. Three of the five groups covered by insurance are seniors (Medicare), children from low-income families (Medicaid/Medi-Cal) and military veterans (VA).

The imbalance in economics comes when private, for-profit insurers can cherry-pick plum customers. If all insured Americans – young and old, healthy and sick – were part of the same “risk pool,” instead of segregated, premiums from the former would cover expenses of the latter.

The so-called “government option” would have been a disaster, one Mad As Hell Doctor explained, because “the private insurers would game the system and throw all the sick people to the public option, and when the public option failed, the private insurers would say, ‘See, the government can’t do healthcare!'”

The idea of a government-run insurance monopoly raises understandable fears, even among those who see benefits in a single system – benefits such as less paperwork, fewer sets of rules and, correspondingly, a greater share of each healthcare dollar going to actual healthcare.

Before getting alarmed, though, it’s important to look at the status quo and assess fears accordingly. Take the notions of lines and rationing, for instance. There already are lines. Emergency rooms are backed up. It’s hard to get a doctor’s appointment if you don’t already see a primary-care physician. And, as one MAHD speaker asked, how long have you waited on the phone line when calling an insurer?

As for rationing, insurers do this now when they deny treatment or require lengthy authorization processes for procedures, medicines and equipment they cover. The Mad As Hell Doctors gave me a lot to think about, and I know I’m not alone.

http://www.paradisepost.com/opinion/ci_16371041

Expert: Single-Payer Health System Could Save Maine $1 Billion a Year

With health care costs high and rising, state lawmakers are trying to come up with new alternatives incorporating recent federal reform laws. Today in Augusta, a committee heard from a health care expert who says a single-payer system could save a billion dollars in Maine each year.

» Click here to listen to the story

Maine Public Broadcasting Network
Oct 19, 2010

In the early 1990s, when Taiwan wanted to tackle rising health care costs, it hired economist William Hsiao to come up with a solution. And it was a tall order, Hsiao told the Legislature’s Joint Select Committee on Health Care Reform Opportunites and Implementation.

“Taiwan decided that everyone should have access to basic health care. However, health care costs money, and regardless of how you pay for it — either out of your own pocket or though premiums paid partly by your employer or out of your own pocket — it’s going to be paid by somebody, through some avenue.”

With the goal of affordable universal coverage that is sustainable over time, Taiwan developed a single-payer system, adminstered by the government. Hsiao, a professor at Harvard, says the cost is much lower than in the United States health care system, and it is paid for by employers, employees and the federal government.

And, he says, nearly everybody is covered. “They even sent people under the bridges to find the homeless to enroll them. And the Taiwanese that live overseas fly back to Taiwan for their health care, because it is literally free, and high quality.”

Hsiao spoke to a committee room crowded with health care lobbyists. The committee was formed following the passage of the federal Affordable Care Act last spring, to prepare Maine for the law’s implementation.

One committee member wondered if there is another way to develop mandatory, standardized health care coverage while still using private insurers, in a system more like that seen in Holland and Germany.

“I wouldn’t call it single-payer, but then I’m a Republican,” says Rep. Les Fossel, a Republican from Alna. He points out that the state requires car insurance, and it is provided through private insurers. Though he is not sold on single-payer, he says something needs to change.

“The thing is, we simply can’t sustain the system as it is going forward now,” Fossel says. “The Affordable Health Care Act did a whole lot to define coverage, but Truman had it wrong when he said ‘the buck stops here.’ The buck keeps being shoved down to the guy at the lowest level. And we have to figure out a way to pay for it. And this is going to be an extraordinarily difficult thing, and yet if we don’t, we are going to kill people.”

And kill jobs, he might have added. Jim Miller, general manager of Wooden Boat Publications, which employs 33 people in Brooklin, says small businesses are struggling with fast-rising health care costs.

“We had a renewal in May and we experienced a 17 percent increase in premiums, which is an increase of $48,000. That’s a one-year increase,” Miller says. “Unfortunately, there is nothing we can do to offset this cost, nor is there any way to understand why this happened.”?

Miller spoke at a press conference held by Maine AllCare, which used Hsiao’s visit to beat the drum for health care reform. He says Wooden Boat is self-insuring part of its employees’ deductibles this year, basically gambling on the health of its employees. And Miller says the lack of affordable health care puts the business at a competitive disadvantage.

“We are also faced with competition from international magazines located in countries that offer national health insurance,” he says. “They are at a cost advantage, as are the U.S. magazines we compete against who have chosen to drop coverage for their staff.”

William Hsiao is now working as a consultant to the state of Vermont, as it tries to develop an affordable health care plan. And he says that if Taiwan is any example, the United States could save a lot of money by moving toward a single-payer system.

“Taiwan right now, 2009, is spending 6.1 percent of its GDP for health care. The United States last year was spending 16.7 percent of its GDP for health care,” he says.?

In Taiwan, Hsiao says, the system saw 10 percent cost savings just by rooting out the health care providers who were fraudulently or excessively billing for services. Similar savings in Maine, he says, would equal a billion dollars a year.

http://www.mpbn.net/Home/tabid/36/ctl/ViewItem/mid/3478/ItemId/13906/Default.aspx

Poor healthcare may shorten American lives – study

By Maggie Fox, Health and Science Editor
Reuters, Oct. 7, 2010

WASHINGTON — Americans die sooner than citizens of a dozen other developed nations and the usual suspects — obesity, traffic accidents and a high murder rate — are not to blame, researchers reported on Thursday.

Instead, poor healthcare may be to blame, the team at Columbia University in New York reported.

They found that 15-year survival rates for men and women aged 45 to 65 have fallen in the United States relative to the other 12 countries over the past 30 years.

Such figures are frequently cited by supporters of healthcare reform, and critics often point out that the United States also has higher rates of obesity, more traffic fatalities and more murders than these countries.

Columbia’s Peter Muennig, who led the study published in the journal Health Affairs, said his team accounted for these factors this time.

“But what really surprised us was that all of the usual suspects — smoking, obesity, traffic accidents, and homicides — are not the culprits,” Meunnig said in a statement.

“The U.S. doesn’t stand out as doing any worse in these areas than any of the other countries we studied, leading us to believe that failings in the U.S. health care system, such as costly specialized and fragmented care, are likely playing a large role in this relatively poor performance on improvements in life expectancy.”

In June, the Commonwealth Fund, which advocates on and does research focusing on healthcare reform, reported that Americans spend twice as much on healthcare as residents of other developed countries — $7,290 per person — but get lower quality and less efficiency.

Muennig and Sherry Glied compared the United States to Australia, Austria, Belgium, Britain, Canada, France, Germany, Italy, Japan, the Netherlands, Sweden and Switzerland.

All these countries provide universal health insurance, in contrast to the United States, where 15 percent of the population lacks health insurance, although healthcare reform passed in March is designed to lower that disparity.

Republicans have promised to derail the legislation if they gain power in Congress in next month’s elections.

COSTS GO UP

Between 1975 and 2005, medical costs went up in all the countries, as did life expectancy. But costs went up far more in the United States and life expectancy increased to a far lower degree.

Glied and Meunnig do not believe obesity accounts for the differences. While more Americans are obese, overall the populations in all the nations have been getting fatter, they said.

“For obesity to explain the decline in U.S. life expectancy or the increase in health spending relative to the 12 comparison countries, Americans would have to be becoming obese at a faster rate than people in the comparison nations over time,” they wrote. But this has not been happening.

Americans are less likely to smoke, and while Americans are more likely to die in car crashes or be murdered, again these rates do not explain the lower life expectancy, the Columbia team said.

“The findings undercut critics who might argue that the U.S. health care system is not in need of major changes,” they wrote.

They noted that the United States has been dropping in life expectancy tables for decades.

“In 1950, the United States was fifth among the leading industrialized nations with respect to female life expectancy at birth, surpassed only by Sweden, Norway, Australia, and the Netherlands,” they wrote. At last count, the United States was 46th in female life expectancy; 49th for both sexes. (Editing by Eric Walsh)

http://www.reuters.com/article/idUSN0622294120101007

Low-Cost Lessons from Grand Junction, Colorado

By Thomas Bodenheimer, M.D., M.P.H., and David West, M.D.
The New England Journal of Medicine
October 7, 2010

According to the Dartmouth Atlas of Health Care, average per capita Medicare spending in Grand Junction was $6,599 in 2007 – 24% lower than the national average and 60% below high-cost Miami.

Moreover, Grand Junction scored above the national average on a number of measurements of preventive care, diabetes, asthma, and other quality metrics.

We believe that seven interrelated features of the health care system that may explain the relatively low health care costs could be adopted elsewhere. These are leadership by the primary care community; a payment system involving risk sharing by physicians; equalization of physician payment for the care of Medicare, Medicaid, and privately insured patients; regionalization of services into an orderly system of primary, secondary, and tertiary care; limits on the supply of expensive resources, including specialists, beds, and equipment; payment of primary care physicians for hospital visits; and robust end-of-life care. These features could be replicated in other markets – though generally not without political battles.

http://www.nejm.org/doi/pdf/10.1056/NEJMp1008450

Comment:

By Don McCanne, MD

Although I am taking a break this week and won’t provide a comment here, an excellent commentary on the Bodenheimer and West article has been posted by Joshua Freeman, Professor and Chair of the Department of Family Medicine for the University of Kansas School of Medicine. He states, “Grand Junction, Colorado may not have all the answers to our health care system, any more than Canada or Britain or Switzerland do. But it is doing a lot of things right, it is saving money, and it is improving the health of the community, and that’s a lot more than most areas in the US are doing.”

For Josh Freeman’s full commentary:
http://medicinesocialjustice.blogspot.com/2010/10/lower-costs-in-grand-junction-primary.html

Low-Cost Lessons from Grand Junction, Colorado

Low-Cost Lessons from Grand Junction, Colorado

By Thomas Bodenheimer, M.D., M.P.H., and David West, M.D.
The New England Journal of Medicine
October 7, 2010

According to the Dartmouth Atlas of Health Care, average per capita Medicare spending in Grand Junction was $6,599 in 2007 – 24% lower than the national average and 60% below high-cost Miami.

Moreover, Grand Junction scored above the national average on a number of measurements of preventive care, diabetes, asthma, and other quality metrics.

We believe that seven interrelated features of the health care system that may explain the relatively low health care costs could be adopted elsewhere. These are leadership by the primary care community; a payment system involving risk sharing by physicians; equalization of physician payment for the care of Medicare, Medicaid, and privately insured patients; regionalization of services into an orderly system of primary, secondary, and tertiary care; limits on the supply of expensive resources, including specialists, beds, and equipment; payment of primary care physicians for hospital visits; and robust end-of-life care. These features could be replicated in other markets – though generally not without political battles.

http://www.nejm.org/doi/pdf/10.1056/NEJMp1008450

For Josh Freeman’s full commentary:
http://medicinesocialjustice.blogspot.com/2010/10/lower-costs-in-grand-junction-primary.html

As Nov. 6 PNHP meeting nears, activity steps up

Oct. 20, 2010

Dear PNHP colleagues and friends,

Momentum is building for PNHP’s Annual Meeting, which is only a couple of weeks away – Saturday, Nov. 6 – in Denver, but it’s still not too late to register. We also have a few spots open for our highly acclaimed Leadership Training Institute the day before (Nov. 5). Please register for one or both today.

You won’t want to miss distinguished speakers like Democracy Now host Amy Goodman, PNHP co-founders Drs. David Himmelstein and Steffie Woolhandler, pharmaceutical industry critics Donald Light (editor of the new book “The Risks of Prescription Drugs”) and Joel Lexchin, American pediatric surgeon practicing in Canada Dr. Sherif Emil, labor activist Rose Roach and journalist T.R. Reid (author of “The Healing of America”), among others.

And you won’t want to miss the chance to compare notes with PNHP activists from all over the country who are continuing the drive for single-payer health reform on the state and national levels.

All events will be held at the Sheraton Denver Downtown Hotel at 1550 Court Place, Denver. To book your room, call 800-325-3535. If you have questions, call the PNHP office at (312) 782-6006. If you are unable to attend, please consider making a donation to help pay for scholarships for medical students to participate.

Meanwhile, PNHP leaders and activists have been active on multiple fronts in recent weeks.

Thirty-nine physicians joined or renewed their membership in PNHP at the recent meetings of the American Academy of Family Physicians and the American Academy of Pediatrics, where we had exhibit booths. Our membership continues to grow – we’re now over 18,000!
Dr. Margaret Flowers and PNHP staffer Ali Thebert just completed a successful chapter visit to North Carolina, where area members arranged for Dr. Flowers give grand rounds, radio interviews and presentations in churches and community halls in Charlotte, Greensboro and Durham-Chapel Hill. In the weeks ahead, similar visits are planned for New Jersey, Wisconsin and Colorado. To arrange a chapter visit, contact Ali Thebert at ali@pnhp.org.
PNHP’s banner at the Oct. 2 “One Nation Working Together” march in Washington calling for “Single payer – improved Medicare for all” was very well received. An estimated 175,000 people attended the event, which is described by Drs. Flowers and Andy Coates here. You can see a picture of our banner here.
Our Washington staff, notably PNHP congressional fellow Dr. Flowers and Ron Hikel, have been meeting with the health legislative assistants of several U.S. senators, aiming to line up more support for single-payer legislation in that chamber. On the House side, the main points of our successful congressional briefing on Sept. 23 are summarized here. The briefing, which focused on the Deficit Commission’s threats to Medicare, drew several dozen health LAs and the participation of Rep. Lynn Woolsey, honorary co-host of the event, and Rep. John Conyers. Rep. Raul Grijalva also co-hosted.
The Nov. 2 midterm elections are just around the corner, and single payer is an issue in many campaigns. You can read the comments of PNHP’s national coordinator, Dr. Quentin Young, on this fall’s political scene at The Huffington Post.
Our physicians continue to engage in a lively debate about health reform on the opinion pages of their regional newspapers. See, for example, the recent op-eds of Dr. Wally Retan in the Birmingham News and Dr. James Mitchiner in the Ann Arbor News. A great resource for evaluating the new health law and making a compelling case for single payer is Dr. John Geyman’s new book, “Hijacked: The Road to Single Payer in the Aftermath of Stolen Health Reform.” You can order it easily through PNHP’s store.

Thanks for your continued support and especially your priceless efforts for reform!

Cordially,

Quentin Young, M.D.
National Coordinator

Mark Almberg
Communications Director

P.S. If you’re a member of CREDO’s phone services or CREDO Action, you can help PNHP by voting on how CREDO distributes its 2010 donations funding. This year PNHP is on the ballot and we need your votes! The more votes we get, the more funding we’ll receive from CREDO. Two years ago we received nearly $65,000 in this way. Voting is easy. Go to http://www.credomobile.com/ballot and vote for us. It’s a quick and effective way to support PNHP — at no extra cost to you. Of course, you can always make a direct, tax-deductible contribution to PNHP online or by mail, too!

State needs single-payer health system

By WALLY RETAN
Birmingham News, Oct. 10, 2010

The cost of health care is out of control. We have to do something about it. Now.

As a nation, we spent about $8,000 per person on health care last year. Tha
t includes premiums, co-payments, deductibles and out-of-pocket payments for what insurance didn’t cover. That’s also the money employers didn’t put into paychecks because they sent it to an insurance company.

It’s also taxes. Medicaid is bankrupting many state governments, including ours, but health care costs also include taxes for the veterans medical system, military medicine and Medicare.

In 1970, health care costs were only $350 per person. Government experts expect the spending to rise to $13,000 per person by 2018, the year the major cost-controlling measures of the new health care law finally become fully effective. That would be more than $30,000 a year for an average family.

We can’t afford to wait for the law to do whatever it’s going to do to control costs.

Medical expenditures in Great Britain, Sweden and Spain are about $3,000 per person each year. The quality of health care in those countries scores very high in international comparisons; in some cases, higher than ours. People who live there are generally well-satisfied with the care they have.

America can follow their example and provide high-quality health care for everyone for about half of what we’re spending now. What it would take is a publicly financed, national health insurance program like those in European countries — a single-payer health care system.

Today, of every U.S. dollar spent for health care, 30 cents or more go to administration, most of it wasted on the paperwork and bureaucracy imposed by private health insurance companies. By comparison, the administrative overhead in the Medicare system is less than 4 cents per dollar.

We need the efficiency of a single, publicly financed health care system, like an improved form of Medicare, providing affordable, high-quality care for everyone. Medicare preserves the right to choose and change one’s physician, fundamental to patient autonomy. Patients would be free to seek care from any licensed health care professional.

Our health facilities should be geared toward optimal patient care, not for optimal return to shareholders. Hospitals should operate as public service organizations, with regional planning agencies setting their global budgets, including their capital expenditures. This would eliminate most of today’s irrational waste.

So, is this the way our country should go?

Doctors would like it. Physicians in single-payer countries live comfortably, much like physicians here. They have much less medical school debt, much lower malpractice insurance and wonderful freedom from hassles with insurance companies.

Patients would like it. We’d all pay a little more Medicare tax, but we’d be free of those sky-high premiums, co-payments and deductibles, and free of wrongful claim denials. We’d know that every one of us could get all of the care we really need, without favoritism and with no one left out.

Businesses would like it. No more double-digit premium increases each year to struggle with. No more worrying about the cost of health care for employees. Employers could get out of the health insurance business and back to doing what they know best.

A single-payer program would also give us powerful tools like the ability to negotiate fees and pharmaceutical prices, thus giving us long-term cost control.

States all across the country are looking hard at what the new health care reform law requires of them. Many states are also looking hard to see if a state single-payer option would make sense for them.

Alabama should be looking at a state single-payer option, too.

Wally Retan, M.D., of Mountain Brook is state coordinator for the Alabama chapter of Physicians for a National Health Program (www.PNHP.org) and Health Care for Everyone — Alabama (www.HealthCareFor-Everyone-Alabama.org). E-mail: info@healthcareforeveryone-Alabama.org.

http://blog.al.com/birmingham-news-commentary/2010/10/my_view_state_needs_single-pay.html

Model exists to provide health insurance for all – it’s called Medicare

By Dr. James C. Mitchiner
Ann Arbor News, Oct. 3, 2010

The announcement last month by the Census Bureau that the number of uninsured increased last year to a record 50.7 million individuals should come as no surprise to those who understand the uniquely American tradition of linking health insurance to employment.

Combined with the corresponding finding that the rate of employer-based insurance has decreased, the conclusion is obvious: in a declining economy, as unemployment rates increase and employer payrolls tighten, the number of people lacking health insurance goes up.

Why is this? I have never understood why health insurance must be associated with employment. Historically, I recognize how businesses’ response to FDR’s wartime wage and price controls lead to the situation we have now. But I fail to see how a model first applied in the 1940s should continue to operate in the 21st century. Other forms of insurance – car, home, boat, flood, and universal life insurance – are not linked to a job, so why should health insurance have this unique relationship?

Imagine a world where your health care coverage would not be predicated on what you did or where you worked, where you lived under a system that provided continual access to care as you moved from job to job or state to state, and guaranteed your health security even if you were laid off or terminated. Picture yourself in such a world where “choice” refers not to your choice of health insurer, but instead to the freedom to choose your own doctor and hospital, based on whatever criteria you and you alone deem to be personally relevant. And imagine a world where more than 95 percent of your contribution to health insurance was actually spent on health care, with no substantial contributions to a bloated and mindless bureaucracy.

The good news is that such a model exists. It is called a single-payer, Medicare-for-All program. It is a plan modeled on Medicare, a popular program that is universal, portable, affordable, non-profit, non-discriminatory, and administratively efficient. An expanded Medicare program would sever the link between employment and health insurance for all Americans, and use as its sole entry criteria nothing more than U.S. citizenship. Such a program would drastically reduce the number of uninsured, at a total cost much less than what we are paying now. And, under a single-payer system, private insurance firms would be used for simple administrative functions only, and not for decisions that place greedy corporate profits over an individual’s right to medical care.

And the bad news? The United States remains the only western democracy that does not have universal single-payer health insurance. For illogical reasons, we as a country continue to have blind faith in the ability of the private insurance industry to solve the dual problems of access to care and cost containment. If for-profit insurance has not fixed the problems with health care after over 60 years of existence, why would anyone believe it would happen now under the recently passed health care reform act, where private insurance continues to play a dominant role? Clearly, the only logical solution is to insure everyone, and the most efficient way to do that is through single-payer national health insurance.

Dr. James Mitchiner, an Ann Arbor physician, is the fo
rmer president of the Washtenaw County Medical Society and a member of Physicians for a National Health Program.

http://www.annarbor.com/news/opinion/model-exists-to-provide-health-insurance-for-all—its-called-medicare/

Socialized, single payer health care in the U.S. – that works!

By Richard Cranium
Daily Kos, Oct. 15, 2010

Yesterday, I was introduced to a socialized, government-run, single payer health care system that works. And it is working beautifully, right here in America.

It would be almost schadenfreude-ish to see every Republican and blue dog Dem try to take a swipe at this highly efficient model of medical care provision. But they won’t, because it wouldn’t be politically expedient to do so, as it is with “Obamacare”.

If you’re interested in taking a look at what a comprehensive, national health care system might look like – one that is actually operating in the U.S. right now – hop down below the fold.

Toward the end of the health care reform debate, there was a big outcry (championed most publicly by Howard Dean) that the end result should be “Medicare for all”. That’s not a half bad idea, as far as it goes. And it would have been an improvement on what the final HCR bill looked like. I’m wondering, though, if we missed an opportunity. The end result of a comprehensive overhaul of the provision of health care in the United States might actually be closer to the Veterans Administration health care system.

Allow me to explain my own first encounter with the VA model. Now, granted, my experience yesterday was only my first visit, but the coordination of the care I received from the moment I checked in was extremely – and I mean, extremely – efficient.

Here are the bullet points of my day:

12:55 – Arrived at VA medical center, checked in
1:05 – Called by a team nurse, vitals checked, basic information collected, received flu shot
1:15 – Taken to waiting room to see my primary
1:20 – Primary comes to waiting room, introduces herself, we go to her office
2:00 – Leave primary’s office, go to nurse station. Receive Tdap booster.
2:05 – Sign up at lab station
2:10 – Called for lab work
2:15 – Lab samples drawn; head for specialty clinic to make appointment
2:20 – Go to pharmacy to pick up prescriptions; prescriptions are ready
2:25 – Go to radiology clinic
2:45 – Chest Xray and EKG complete
2:55 – Make appointment at another specialty lab
3:00 – Take care of some administrative details at Eligibility station
3:15 – Leave VA medical center

The Details

My primary was very thorough, and took a good amount of time with me to get all of my background, discuss my overall health issues, and conduct a brief physical exam. She was able to write up all of my current meds right from her computer. I can’t emphasize enough how absolutely thorough she was in her data collection and evaluation, and all of this was entered into my profile right on her computer as we talked. More on this in a minute.

During the course of my day, I received a lab workup, a flu shot, Tdap booster, EKG, chest xray, and two specialty referrals (including audiology). By the time I finished the lab, and went to the pharmacy, my prescriptions were ready and waiting – no more than 20 minutes after I had left the primary’s office. I did not wait more than 5 minutes at any one station, from the time I checked in, until the time I checked out. In my 56 years on the planet, that alone made this a unique experience.

I went to Eligibility after everything was complete, and got a form for a hardship request (because I’m out of work) to lower my copays, and to have my picture taken for an ID. And finally, per my primary’s request, I walked the EKG results down to her, knocked on her door, she looked at them and said, “looks great! See you in a month.” I asked her if she wanted the graph. “Not necessary,” she said. “It’s already in the computer and I’ll get a reading sent down by the cardiologist.”

Damn.

The entire process took 2 hours and 15 minutes, from the time I walked in until the time I walked out. I was truly amazed that any health care system that was this efficient, and thorough, was available to me. As I was leaving, I complimented the process to the last woman I spoke with in Eligibility. And I told her: “Every person in America should experience that efficiency and level of caring one time. One time.”

In a two and one quarter hour period, I accomplished more for my medical care than I would have in days with my prior physician, and the outside labs and radiology clinics and specialists. The longest wait time that I had all afternoon was waiting for the elevator after I left the radiology lab.

Here’s the real kicker. Remember that computer stuff the primary was doing? Actually, from the time I first contacted VA about health care, a computer record of me was established. What we did yesterday was to fill in the holes in that record. And now, I can walk into any VA medical clinic or hospital anywhere in the United States, and the medical personnel in that facility will have access to my complete medical history. Talk about records portability.

The cost for all of this? $18 co-pay for each of my 3 prescriptions, and $15 co-pay to see my primary. The efficiency, cost effectiveness, and care that I felt along the way? Priceless.

I have absolutely no doubt that if everyone had the opportunity to experience what I experienced yesterday just once, that there would be a nationalized, single payer health care system in the U.S. in a relatively short period of time.

*************

This diary would be incomplete without acknowledging the assistance of several Kossaks who are also VA customers and military vets. The advice and direction that they generously provided in my previous diary (and off-list email) on the VA medical system helped me to understand the process and navigate the bureaucracy a bit more cleanly before I walked in the door for the first time.

http://www.dailykos.com/story/2010/10/15/102527/19

The midterm elections and Medicare for all

By Dr. Quentin Young
The Huffington Post, October 15, 2010

As we approach Nov. 2, it’s fair to say that in many ways the distortion of political discourse in our country has never been worse.

Extreme right-wing personalities – reincarnated Know-Nothings – are elbowing their way into the nightly airwaves via paid advertisements and Fox News. Billionaires are lavishly funding the Tea Party movement and an assortment of anti-government themes.

As our serious economic destabilization continues, and in the absence of vigorous progressive voices offering convincing, evidence-based solutions to our problems, our population is increasingly being abandoned to the clutches of ultra-right yahoos like Sharron Angle in Nevada, Pat Toomey in Pennsylvania, Ed Martin in Missouri and Christine O’Donnell in Delaware, to name just a few.

Pernicious ballot initiatives aiming to turn the clock back on health care and other social issues have been put on several state ballots, often the result of ultra-conservative stealth organizations deploying deliberately misleading language. Arizona’s Proposition 106, which would proscribe a single-payer system (and prohibit various other federal health programs), is a case in point.

These developments are creating a perilous situation for the republic.

It must be said that the quality of political discourse in the run-up to the midterm elections has not been facilitated by the flawed health reform legislation that the administration squeaked through Congress this spring.

While there are some desirable parts of the Obama administration’s new health law – the funding of community health centers, the expansion of Medicaid, the modest but not unimportant efforts to curb insurance company abuses – it is still widely viewed with unease by the public.

In fact, a recent AP/Stanford/Robert Wood Johnson Foundation poll showed twice as many Americans – 40 percent – believe that the law doesn’t go far enough as believe the government should not have a role in health care, and four-fifths of the public favor “making sure that more Americans get the health care they need.”

The recent spate of insurance company premium hikes and their pre-emptive dropping of whole classes of potentially unprofitable policies, such as those that cover individual children, by insurers like WellPoint, UnitedHealth Group, Aetna, Cigna and Humana, haven’t helped build public confidence in the new law’s ability to rein in these corporate profiteers.

Nor have reports that insurance companies and employers are successfully negotiating waivers to evade some of the modest requirements contained in the law.

As a result, skepticism in the law abounds. Polls suggest Republican calls to repeal or defund the new law have gotten some traction, even though their crude scare tactics – e.g. their charge that the administration’s health law is “socialist” – are patently ridiculous.

Big insurers are giving large donations to the GOP again (after having given so generously to Democrats in the run-up to the new law), hoping to dictate the terms of the law’s implementation in a way most favorable to their mercenary interests.

Meanwhile the health care situation in the U.S. is deteriorating at a more rapid pace. The Census Bureau data reported a few weeks ago indicated a startling 4.3 million increase in the number of uninsured since 2008, to 50.7 million people last year. This number would have been much larger if public insurance programs, in the first place Medicaid, hadn’t enrolled an additional 6 million people. The new uninsured numbers represent enormous human suffering.

It’s worth noting that the much vaunted public option, had it been incorporated into the new law, would have had a negligible affect on this number, according to a letter from the Congressional Budget Office. Besides inviting an insurer’s field day of cherry picking, such a provision would have been anything but a step toward single payer, as some of its advocates claimed.

So what to do?

First, it’s important to recognize there are a number of candidates running for office this November who support single-payer legislation, both incumbents and challengers. The candidacy of Dr. David Gill in Illinois’ 15th congressional district is but one example. Building up a single-payer caucus in Congress is an important goal, as is the continuing enlistment of support for single-payer legislation like Rep. John Conyers’ H.R. 676 and Sen. Bernie Sanders’ S. 703.

Second, several state-based movements for single payer are pressing their agenda for local reform. These states include Vermont, where an important Legislature-funded study on state models for reform – including single payer – is well under way, where several candidates have been vying with each other as to who’s more supportive of single payer, including gubernatorial candidate Peter Shumlin. Sen. Sanders has pledged to seek whatever federal waivers are needed should the people of his state declare their preference for a single-payer system.

Third, Medicare, Medicaid and Social Security are under a serious threat from the National Commission for Fiscal Responsibility and Reform. The commission is presumably going to make recommendations for changing these vital social insurance programs in its report to a lame-duck Congress by Dec. 1. Any cuts should be emphatically rejected. Medicare should be strengthened by improving it and expanding it to everyone. That’s also one of the surest ways to control skyrocketing health costs, as a recent congressional briefing by PNHP leaders and others recently pointed out.

Finally, our educational work in support of an improved Medicare for all remains indispensable. There are good reasons to believe that the new health law will be subject to destabilizing pressures from several quarters, including from actions by incorrigible offenders like the insurance industry (which is already complaining about the law’s minimal restraints), and the law may unravel sooner than
many suspect. Single-payer Medicare for all needs to be ready to fill the gap when that happens, and a powerful people’s movement needs to be ready to push it forward in a new, dramatic way.

http://www.huffingtonpost.com/dr-quentin-young/the-midterm-elections-and_b_764305.html

Comment:

Low-Cost Lessons from Grand Junction, Colorado

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