PNHP

Saving our children from THEIR deficit

Saving our children from THEIR deficit

Taming the Deficit

Saving Our Children from Themselves

By David Rosnick and Dean Baker
Center for Economic and Policy Research (CEPR)
December 2009

Understanding the Deficit

One of the most popular causes among Washington political insiders is reducing the budget deficit. The conventional story in these circles is that current and projected future deficits will place an unbearable burden on future generations. Their argument is that the need to reduce the deficit is a question of intergenerational equity.

The leading spokespeople for this position, such as David Walker, the President of the Peter G. Peterson Foundation, often refer to the country’s $62.1 trillion “real federal financial hole.”

However, it seems that very few people have a clear understanding of this debt figure. This figure is not in any way a measure of money transferred from younger generations to older generations. In fact, rather than being a measure of how much debt older generations will pass on to today’s young people, to a large extent this ominous debt figure is actually a measure of the debt that today’s young people are projected to run up given the current structure of existing programs, most importantly Medicare. In other words, the huge debt numbers that are being used to scare the country – especially the young – are largely projections of how much debt today’s young will pass onto future generations.

The Cause of the Projected Debt

There are two reasons why later-age cohorts are projected to add more to the debt than the generations that preceded them. First, life expectancy is increasing decade by decade and is projected to continue to do so. Life expectancy after age 65 is currently 18.9 years. It is projected to be 23.2 years in 2085. If the tax and benefit formulas for Social Security and Medicare remain unchanged, then the benefits received in these programs will rise through time, as workers collect benefits for a longer period of time.

However, increasing longevity is a relatively minor factor in the rising deficit projections. The main factor is that per person health care costs are projected to far outpace the rate of per capita GDP growth. In other words, the main reason that today’s young and those yet to be born are projected to impose a far larger burden on the government than their parents and grandparents is that their health care is projected to be far more costly.

If the United States had health care costs that were in line with those of other wealthy countries, then the projections would show enormous surpluses, not deficits. Figure 3 shows long-term budget projections for the United States and then adjusts these projections under the assumption that it has the same per capita health care costs of Germany, Canada, Spain, and the United Kingdom.

As can be seen in all of these cases, the United States is projected to run enormous surpluses. For example, if the United States had the same per capita health care costs as Canada, its budget surplus would be equal to 0.13 percent of GDP by 2050. By 2080, its budget surplus would be 2.52 percent of GDP. In short, the budget problem facing the United States is almost entirely an issue of dealing with an out of control health care system, not the old stealing from the young.

http://www.cepr.net/documents/publications/taming-the-deficit-2009-12.pdf

Comment: 

By Don McCanne, MD

It has been said the the profligacy of our boomer generation, in wanting to keep our Medicare and Social Security benefits, is resulting in an intergenerational transfer that will drown our children and grandchildren in debt racked up by the tsunami of federal budget deficits caused by these two programs.

The potential is very real, but the framing is flat out wrong because it leads to advocacy of policies that could not be more damaging: cut Social Security benefits and make even deeper cuts in Medicare benefits.

Social Security is not a problem. The program requires little more than a few tweaks to make it solvent forever.

Medicare is the problem, but it is not due to our overuse of health care services. Our level of use is comparable to other nations. It is the outrageous rate of health care inflation that is the driving force that will create intolerable deficits in the future. We do not need to eliminate beneficial health care services. We need only to tame health care inflation, just as every other nation has already done by adopting some form of social insurance.

Because we are way behind schedule, with health care inflation already taking a heavy toll, we should not accept the less efficient models of social insurance but instead try to make up with a more efficient version – a single payer Medicare for all.

This report should be downloaded since it is invaluable as a resource to educate others. In fact, right now click on the link and quickly look at Figure 3 (cited above). That alone should motivate you to retain this report and share it with others.

We do have an obligation to our children and grandchildren, though it is not in declining the intergenerational transfer to finance our programs that provide us with security in retirement. Our obligation is to create and transfer to them a health care financing program that will ensure that they always will have the security of health care without the insecurity of mounting debt to pay for it. We need to transfer to our progeny a financing system which will save them from THEIR deficit.

Senate Tweaks Away Your Healthcare

By Donna Smith
CommonDreams, December 11, 2009

As my grandmother used to say, “I was born on a weekend but not last weekend.” The latest insult to Americans hungry for a bit of healthcare justice for all comes from the news that the Senate health bill now allows insurance companies to place annual limits on payments for some catastrophic illnesses, like cancer.

Surprise, surprise, surprise. Another day. Another lie uncovered in the process. Another piece of this reform bill that favors the for-profit health insurance industry.

Associated Press’ Ricardo Alonso-Zaldivar, ” [The] health care loophole would allow coverage limits:” A loophole in the Senate health care bill would let insurers place annual dollar limits on medical care for people struggling with costly illnesses such as cancer, prompting a rebuke from patient advocates. 

“The legislation that originally passed the Senate health committee last summer would have banned such limits, but a tweak to that provision weakened it in the bill now moving toward a Senate vote.

“As currently written, the Senate Democratic health care bill would permit insurance companies to place annual limits on the dollar value of medical care, as long as those limits are not ‘unreasonable.’ The bill does not define what level of limits would be allowable, delegating that task to administration officials.”

Read that passage again folks. The bill was “tweaked.” No official or legal amendment required when the insurance industry needs a tweak they damn well get a tweak. And this is quite a tweak.

Just hours ago, I continued to read reports that claimed our healthcare reformers in Congress were doing away with pre-existing condition clauses and also ending lifetime caps on coverage. Some patients and families were thrilled with this change alone, and most especially those people struggling with serious illnesses.

This summer, a friend of mine in Colorado was asked to introduce President Obama at a forum in Grand Junction. Nathan Wilkes was selected to do so because he could speak clearly and passionately about his family’s troubles keeping enough insurance coverage for his son, Thomas, who has a serious blood disorder. My friend has been and is a supporter of Medicare for all, single-payer type reform, but this opportunity to introduce the President and weigh in about eliminating lifetime benefit caps was a powerful pull. Nathan gave an intelligent and emotional intro for the President, and he was later invited to Washington to watch Obama’s address to Congress on healthcare reform.

Well, the joke’s on you Nathan and on a lot of others who trusted the details of reform being sold by members of Congress and President Obama. Only this is not at all funny. Families like the Wilkes family will go broke trying to keep kids like Thomas alive. And kids like Thomas will die without the care they need. The death panels allowed by this legislation are those set up and protected by the insurance industry–and tweaked into law by Congress and the President.

You simply cannot do this sort of tweaking and not have people notice. Did you think the Wilkes family wouldn’t notice when the annual cap is reached for Thomas and they have to start paying out of pocket or stop treatment?

This process has been fraught with disclosures of the misleading marketing of various details in the reform legislation from all involved. Who can the American public trust on this? Anybody?

As we sit on the verge of 2010, we citizens have some more political work of our own to do. We need to do some tweaking in the streets and at the polls. Because we surely are not going to get healthcare as a basic human right from this Congress and this administration. Neither the Republicans nor the Democrats seem to get it.

When we do the math for ourselves and when we watch you all play a deadly game of push-me, pull-me with our healthcare reform legislation, we know for certain you are only maneuvering for political advantage while we are out here fighting for our lives, our health and for our financial security. You didn’t hear us loudly enough at the polls in 2008, apparently.

Let me get this straight. You will force us to buy private insurance products that will not guarantee approval of treatment or payment for treatment. You will tax our insurance benefits if our employers offer those deemed as “Cadillac coverage” regardless of whether or not we make less than $250,000 a year. You cannot guarantee that employers will keep our current insurance plans and provider networks or that insurance companies will keep benefits and providers the same–therefore we cannot keep what we’ve got if we like it. You’ve crumbled on the notion of any real public option for coverage at all much less a “robust” option – whatever that squishy word ever meant. And now insurance companies will decide when we’ve had enough treatment for serious illness each year.

Wow. Sweet tweaking indeed for the profit-takers–and without so much as a debate or airing on the floor of the Senate. It seems only the things that would benefit real people require an appropriate following of legal process in Congress and full debate–amendments like Senator Bernie Sanders’ single-payer amendment aimed at strengthening real reform haven’t even gotten a hearing. We’re still fighting for that.
Please don’t insult us any more by selling this legislation as healthcare reform or even health insurance reform. This seems more and more like health industry protection and less like anything at all to do with providing what President Obama declared as a basic human right during the campaign. Even he said the only way to get to full coverage is a single-payer plan. And that’s a tweak too far from profit protection, it seems.

Hang on, fellow citizens. This healthcare mess is about to get messier and make you wonder if anyone told us the truth at all. Then we’ll have some serious tweaking of our own to do in 2010 and 2012. We will not forget this.

http://www.commondreams.org/view/2009/12/11-7

Maine AFL-CIO Calls for Labor Summit & Strategy to Win Single Payer

by Matt Schlobohm
Public Policy & Poltical Mobilization Director
Maine AFL-CIO, and Charlie Urquhart, Organizer, Maine Labor Group on Health

On Friday October 23, 2009 the delegates at the Maine AFL-CIO’s 27th Biennial Convention unanimously passed a resolution calling on the AFL-CIO to convene, after the current healthcare reform process in Congress concludes, a democratic strategic planning process to develop a long term strategy to win Single Payer national health insurance.

The resolution was enthusiastically supported by the delegates and is rooted in the belief that to win a Medicare for all single payer system the labor movement needs to pursue a different strategy – one that is rooted in building a broadbased social movement, taking a long term approach to this fight, organizing around basic principles and pursuing relentless rank & file education and mobilization.

Maine AFL-CIO Vice President & IBEW 567 Training Director Don Berry laid out the Federation’s position, “Most union leaders are clear that we need a single payer system to solve the healthcare crisis. Yet as a labor movement our strategy has not been clearly, solidly and unambiguously behind single payer.  We think it is time for us to commit to and stick with a long term strategy to win Medicare for All.  That’s the only thing that’s going to get us out of the healthcare crisis we face at the bargaining table and in society at large and its high time we put our full force behind it.”

Building on the momentum of the National AFL-CIO’s historic and unanimous passage of Resolution 34 that called for the creation of a Medicare for All, single payer social insurance program, the Maine AFL-CIO saw this resolution as an important step to making that resolution real and pursuing some important next steps.

In this spirit the Maine AFL-CIO unanimously passed the following resolution:

RESOLUTION # 5

Single Payer Healthcare Resolution Whereas the National AFL-CIO unanimously passed Resolution 34 strongly endorsing a Medicare for All single payer health care system;

Whereas 39 State AFL-CIO Federations, 134 Central Labor Councils, and 572 different labor organizations have endorsed HR 676;

Whereas as a State Federation we strongly believe that a Medicare for all national health insurance system with single payer financing is the solution that is required to solve the healthcare crisis union members face at the bargaining table and that we face collectively as a society;

Whereas regardless of how the current healthcare reform effort concludes in Congress it will not come close to solving the current healthcare crisis;

Whereas historically, significant structural changes in this country have occurred when progressive forces have built powerful social movements that organize around a long term strategy that involves relentless rank & file education, organizing around basic fundamental principles, having rank & file leaders lead the movement and committing to a long term approach to the issue;

Whereas we strongly believe that to win a single payer national health insurance system the labor movement needs to pursue that kind of strategy and work to build a broad based working class social movement and;

Whereas we believe that had we collectively pursued such a strategy after the last healthcare policy failure in Congress in the mid 1990s – by staking out a strong single payer position, educating our membership as deeply as possible, pushing for political support of single payer legislation and sticking with that approach for the last fifteen years – we would be in a much stronger position today to win meaningful healthcare reform;

Therefore, we call on the National AFL-CIO to convene, after the current healthcare reform process in Congress concludes, a democratic strategic planning process to develop a long term strategy to win Single Payer national health insurance. We think this process should:

1. Start with a Single Payer labor movement summit

2. Involve, among others, Central Labor Councils, State Federations and rank & file single payer union activists in the planning process

3. Do an assessment of how we’ve historically built powerful social movements in this country and put our best thinking forward about what would need to be done today to build a social movement powerful enough to win single payer

4. Include a commitment of resources from the AFL-CIO of no less than the resources that have been devoted to the current health care reform effort

5. Include a commitment from the AFL-CIO to support state’s efforts to pass single payer legislation

Submitted by: the Western Maine Labor Council to the Maine AFL-CIO’s 27th
Biennial Convention
Approved unanimously by Maine AFL-CIO Convention delegates: Friday October 23, 2009

Distributed by:
All Unions Committee For Single Payer Health Care–HR 676
c/o Nurses Professional Organization (NPO)
1169 Eastern Parkway, Suite 2218
Louisville, KY 40217
(502) 636 1551
Email: nursenpo@aol.com
http://unionsforsinglepayerHR676.org
12/10/09

Maine AFL-CIO Calls for Labor Summit & Strategy to Win Single Payer

by Matt Schlobohm
Public Policy & Poltical Mobilization Director
Maine AFL-CIO, and Charlie Urquhart, Organizer, Maine Labor Group on Health

On Friday October 23, 2009 the delegates at the Maine AFL-CIO’s 27th Biennial Convention unanimously passed a resolution calling on the AFL-CIO to convene, after the current healthcare reform process in Congress concludes, a democratic strategic planning process to develop a long term strategy to win Single Payer national health insurance.

The resolution was enthusiastically supported by the delegates and is rooted in the belief that to win a Medicare for all single payer system the labor movement needs to pursue a different strategy – one that is rooted in building a broadbased social movement, taking a long term approach to this fight, organizing around basic principles and pursuing relentless rank & file education and mobilization.

Maine AFL-CIO Vice President & IBEW 567 Training Director Don Berry laid out the Federation’s position, “Most union leaders are clear that we need a single payer system to solve the healthcare crisis. Yet as a labor movement our strategy has not been clearly, solidly and unambiguously behind single payer.  We think it is time for us to commit to and stick with a long term strategy to win Medicare for All.  That’s the only thing that’s going to get us out of the healthcare crisis we face at the bargaining table and in society at large and its high time we put our full force behind it.”

Building on the momentum of the National AFL-CIO’s historic and unanimous passage of Resolution 34 that called for the creation of a Medicare for All, single payer social insurance program, the Maine AFL-CIO saw this resolution as an important step to making that resolution real and pursuing some important next steps.

In this spirit the Maine AFL-CIO unanimously passed the following resolution:

RESOLUTION # 5

Single Payer Healthcare Resolution Whereas the National AFL-CIO unanimously passed Resolution 34 strongly endorsing a Medicare for All single payer health care system;

Whereas 39 State AFL-CIO Federations, 134 Central Labor Councils, and 572 different labor organizations have endorsed HR 676;

Whereas as a State Federation we strongly believe that a Medicare for all national health insurance system with single payer financing is the solution that is required to solve the healthcare crisis union members face at the bargaining table and that we face collectively as a society;

Whereas regardless of how the current healthcare reform effort concludes in Congress it will not come close to solving the current healthcare crisis;

Whereas historically, significant structural changes in this country have occurred when progressive forces have built powerful social movements that organize around a long term strategy that involves relentless rank & file education, organizing around basic fundamental principles, having rank & file leaders lead the movement and committing to a long term approach to the issue;

Whereas we strongly believe that to win a single payer national health insurance system the labor movement needs to pursue that kind of strategy and work to build a broad based working class social movement and;

Whereas we believe that had we collectively pursued such a strategy after the last healthcare policy failure in Congress in the mid 1990s – by staking out a strong single payer position, educating our membership as deeply as possible, pushing for political support of single payer legislation and sticking with that approach for the last fifteen years – we would be in a much stronger position today to win meaningful healthcare reform;

Therefore, we call on the National AFL-CIO to convene, after the current healthcare reform process in Congress concludes, a democratic strategic planning process to develop a long term strategy to win Single Payer national health insurance. We think this process should:

1. Start with a Single Payer labor movement summit

2. Involve, among others, Central Labor Councils, State Federations and rank & file single payer union activists in the planning process

3. Do an assessment of how we’ve historically built powerful social movements in this country and put our best thinking forward about what would need to be done today to build a social movement powerful enough to win single payer

4. Include a commitment of resources from the AFL-CIO of no less than the resources that have been devoted to the current health care reform effort

5. Include a commitment from the AFL-CIO to support state’s efforts to pass single payer legislation

Submitted by: the Western Maine Labor Council to the Maine AFL-CIO’s 27th
Biennial Convention
Approved unanimously by Maine AFL-CIO Convention delegates: Friday October 23, 2009

Distributed by:
All Unions Committee For Single Payer Health Care–HR 676
c/o Nurses Professional Organization (NPO)
1169 Eastern Parkway, Suite 2218
Louisville, KY 40217
(502) 636 1551
Email: nursenpo@aol.com
http://unionsforsinglepayerHR676.org
12/10/09

Protest Held Outside Senator McConnell's Office

By Gabe Bullard  

WFPL News (Louisville, K.Y.) December 10, 2009 

About ten area residents gathered in Louisville Thursday to voice support for a single-payer health care plan.

Many of the same demonstrators have held similar protests in the last few months. This particular demonstration was one of about 20 held across the country to mark Human Rights Day.

The protestors are unhappy with the compromises many Democrats have made to the current healthcare overhaul proposal. Harriette Sieler is the secretary of Kentuckians for Single-Payer Healthcare.  She says she’s also not happy with the debate surrounding the legislation.

“Right now in Congress they are saying the eligibility age of Medicare to 55,” she says. “I say lower it to zero.”

The group gathered outside of Senator Mitch McConnell’s office downtown.

Dr. Garrett Adams with Physicians for a National Health Program took issue with Senator McConnell’s recent statement that he hasn’t heard from any Kentucky doctors who support the healthcare overhaul.

“Mr. McConnell’s statement is not correct,” he says. “The facts belie his statement that physicians do not support national healthcare, because they do.”

McConnell is among the proposal’s opponents. He says, among other things, the plan would be too expensive.

http://www.wfpl.org/2009/12/10/healthcare-protest-held-outside-mcconnells-office/

Protest Held Outside Senator McConnell’s Office

By Gabe Bullard  

WFPL News (Louisville, K.Y.) December 10, 2009 

About ten area residents gathered in Louisville Thursday to voice support for a single-payer health care plan.

Many of the same demonstrators have held similar protests in the last few months. This particular demonstration was one of about 20 held across the country to mark Human Rights Day.

The protestors are unhappy with the compromises many Democrats have made to the current healthcare overhaul proposal. Harriette Sieler is the secretary of Kentuckians for Single-Payer Healthcare.  She says she’s also not happy with the debate surrounding the legislation.

“Right now in Congress they are saying the eligibility age of Medicare to 55,” she says. “I say lower it to zero.”

The group gathered outside of Senator Mitch McConnell’s office downtown.

Dr. Garrett Adams with Physicians for a National Health Program took issue with Senator McConnell’s recent statement that he hasn’t heard from any Kentucky doctors who support the healthcare overhaul.

“Mr. McConnell’s statement is not correct,” he says. “The facts belie his statement that physicians do not support national healthcare, because they do.”

McConnell is among the proposal’s opponents. He says, among other things, the plan would be too expensive.

http://www.wfpl.org/2009/12/10/healthcare-protest-held-outside-mcconnells-office/

Bernie Sanders Presses For Vote On State Single-Payer Option

By Jeff Muskus
The Huffington Post, Dec. 10, 2009

While Democratic leaders abandoned the public option on Thursday, one senator reignited his push for an amendment that would allow states to test-pilot single-payer health insurance systems.

No matter what federal health care reform finally looks like, the Senate should give interested state governments the right to prove single-payer critics wrong, Sen. Bernie Sanders (I-Vt.) said during a floor speech Thursday.

“I think we have got to give states the option, the flexibility to go forward with a single-payer system if that is what they want to do,” Sanders said. “Once they’ve done it and done it well, other states around the country will say, ‘We want the same thing. It’s the cost-effective way to provide comprehensive health care to all of our people.'”

Sanders said his state single-payer amendment “could pass and could have the Republicans’ support.” Given the death of even a weak public option from which states could opt out, he shouldn’t bet on it. Sanders acknowledged he won’t get much support for the federal single-payer amendment he penned with Democratic Sens. Sherrod Brown (Ohio) and Roland Burris (Ill.), but he wants the chance to fight for it just the same.

“One of my concerns as we hurdle down to the finish line here, I don’t know who will be able to offer amendments,” Sanders said. “I offered the amendment, I want the right to have that debate. I don’t need 20 hours, I don’t need five days. I would love to discuss with my Republican friends that issue, Democrats, that’s an amendment that has a right to be offered and should be offered.”

States would still run the government insurance system even in Sanders’ federal single-payer model, but the feds would cover the costs with additional payroll and income taxes. Though he said the current bill marks progress, Sanders said the needed debate and changes are far from over, and one change tops his list.

“I do not think we are at the two-yard line. I think a lot of work has to be done to improve this bill,” he said. “I think at the end of the day, the only way you’re going to provide comprehensive universal health care to all is with a Medicare single-payer system, which ends hundreds of billions of bureaucracy and waste engendered by the private insurance companies.”

Local physician condemns healthcare reform plans now before Congress

By MIMI KOREN  
Sound and Town Report (Larchmont and Mamaroneck, N.Y.)
Wednesday, November 25, 2009

A Mamaroneck physician believes that a single-payer plan would be the only effective way to reform the nation’s health system. Early this week she denounced the reform bills passed by the House of Representatives and now up for debate in the Senate. “I don’t think [they] will fix things,” said Dr. Elizabeth Rosenthal. “The best thing to do [would be] scrap them both and do single-payer. But it doesn’t look like that’s going to happen.”

A dermatologist who lives in Larchmont, Rosenthal spoke at a recent meeting of the Larchmont/Mamaroneck League of Women Voters (LWV-LM), where she said 60 percent of doctors nationwide support a single-payer system. Rosenthal is a board member of Physicians for a National Health Program (PNHP)/NY Metro chapter, a non-profit research and education organization whose 17,000 members support single-payer national health insurance. But single-payer is absent from the bills now before Congress.

On Nov. 6, Dr. Rosenthal told the LWV audience at Hector’s Village Cafe in Mamaroneck, “I went into medicine to help people get better.” But that is increasingly difficult to accomplish, she said, because “the business side” of medicine is taking over. She said the cost of the reform will be more than legislators anticipate; she called the system difficult to navigate and added it still left many uncovered.

The doctor cited Medicare as an example of a single-payer system which she said has worked well for 40 years. “In Canada they have Medicare for everybody,” she said.

She further charged that the current bills allow insurance companies to continue to act as middlemen between patient and doctor. “How are they going to bring down the cost without eliminating the middleman?” she said. The companies spend huge amounts of money on administration, 20 percent of total expenditures, according to PNHP, while the single-payer Medicare spends 2 percent. “With the money we’d save by getting rid of the insurance industry, we could take care of everybody,” she declared. Yet neither bill addresses costs, she believes. Instead, she said, “Insurance companies and pharmaceutical companies are going to get millions of new customers.”

In addition, she said that the “public option” in either bill had been so watered down as to be “meaningless.” (The inclusion of any kind of public option is strongly opposed by some Senators). She denounced the exclusion of illegal immigrants in the proposal.

The bills’ only positive aspects, she said, are that they prohibit insurance companies from rejecting patients for pre-existing conditions, dropping them once they become sick, and placing caps on the amounts they pay out.

Rosenthal countered critics of a national health plan who fear it will lead to rationing of healthcare. “We already have rationing,” she stated, via money: those who can afford more comprehensive insurance have access to more healthcare than those who cannot.

The doctor found many other faults with the current healthcare system, including:

  • It rewards doctors for giving “too much care,” via superfluous tests.
  • It is “top heavy with specialists” and lacks enough primary-care physicians.
  • The pharmaceutical industry spends more on marketing than on research and development, which drives up the cost of prescription drugs.

“At some point you have to choose between [pleasing] the people who profit from healthcare [and making] a commitment to see that all people are protected with healthcare they can afford,” Dr. Rosenthal insisted this week. “Our country has not made a commitment to take care of all the people.”

As to the future, “Of course we’re going to continue the struggle,” Rosenthal said.

But it looks like any possibility of a single-payer plan will have to wait till another year.

http://mysoundandtown.com/index.php?option=com_content&view=article&id=387:local-physician-condemns-healthcare-reform-plans-now-before-congress&catid=34:news&Itemid=53

Dr. Laura Boylan, demanding Medicare for All, arrested at Schumer protest

[The following statement was released by neurologist Dr. Laura Boylan after her arrest on Thursday morning in midtown Manhattan for sitting down with others in front of the building housing the offices of Sen. Charles Schumer, D-N.Y., and refusing to move. She was charged with disorderly conduct and released shortly afterward.]

I was arrested this morning in an act of peaceful civil disobedience along with a diverse group of seven others, including a medical student and a nurse, similarly passionate about Medicare for All. Ours was one of 17 actions organized by Mobilization for Health Care for All across the country to honor International Human Rights Day. We blocked the doors to Sen. Charles Schumer’s office building.

Sen. Schumer is a powerful player in health reform. This week some senators have proposed expanding Medicare to cover those 55 and over. No details of the plan have been released, but the idea has been floated.

I’m a physician with the American majority who’d really like in on Medicare. I support Medicare for All, single-payer health care for all. Medicare’s not perfect, but we can make Medicare 2.0. It’s the only way to get quality, universal access and affordability. Its principal weakness is the threat it poses to the insurance and pharmaceutical industries.

Many congressmen and senators, including Sen. Schumer, say they support Medicare for All or acknowledge its superiority. They insist, however, that it is “politically unfeasible.” This is not because Americans are anti-Medicare – far from it. Medicare is one of American’s most beloved public programs.

As the coins hit the fan, the time will come when it will be politically unfeasible to continue to bailout our for-profit insurance industry with taxpayer subsidies. Medicare provides much higher value for our health care dollar with no money siphoned off in administrative multi-payer waste and stockholder profits.

Meanwhile people are dying. I am not speaking metaphorically; I have seen people dying from lack of access to care. Most recently last month it was a 42-year-old mother of two with a big bleed in her brain from uncontrolled blood pressure. She’d been cutting back on the pills she couldn’t afford.

Fear is being promoted in the land, the idea that we are not all in this together. That if you want yours, someone else must go with less or without. It’s the “illegals,” the “fatties,” the smokers, the oldies, the “Medicaid cheats” and so on. This is a big lie. We can all do better with single-payer Medicare for All.

Only by having “everybody in, nobody out” can Americans get real choice, real freedom and real security. How often does the universe breathe an opening where quality and low cost are bedfellows, where justice and mercy meet and shake hands, where the pragmatic is both just and beautiful?

One life sacrificed to health insurance profits is too much. Right now 45,000 people a year die from lack of insurance. The congressional plan that covers the most people will leave at least 18 million uncovered.

There can be no freedom of opportunity where there is no guaranteed health care. On this day of human rights, we put our bodies on the line to affirm that health care is a human right. We, his constituents, insist to Sen. Schumer: Medicare enrollment should start at birth.

Saving our children from THEIR deficit

Taming the Deficit

Saving Our Children from Themselves

By David Rosnick and Dean Baker
Center for Economic and Policy Research (CEPR)
December 2009
Understanding the Deficit
One of the most popular causes among Washington political insiders is reducing the budget deficit. The conventional story in these circles is that current and projected future deficits will place an unbearable burden on future generations. Their argument is that the need to reduce the deficit is a question of intergenerational equity.
The leading spokespeople for this position, such as David Walker, the President of the Peter G. Peterson Foundation, often refer to the country’s $62.1 trillion “real federal financial hole.”
However, it seems that very few people have a clear understanding of this debt figure. This figure is not in any way a measure of money transferred from younger generations to older generations. In fact, rather than being a measure of how much debt older generations will pass on to today’s young people, to a large extent this ominous debt figure is actually a measure of the debt that today’s young people are projected to run up given the current structure of existing programs, most importantly Medicare. In other words, the huge debt numbers that are being used to scare the country – especially the young – are largely projections of how much debt today’s young will pass onto future generations.
The Cause of the Projected Debt
There are two reasons why later-age cohorts are projected to add more to the debt than the generations that preceded them. First, life expectancy is increasing decade by decade and is projected to continue to do so. Life expectancy after age 65 is currently 18.9 years. It is projected to be 23.2 years in 2085. If the tax and benefit formulas for Social Security and Medicare remain unchanged, then the benefits received in these programs will rise through time, as workers collect benefits for a longer period of time.
However, increasing longevity is a relatively minor factor in the rising deficit projections. The main factor is that per person health care costs are projected to far outpace the rate of per capita GDP growth. In other words, the main reason that today’s young and those yet to be born are projected to impose a far larger burden on the government than their parents and grandparents is that their health care is projected to be far more costly.
If the United States had health care costs that were in line with those of other wealthy countries, then the projections would show enormous surpluses, not deficits. Figure 3 shows long-term budget projections for the United States and then adjusts these projections under the assumption that it has the same per capita health care costs of Germany, Canada, Spain, and the United Kingdom.
As can be seen in all of these cases, the United States is projected to run enormous surpluses. For example, if the United States had the same per capita health care costs as Canada, its budget surplus would be equal to 0.13 percent of GDP by 2050. By 2080, its budget surplus would be 2.52 percent of GDP. In short, the budget problem facing the United States is almost entirely an issue of dealing with an out of control health care system, not the old stealing from the young.
http://www.cepr.net/documents/publications/taming-the-deficit-2009-12.pdf

It has been said the the profligacy of our boomer generation, in wanting to keep our Medicare and Social Security benefits, is resulting in an intergenerational transfer that will drown our children and grandchildren in debt racked up by the tsunami of federal budget deficits caused by these two programs.
The potential is very real, but the framing is flat out wrong because it leads to advocacy of policies that could not be more damaging: cut Social Security benefits and make even deeper cuts in Medicare benefits.
Social Security is not a problem. The program requires little more than a few tweaks to make it solvent forever.
Medicare is the problem, but it is not due to our overuse of health care services. Our level of use is comparable to other nations. It is the outrageous rate of health care inflation that is the driving force that will create intolerable deficits in the future. We do not need to eliminate beneficial health care services. We need only to tame health care inflation, just as every other nation has already done by adopting some form of social insurance.
Because we are way behind schedule, with health care inflation already taking a heavy toll, we should not accept the less efficient models of social insurance but instead try to make up with a more efficient version – a single payer Medicare for all.
This report should be downloaded since it is invaluable as a resource to educate others. In fact, right now click on the link and quickly look at Figure 3 (cited above). That alone should motivate you to retain this report and share it with others.
We do have an obligation to our children and grandchildren, though it is not in declining the intergenerational transfer to finance our programs that provide us with security in retirement. Our obligation is to create and transfer to them a health care financing program that will ensure that they always will have the security of health care without the insecurity of mounting debt to pay for it. We need to transfer to our progeny a financing system which will save them from THEIR deficit.

An Unworkable Mess

By Steffie Woolhandler and David Himmelstein
New York Times, Room for Debate blog, Dec. 11, 2009

Milk and lemon both taste good in tea. But mix them together and it’s a curdled mess. Similarly, the latest Senate health reform compromise combines two appetizing elements — a Medicare expansion and tighter insurance regulations –- to create a noxious brew.

Both the House and Senate versions of reform would turn over hundreds of billions of tax dollars to the same private insurers who’ve proven incapable of controlling costs or giving American families the coverage they need. And these bills would make failure to buy insurers’ defective products a federal offense. Together these measures greatly augment insurers’ financial and, hence, political muscle.

The only concessions wrung out of the insurers for this windfall are modest new regulations on the policies they sell to individuals: insurers will have to accept every applicant; they won’t be allowed charge the sick higher premiums; and they’ll be able to charge older people only two to three times more than the young.

Most of these regulations won’t change things for people who get their coverage through an employer, but they’re helpful for the many of the roughly 7 percent of the population who buy their own private insurance.

For insurers, the regulations make the near-elderly who don’t get employer-sponsored coverage into pariahs. On average, they cost insurers far more than twice as much as the near-teens, but they can’t be charged premiums to match their costs.

Now the Senate plans to take some of these high-cost patients off private insurers’ books, and make them Medicare’s problem. Consequently, the costs of this Medicare buy-in will be high — both for patients and for the taxpayers who will subsidize the near-poor starting in 2014.

Meanwhile, younger, healthier and hence more profitable patients will be forced into private insurance. There’s no public option for them, nor for anyone offered employer-sponsored coverage. If you have private insurance and you like it, you can keep it; if you have private insurance and you don’t like it, you still have to keep it.

But even though it’s bad health policy, this new compromise is brilliant politics. For insurers, it offers a hidden subsidy. Meanwhile, it gives the appearance of responding to the vocal and growing legion of single payer supporters who want Medicare for All.

In the end, the Senate compromise, like its House counterpart, will do little to salvage the sinking U.S. health system. Costs will continue to skyrocket, putting coverage more and more out of reach for middle class Americans, and driving the costs of taxpayer-funded subsidies through the roof.

In contrast, a single payer system could save nearly $400 billion annually on health insurers’ overhead and the paperwork they inflict on doctors and hospitals -– savings that would make universal coverage affordable. Medicare for All won’t grow from the Senate compromise, but from its ashes.

Steffie Woolhandler is a professor of medicine and David Himmelstein is an associate professor of medicine, both at Harvard Medical School. They are co-founders of Physicians for a National Health Program (www.pnhp.org).

http://roomfordebate.blogs.nytimes.com/2009/12/10/medicare-for-50-somethings/

Lesson for Congress: Medicare Advantage

New Report Highlights Medicare Advantage Insurers’ Higher Administrative Spending

Committee on Energy and Commerce
U.S. House of Representatives
December 9, 2009

Today Energy and Commerce Committee Chairman Henry A. Waxman and Oversight and Investigations Subcommittee Chairman Bart Stupak released a new report which found that 34 Medicare Advantage insurers expend significant sums on profits, marketing, and other corporate expenses.

The report found:

From 2005 through 2008, the average Medicare Advantage insurer spent over 15% of premium revenue on profits, marketing, and other corporate expenses. Two-thirds of the Medicare Advantage insurers surveyed by the Committee had a medical loss ratio below 85% during at least one of the four years examined. Six of the insurers had medical loss ratios below 75% in one or more years. In comparison, traditional Medicare spends less than 1.5% on administrative expenses and over 98% on health care. In the aggregate, the Medicare Advantage insurers spent $1,450 per beneficiary in 2008 on profits, marketing, and other corporate expenses, nearly ten times as much as traditional Medicare spent on administrative expenses per beneficiary.

Requiring all Medicare Advantage insurers to have a medical loss ratio of 85% would provide billions of dollars in additional medical services to seniors. The total amount spent on profits, marketing, and other expenses by Medicare Advantage insurers over the last four years was $27 billion. The House health care reform bill requires Medicare Advantage plans to spend at least 85% of their total premium revenues on medical claims. If this threshold had been in effect from 2005 through 2008, the Medicare Advantage insurers would have spent an additional $3 billion on their beneficiaries’ medical care, enough to eliminate all copays for preventive care for all Medicare beneficiaries for ten years.

In 2007 and 2008, Medicare Advantage insurers with medical loss ratios lower than 85% paid their executives over $1.2 billion. In 2007, a company that had a medical loss ratio of 79% paid an executive over $35 million. The same company paid 16 more executives salaries and bonuses worth $1 million or more. Another company with a medical loss ratio of 79% paid more than $210 million in compensation to 260 executives.

Medicare Advantage insurers have spent millions on expensive retreats. In 2007, one company with a medical loss ratio of 83% spent $3.1 million for two events in Hawaii. In 2007, a company with a medical loss ratio of 84% spent $2.5 million on employees and agents at a retreat in San Jose del Cabo, Mexico and $1.4 million on an event in Rome, Italy. In 2008, a company with a medical loss ratio of 82% spent $1.5 million on a meeting in Edinburgh, Scotland and $1.8 million on a trip to Cancun, Mexico.

http://energycommerce.house.gov/index.php?option=com_content&view=article&id=1851:new-report-highlights-medicare-advantage-insurers-higher-administrative-spending&catid=122:media-advisories&Itemid=55

Full report:
http://energycommerce.house.gov/Press_111/20091209/MedicareAdvantageReport120909.pdf

Comment:

By Don McCanne, MD

Congress and the Obama administration decided up front that reform would be based on private insurance plans, rejecting without consideration the single payer Medicare for all model.

They are proposing innovative pilot programs as experiments in containing health care costs, glossing over the logistical nightmares and the lack of a foundation in policy science, as they move forward with these untested policies. Yet they have right in front of them one of the most important, most expensive, and most credible real-life experiments ever conducted: contrasting the government Medicare model with the private Medicare Advantage insurance plans.

In comparing traditional Medicare with Medicare Advantage, we need to set aside from consideration the funds that are used to pay for actual health care since these are our funds merely held in trust for the payment of medical bills. What we need to compare are the costs of the administrative services that are being provided by each entity.

The experiment has been completed, and the results are in. The private Medicare Advantage insurers spend nearly ten times the amount per beneficiary that is used to administer the government Medicare program. TEN TIMES!

Some might say that we aren’t being fair because some of the ten fold increase in spending goes to profits and to expensive retreats for the private insurance executives, whereas the traditional Medicare program doesn’t have those obligations. In this instance, what’s fair in the business community is fraud in the government.

Congress has the results of this study. The report has been generated by one of its own committees. Our legislators have a fundamental moral obligation to study this crucial real-life experiment. They then need to act upon it instead of upon the magical thinking behind the nebulous pilot projects.

In fact, even this report contains one such flawed policy recommendation. They recommend that the private insurers be limited to 15 percent of the insurance pool to use for administration and profits. That is still about eight times the administrative costs of Medicare. EIGHT TIMES! Is that the best that Congress can come up with?

Medicare is already under attack for its perceived parsimoniousness. Since the pilot projects would be designed to further reduce spending within the Medicare program, that perception would be amplified, seriously threatening the support of the health care providers.

We first need the broad, solid infrastructure of single payer Medicare for all and only then should we consider new pilot projects that are based on sound policy science that would work for all of us, providing quality care while protecting our finances. The probability of getting the policies right would be much greater in a single system in which patients, providers and the government are all working together toward a common goal: quality, affordable health care for all.

There is something for those who disagree: a little vicarious serendipity. You can check out the brochures and websites of the expensive resorts, and then close your eyes, lean back and dream about the great time that the insurance executives are having with the money you paid them in the form of excessive insurance premiums. Pleasant dreams.