PNHP

‘Medicare buy-in’ is really a subsidy to private insurers: Harvard professor

‘Medicare buy-in’ is really a subsidy to private insurers: Harvard professor

See also “An Unworkable Mess,” (New York Times, Room for Debate Blog, Dec. 11, 2009) by Drs. Steffie Woolhandler and David Himmelstein.

FOR IMMEDIATE RELEASE
Dec. 10, 2009

Contact:
Steffie Woolhandler, M.D., M.P.H.
Mark Almberg, Physicians for a National Health Program, (312) 782-6006, mark@pnhp.org

The Senate proposal to allow uninsured people over age 55 an opportunity to buy into Medicare constitutes yet another government subsidy to the private health insurance industry, a leading health policy analyst and single-payer advocate says.

Dr. Steffie Woolhandler, co-founder of Physicians for a National Health Program and professor of medicine at Harvard Medical School, told a radio host Wednesday morning, “One of the better provisions of the reform legislation was that it prohibited charging older people more than twice (or thrice in the some versions) as much as you charge younger people in the individual market. But by saying everyone over 55 in the individual market can be picked up by Medicare, you’ve really let the insurance industry off the hook.”

Woolhandler continued: “That is, the highest-cost patients in the individual market will be taken off their hands and paid for by the taxpayers; and private insurance will remain the only option for people under the age of 55 and for anyone who gets their insurance through their employer. Another way of saying that is: if you now have private health insurance and you don’t like it, you’re forced to keep it.

“The buy-in to Medicare is only for those 55 to 64 and it’s only for people who are not offered private health insurance through an employer. So it turns into just a subsidy to private health insurance: the taxpayers will pay for the high-cost patients and the health insurance industry can take the lower-cost patients.”

Woolhandler, who also practices primary care at Cambridge Hospital in Massachusetts, is a prominent advocate for single-payer national health insurance, sometimes called an expanded and improved Medicare for All. She says research has demonstrated that replacing today’s multi-payer system, with its wasteful paperwork and bureaucracy, with a streamlined single-payer system would save about $400 billion annually, enough to assure everyone comprehensive, quality care.

“I want to remind people that at its core, this bill takes $450 billion in new taxes from the taxpayers, and hands it over to the private health insurance as subsidies. So, the core of the bill is a financial strengthening of the private health insurance industry. Now, one of the small things that was good about the plan, that is, forcing the insurance industry to lower the prices for older enrollees, has been taken out of the bill, essentially.”

Woolhandler also said the proposal for an exchange of private, nonprofit insurance plans for those under 55 will be of little benefit, noting, “It’s similar to the menu that is offered to federal workers, but of course federal workers actually get money to buy the health insurance. They don’t just get the menu, they get the money.”

A full audio recording of the interview, conducted by an affiliate of KPFK Pacifica radio in Los Angeles, is available here.

Woolhandler is also co-author of several studies published in prominent medical journals this year, including one showing 62 percent of personal bankruptcies are linked to medical bills or illness and another showing that nearly 45,000 excess deaths annually are attributable to lack of health insurance.

Dr. Woolhandler and other leaders of Physicians for a National Health Program are available for interview on the most recent developments in the emerging health reform legislation.

Physicians for a National Health Program (www.pnhp.org) is an organization of 17,000 doctors who support single-payer national health insurance. To speak with a physician/spokesperson in your area, visit www.pnhp.org/stateactions or call (312) 782-6006.

See also “An Unworkable Mess,” (New York Times, Room for Debate Blog, Dec. 11, 2009) by Drs. Steffie Woolhandler and David Himmelstein.

Single-Payer Amendment Needs Debate and a Vote In the Senate

By Donna Smith

Time to let Senate Majority Leader Harry Reid know that the American people want a debate and a vote on Medicare for all, single-payer healthcare during this Congressional effort.  And it’s crunch time for the Sanders/Brown/Burris Medicare for all, single-payer amendment in the Senate.

In the effort to move something quickly, some amendments may not be considered unless the Leader perceives the importance of such consideration or the consequences of not hearing amendments that are critical to various Senators and constituencies.

Amendment No. 2837 would extend healthcare as a basic human right to all.  The three original sponsors of the amendment understand that the American people need access to care that is not dependent on wealth or level of private insurance coverage.

Call Senator Reid today.  Tell him you want Senator Sanders’ amendment number 2837 to be debated and you want a vote to be taken.  Phone in DC at 202-224-3542 or the Capitol Switchboard at 202-224-3121, or Senator Reid’s Las Vegas office at 702-388-5020

Understanding Obamacare

By Luke Mitchell
Harper’s Magazine, Dec. 9, 2009

The idea that there is a competitive “private sector” in America is appealing, but generally false. No one hates competition more than the managers of corporations. Competition does not enhance shareholder value, and smart managers know they must forsake whatever personal beliefs they may hold about the redemptive power of creative destruction for the more immediate balm of government intervention. This wisdom is expressed most precisely in an underutilized phrase from economics: regulatory capture.

When Congress created the first U.S. regulatory agency, the Interstate Commerce Commission, in 1887, the railroad barons it was meant to subdue quickly recognized an opportunity. “It satisfies the popular clamor for a government supervision of railroads at the same time that that supervision is almost entirely nominal,” observed the railroad lawyer Richard Olney. “Further, the older such a commission gets to be, the more inclined it will be found to take the business and railroad view of things. It thus becomes a sort of barrier between the railroad corporations and the people and a sort of protection against hasty and crude legislation hostile to railroad interests.” As if to underscore this claim, Olney soon after got himself appointed to run the U.S. Justice Department, where he spent his days busting railroad unions.

The story of capture is repeated again and again, in industry after industry, whether it is the agricultural combinations creating an impenetrable system of subsidies, or television and radio broadcasters monopolizing public airwaves for private profit, or the entire financial sector conjuring perilous fortunes from the legislative void. The real battle in Washington is seldom between conservatives and liberals or the right and the left or “red America” and “blue America.” It is nearly always a more local contest, over which politicians will enjoy the privilege of representing the interests of the rich.

And so it is with health-care reform. The debate in Washington this fall ought to have been about why the United States has the worst health-care system in the developed world, why Americans pay twice the Western average to maintain that system, and what fundamental changes are needed to make the system better serve us. But Democrats rendered those questions academic when they decided the first principle of reform would be, as Barack Obama has so often explained, that “nothing in our plan requires you to change what you have.”

This claim reassured not just the people who like their current employment benefits but also the companies that receive some part of the more than $2 trillion Americans spend every year on health care and that can expect to continue receiving their share when the current round of legislation has come to an end. The health-care industry has captured the regulatory process, and it has used that capture to eliminate any real competition, whether from the government, in the form of a single-payer system, or from new and more efficient competitors in the private sector who might have the audacity to offer a better product at a better price.

The polite word for regulatory capture in Washington is “moderation.” Normally we understand moderation to be a process whereby we balance the conservative-right-red preference for “free markets” with the liberal-left-blue preference for “big government.” Determining the correct level of market intervention means splitting the difference. Some people (David Broder, members of the Concord Coalition) believe such an approach will lead to the wisest policies. Others (James Madison) see it only as the least undemocratic approach to resolving disputes between opposing interest groups. The contemporary form of moderation, however, simply assumes government growth (i.e., intervention), which occurs under both parties, and instead concerns itself with balancing the regulatory interests of various campaign contributors. The interests of the insurance companies are moderated by the interests of the drug manufacturers, which in turn are moderated by the interests of the trial lawyers and perhaps even by the interests of organized labor, and in this way the locus of competition is transported from the marketplace to the legislature. The result is that mediocre trusts secure the blessing of government sanction even as they avoid any obligation to serve the public good. Prices stay high, producers fail to innovate, and social inequities remain in place.

No one today is more moderate than the Democrats. Indeed, the triangulating work that began two decades ago under Bill Clinton is reaching its apogee under the politically astute guidance of Barack Obama. “There are those on the left who believe that the only way to fix the system is through a single-payer system like Canada’s,” Obama noted (correctly) last September. “On the right, there are those who argue that we should end employer-based systems and leave individuals to buy health insurance on their own.” The president, as is his habit, proposed that the appropriate solution lay somewhere in between. “There are arguments to be made for both these approaches. But either one would represent a radical shift that would disrupt the health care most people currently have. Since health care represents one-sixth of our economy, I believe it makes more sense to build on what works and fix what doesn’t, rather than try to build an entirely new system from scratch.”

With such soothing words, the Democrats have easily surpassed the Republicans in fund-raising from the health-care industry and are even pulling ahead in the overall insurance sector, where Republicans once had a two-to-one fund-raising advantage. The deal Obama presented last year, the deal he was elected on, and the deal that likely will pass in the end is a deal the insurance companies like, because it will save their industry from the scrap heap even as it satisfies the “popular clamor for a government supervision.”

The private insurance industry, as currently constituted, would collapse if the government allowed real competition. The companies offer no real value and so instead must create a regulatory system that virtually mandates their existence and will soon actually do so.

A study by the McKinsey Global Institute found that health insurance cost the United States $145 billion in 2006, which was $91 billion more than what would be expected in a comparably wealthy country. This very large disparity may be explained by another study, by the American Medical Association, which shows that the vast majority of U.S. health-insurance markets are dominated by one or two health insurers. In California, the most competitive state, the top two insurance companies shared 58 percent of the market. In Hawaii, the top two companies shared the entire market. In some individual towns there was even less competition—Wellmark, for instance, owns 96 percent of the market in Decatur, Alabama. “Meanwhile, there has been year-to-year growth in the largest health insurers’ profitability,” the AMA reports, even as “consumers have been facing higher premiums, deductibles, copayments and coinsurance, effectively reducing the scope of their coverage.” And yet no innovating entrepreneurs have emerged to compete with these profitable enterprises. The AMA suggests this is because various “regulatory requirements” provide “significant barriers to entry.” Chief among those barriers, it should be noted, is an actual congressional exemption from antitrust laws, in the form of the McCarran–Ferguson Act of 1945.

Insurance companies aren’t quite buggy-whip manufacturers. But they are close. In the past, one could have made an argument that in their bureaucratic capacities—particularly, assessing risk and apportioning payments—insurance companies did offer some expertise that was worth paying for. Bu
t all of the trends in politics and in information technology are against insurance companies’ offering even that level of value. Insurance is an information business, and as technology makes information-management cheaper, technological barriers to entry will fall, and competition will increase. (People who relied on the cost of printing presses to maintain a monopoly should be able to relate.)

At the same time, the very idea of assessing health risk is beginning to be understood as undemocratic, as was revealed by the overwhelming support for the 2008 Genetic Information Non-Discrimination Act, which bars insurers from assessing risk based on genetic information. Over time, more and more information will be off-limits to underwriters, so that insurance ultimately will be commoditized—every unit of insurance will cost about the same as every other unit of insurance. Managers know that one must never allow one’s product to become a mere commodity. When every product is like every other product, brand loyalty disappears and prices plummet.

Which perhaps is one reason why the insurers themselves have always favored the central elements of the Democratic plan. As long ago as 1992, when Hillary Clinton was formulating her own approach to reform, the Health Insurance Association of America (now America’s Health Insurance Plans, or AHIP) announced that insurers would agree to sell insurance to everyone, regardless of medical condition (guaranteed issue) if the government required every American to buy that insurance, and used tax dollars to subsidize those who could not afford to do so (universal mandate). Carl Schramm, the president of the association, said this was the “only way you preserve the private health-insurance industry. It’s plain-out enlightened self–interest.” The deal collapsed nonetheless, in part because Congress wanted to introduce a “community rating” system that would have put an end to underwriting by making insurers sell insurance to everybody in a given community for the same price. Insurers wanted to maintain the profitable ability to charge different prices to different people.

Last December, though, AHIP said it would support community rating as well, and since then the real negotiation has been all about details. The insurance companies would agree to sell their undifferentiated commodity to all people, no matter how sick, if the government agreed to require all people, no matter how healthy, to buy their undifferentiated commodity. Sick people who need insurance get insurance and healthy people who don’t need insurance cover the cost. A universal mandate would include the 47 million uninsured—47 million new customers.

The Democratic plan looks to be a huge windfall for the insurance companies. How big is not known, but as BusinessWeek reported in August, “No matter what specifics emerge in the voluminous bill Congress may send to President Obama this fall, the insurance industry will emerge more profitable.” The magazine quoted an unnamed aide to the Senate Finance Committee who said, “The bottom line is that health reform would lead to increased revenues and profits.”

Democrats have crafted a plan full of ideas that almost certainly will help a lot of people who can’t afford insurance now. It also happens to be the case that some of those ideas will significantly benefit the corporations that at one time or another have paid Democrats a lot of money.

The framework for reform, for instance, was authored not by Max Baucus, the Democratic senator who chairs the Finance Committee, but by his senior aide, Liz Fowler, who also directs the committee’s health-care staff. She worked for Baucus from 2001 to 2005 but then left for the private sector. In 2008, reports the Washington gossip paper Politico, “sensing that a Democratic-controlled Congress would make progress on overhauling the health care system,” she returned to Baucus’s side. Where had she retreated to recover from her Washington labors? Politico does not say. In fact, she had become the vice president for public policy and external affairs at WellPoint, one of the nation’s largest health-insurance corporations.

Pretty much everyone involved in health-care reform has been on the payroll of one health-care firm or another. Howard Dean, the former head of the Democratic National Committee and, heroically, a longtime proponent of a single-payer system, nonetheless recently joined McKenna Long & Aldrich, a lobbying firm with many clients in the industry. Nancy-Ann DeParle, the so-called health czar who is overseeing reform at the White House, is reported to have made as much as $6 million serving on the boards of several major medical firms. Tom Daschle, who was set to be Obama’s secretary of health and human services until it emerged that he had failed to pay taxes on his limousine and driver, now earns a $2 million salary as a “special public policy advisor” for the lobbying firm of Alston & Bird, which represents, among many other clients, HealthSouth and Aetna. Asked to describe his current role, Daschle said, “I am most comfortable with the word resource.”

Most illustrative of the clever efficiency with which the Democrats have allowed themselves to be captured, though, is the strange journey of Billy Tauzin. He spent his first fifteen years in Congress as a “conservative” Democrat, struggling mightily to make his fellow party members more amenable to the needs of the health-care industry. In 1994 he founded the “moderate” Blue Dog coalition, whose members continue to deliver the most reliably pro–business vote in the Democratic caucus. But the Blue Dogs of 1994 did not go far enough for Tauzin, so in 1995 he became a Republican, and by 2003 he finally had mastered the system to the degree that he could personally craft one of the largest corporate giveaways in American history: Medicare Part D. After that bill was made into law, he took the natural next step—he became president of the Pharmaceutical Research and Manufacturers of America, the lobbying arm of the drug industry.

Now the circle is complete. The Democratic president of the United States, the candidate of change, the leader of the party Billy Tauzin deserted so long ago for failing to meet the needs of business, must “negotiate” directly with this Republican lobbyist, and rather than repeat this entire tortured journey himself, all Obama has to do is agree to Tauzin’s demands—which he has. The Democratic deal for the drug companies is, if anything, even sweeter than the Democratic deal for the insurance companies. After one of Tauzin’s many visits to the White House, he told the Los Angeles Times that the president had decided Medicare Part D would not be touched. “The White House blessed it,” Tauzin said, assuring his clients that billions of government dollars would continue to flow their way. Democrats, meanwhile, must have been almost equally assured by the subsequent headline in Ad Age: “Pharma Backs Obama Health Reform with $150 Million Campaign.”

What can Republicans do against opponents like that? They are trying to win back their friends in industry, but the effort is a bit sad. In September, for instance, Senator Jim Bunning of Kentucky proposed an amendment that would, among other things, require a “cooling-off period” of seventy-two hours once the bill was completed. His colleague, Pat Roberts of Kansas, said such a pause would provide “the people that the providers have hired to keep up with all of the legislation that we pass around here” the opportunity to say, “‘Hey, wait a minute. Have you considered this?’”

But of course “the people that the providers have hired”—having actually already written the legislation—are quite familiar with the details. The only hope for Republicans right now is if the insurers themselves decide they can get an even better deal by turning on the Democrats, which no doubt they eventually will. Just because competition has
moved from the marketplace to the legislature does not mean it is any less intense. Even as various cartels and trusts compete for the favor of the parties, so too must the parties continue to compete for the favor of the cartels and the trusts. In October, for instance, the insurers appeared to turn against the Democrats when AHIP released a study that claimed the Democratic approach to reform would radically increase the cost of insurance. Obama, meanwhile, hit right back. In his weekly radio address, he said the study was “bogus,” noted that the insurance companies had long resisted attempts at reform, and even called into question the validity of the industry’s antitrust exemption. The New York Times reported that such attacks indicated a “sharp break between the White House and the insurance industry,” but this was better understood as a negotiating gambit—perhaps insurers believed drug manufacturers were getting a better deal and saw an opening, or perhaps they simply wanted to revise a specific term of the bill, which at the time, according to the Wall Street Journal, would have increased their industry’s tax burden by $6.7 billion a year.

As Democrats negotiate such impasses, the Republicans, no longer the favored party of corporate America, are left to represent nothing and no one but themselves. They are opposing reform not for ideological reasons but simply because no other play is available. They have lost the business vote, and even their call for “fiscal responsibility” is gestural at best. The “public plan” so hated by Republicans, for instance, would have reduced the cost of reform by as much as $250 billion over the next decade, yet the party universally opposed it because, as Senator Charles Grassley of Iowa explained, “Government is not a fair competitor. It’s a predator.”

Such non sequiturs have opened the way to the darker dream logic that of late has come to dominate G.O.P. rhetoric. Nothing remains but primordial emotion—the fear, rage, and jealousy that have always animated a significant minority of American voters—so Republican congressmen are left to take up concerns about “death panels” and “Soviet-style gulag health care” that will “absolutely kill seniors.” Republicans, having lost their status as the party of business, have become the party of incoherent rage. It is difficult to imagine anything good coming from a system that moderates the will of corporations with the fantasies of hysterics.

Luke Mitchell is a senior editor of Harper’s Magazine.

http://www.harpers.org/archive/2009/12/0082740

Santa Monica physicians push for single-payer

By Susan Cloke
Opinion
Santa Monica Mirror, Dec. 10, 2009

“Right now the rest of the developed world is spending less money and getting better health care,” said Marcia Angell M.D. testifying for Single-Payer Health Care at the Senate Subcommittee on Health, Employment, Labor and Pensions Hearing.

Health insurance is on the national agenda because it’s breaking the national economy. But it is also a highly personal and individual problem. Are you worried about your health care? If you are, stay healthy. It’s your best option. Healthy people can buy health insurance. Anyone deemed a risk by the insurers pays higher costs for the same coverage. People who are ill often lose their health insurance.

Entering the debate is Physicians for a National Health Program, a single-issue organization dedicated to education and advocacy for comprehensive, universal, single payer health insurance. Founded in 1987 by David Himmelstein and Steffie Woolhandler, both primary care physicians and both professors at Harvard, PNHP now has 17,000 members, 900 in the Los Angeles area. (www.PNHP.org)

Santa Monica physicians Matt Hendrickson, Gene Oppenheim, Geoff White, Nancy Greep and Steve Tarzynski, joining thousands of American physicians frustrated by insurance companies getting in the way of providing good care for patients, started a Santa Monica chapter of PNHP. Sheila Kuehl, the author of the groundbreaking bill for single payer in CA, twice passed by both houses of the CA legislature and twice vetoed by Governor Schwarzenegger, spoke at their first event.

Dr. Hendrickson, says, “We need single payer. We are the only developed nation with a for profit health insurance system. The current proposals in the House and Senate bills do provide some relief. They will remove pre-existing conditions as an opportunity for health insurers to refuse coverage and there may be a public option open to some people. At the same time most Americans will be required to buy insurance, which will hugely benefit the insurance companies.”

“Tragic and touching,” is how Dr. Hendrickson characterized his volunteer work at the Forum for the RAM (Remote Area Medicine) event. “People waited all night, sleeping on bleachers that had been set up in the parking lot, for a chance to get free medical service. This was a sad first for California and we must do better.”

“The American health system is uniquely expensive and inflationary. Last year we spent about $2.5 trillion on health care and costs are growing much faster than the background inflation rate. Our system is unsustainable. And, if that weren’t enough, we don’t get anywhere near our money’s worth.” said Dr. Angell, PNHP member, Harvard Medical School faculty and former editor-in-chief, New England Journal of Medicine.

The health insurance debate is central to our nation’s economic future and to our personal futures. In this country with its well-trained physicians, its great medical schools and its impressive history of contributions to medicine, we have every reason to expect the best in health care. But we need more than training the best doctors; we need the best access.

Speaking to that point, on May 5, 2009, Dr. Margaret Flowers and seven other doctors went to D.C. The Senate Finance Committee had convened a round table of 15 experts. PNHP had requested a seat at the round table and Committee Chairman Senator Baucus had refused. He did not include any advocate for single payer. So they went to our nation’s capitol to testify. Not only were they not allowed to speak, they were arrested. You can watch the un-American spectacle of Senator Baucus calling in the Capitol police to arrest the physicians as they stood at the hearing and requested to speak to the committee on YouTube.

Our president said, on July 22, 2009, “I want to cover everybody. Now, the truth is unless you have what’s called a single-payer system in which everyone’s automatically covered, you’re probably not going to reach every single individual.” Barack Obama

What Say You? Are you healthy?

Do you worry about health insurance?

What do you think we should do?

Originally published under the title “WHAT SAY YOU: Are you Healthy?”

http://www.smmirror.com/MainPages/DisplayArticleDetails.asp?eid=11475

Contradictory Republicans Still Flummoxed By Medicare

By Bob Cesca
Huffington Post, December 9, 2009

If it weren’t for the fact that the Washington media establishment is gamed in favor of Republicans, it’s very likely that they would have long since been relegated to nothing more than a LaRouche-style crackpot cult, handing out mimeographed pamphlets outside the post office.

How else, other than via the self-conscious deference afforded it by the press, do the Republicans get away with issuing the following two press releases within a single 24 hour span:

Sunday: “Cutting Medicare is not what Americans want.”

Monday: “Expanding Medicare a plan for financial ruin.”

In case you’re wondering, these statements didn’t come from one of the many far out wingnuts like Steve King, Michele Bachmann or Virginia Foxx (Medicare recipient). They were, in fact, dispatched from Senate Minority Leader (And Real-Life Albino Sleestak) Mitch McConnell’s office. Yes, the highest ranking Republican in Congress wrote-up both headlines, ostensibly proof-read and unapologetically shoved into the public record.

Two press releases that exactly contradict each other. Yet I’m a little disappointed that Mark Halperin and Chuck Todd didn’t fire off tweets about how the opposing headlines were “bad news for Obama.” After all, every Republican gaffe is somehow “bad news for Obama.” And so they get away with it.

As we have observed over the years, this Republican contradiction problem has been a feature of modern Bush Republicanism for a while now, but it’s only during the past year that the gap between contradictory statements — let’s call it the Wingnut Gap — has narrowed down to just 24 hours. Prior to this week, it took several years for, say, the Republicans to contradict their “criticizing the commander-in-chief during wartime undermines the troops” mantra, or for Glenn Beck to accuse the Obama administration of being Maoists then to inexplicably suggest that America needs to be “more like the Chinese.”

Say nothing of the contradictions evident in Sarah Palin’s America-hating commie Castro headgear.
And don’t give her the benefit of the doubt on this, either. She’s not smart enough to wear it with deliberate irony.

But this is a dynamic that’s most prevalent when the Republicans discuss Medicare. It really flummoxes them. After all, they despise socialized medicine. They despise single-payer health insurance. They despise government-run health care. They voted against the formation of Medicare during the high water mark of LBJ’s Great Society. They ultimately would love to privatize (or drown in a bathtub) the whole thing and be done with it.

Yet at the same time, 55 Republican members of Congress are on Medicare. Congressman Weiner wrote up a list that includes Mitch McConnell. I could be wrong, but I also think proxy-Republican and anti-government-run-insurance drama queen Joe Lieberman, at 67 years old, receives Medicare. He’s eligible. Additionally, I’m still attempting to ascertain how many Republicans get their primary care from the government-run Office of the Attending Physician. The office won’t give me a partisan breakdown of their patients, but we can safely assume that, based on ideology, it’s all Democrats, right?

Today, embattled Republican David Vitter spoke in favor of Byron Dorgan’s Canadian drug-importation amendment and, in the process, praised the Canadian system — which is, as you know, single-payer. However, Olympia Snowe said she doesn’t support the Gang of 10’s Medicare buy-in compromise, but she supports the Canadian importation measure. So she’s siding with the rank and file Senate Republicans against single-payer health insurance on the buy-in, but she supports the single-payer system on the drug importation amendment. And it’s not just Snowe and Vitter. The congressional Republicans are all toeing this upside-down We Hate-Slash-Love Medicare position.

No wonder the teabaggers and dittoheads are screeching in gibberish — steam shooting from their ears. When it comes to Medicare, they have no idea what to support or how to support it. All they know is that President Obama should keep his government hands off their Medicare — whether or not they understand that the government, in fact, runs Medicare. He just should. So there.

The fact is that if the Republicans really supported Medicare, they should also support the Medicare buy-in proposal for Americans between the ages 55-64. But they won’t. Why? Because they hate Medicare. Even though many of them are on it. And even though many of them say they want to protect it from “ruin.”

But expecting logic, reason and consistency from the Republicans is wasted time. (See also Fox News Channel’s Rasmussen poll analysis showing a total of 94 percent of Americans think climate scientists falsified their evidence, while 26 think they didn’t, thus indicating a total of 120 percent.)

The fact remains that the private health insurance system is broken and America is being left behind by the rest of the world as we cling to the decaying wreckage of a failed healthcare system. Medicare is an obvious solution.

If Medicare works for senior citizens, then it can work for everyone else. Expanding the revenue base for Medicare by upwards of 2 million Americans with this buy-in plan, allowing a younger, healthier and, consequently, less costly population to buy into the system by paying the full, unsubsidized premiums, will only help to ameliorate Medicare’s fiscal problems. Likewise, widening the buy-in window to include all adults would ultimately stabilize Medicare even further, because we’d ostensibly be adding even younger and healthier people to the pool, allowing chunks of their unused premiums to flow upwards to older, sicker recipients who need it.

And if you, Mr. and Mrs. Republican, are against a Medicare option for everyone, then you have to be against Medicare period. And feel free to be against it. You just can’t have it both ways — no matter how ridiculous and contradictory your congressional leadership is.

Bob Cesca’s Awesome Blog! Go!

http://www.huffingtonpost.com/bob-cesca/contradictory-republicans_b_386492.html

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

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.

Dr. Scheiner: On life, health care reform and his former patient Obama

By Kennedy Elliott  

Medill Reports, Dec. 9, 2009

He approves the swine flu vaccine, sings to his patients and said he may be one of few people to have been uninvited to the White House. Dr. David Scheiner, President Barack Obama’s former physician, has been serving the Hyde Park community for more than 20 years.

Scheiner’s office sits along the side of a large parking lot on 52nd Street, also home to a McDonald’s and a ribs restaurant.

An 81-year-old woman sits in the corner of the doctor’s examination room one recent morning and looks reverently at Scheiner. Giving her a diligent and thorough exam, he shakes his head. “I am not happy with you, Ms. Robertson. Not happy at all,” the doctor says in a firm but gentle voice.

Back in his office, he explains that he fears she is starving to death. With none of her family members willing to live with her and monitor her well-being, he is doubtful that she will be able to stay independent much longer.

Though the woman’s case is one of the saddest he sees on a regular basis, her story is not unique. With a wealthy stream of U.S. congressmen, University of Chicago faculty and clergymen as patients, physicians at Hyde Park Associates treat a predominantly elderly population who are on Medicare.

Scheiner shakes his head and stares out of his office window onto the battered buildings below with a furrowed brow. It is not unusual for Scheiner to get this wrapped up in his patients, he said. Coming from a small family himself, he refers to his patients as his family.

Scheiner grew up in New Jersey and attended medical school at Columbia University. His subsequent residency at Michael Reese Hospital brought him to Chicago. Over the next several years, he worked at a few practices on the South and West sides of Chicago, landing in Hyde Park and working with the charismatic Dr. Quentin Young.

He joined Young, a renowned physician and health care reform activist, in practice in 1979. He calls it “the best decision I ever made.” Though Young retired years ago, Scheiner has remained at Hyde Park Associates, on-call 24 hours a day and seeing on average 20 to 25 patients a day.

“David is extremely passionate about patient care, and extremely popular with his patients,” Young said. “Deeply involved.”

Young became a sort of mentor to Scheiner, though the two differed in behavior about how “active” a physician should be in pushing a health care agenda to patients. Young had no qualms about insisting upon the importance of a national health care system to the politicians that came through his doors. Scheiner on the other hand expressed more reserve in his opinions and felt that, if patients wanted to hear his political views, they would ask.

This became more important with one patient in particular, a rising star on Capitol Hill – Illinois’ Sen. Barack Obama. Scheiner had been President Obama’s primary care physician for more than 20 years until he left Chicago for the White House.

Scheiner saw Obama’s popularity with staff and other patients at Hyde Park Associates and said he knew instantly that the young politician would become a leader in national affairs. Surprisingly, though, Scheiner said that he did not discuss views about health care reform with the future president.

“David would say, ‘That would be unethical,’” Young said with a laugh. “I certainly didn’t think it was unethical.”

In fact, Scheiner’s seemingly valuable views from the perspective of a physician working within the system were never heard by Obama. But, like Young, Scheiner has been a long-time advocate of health care reform. And reporters flocked to him when he announced that he did not support Obama’s proposed health care agenda earlier this year.

Scheiner supports a single-payer insurance system, which would create a single non-profit insurance institution for everyone, much different than the current free-market system. He said that the government has a moral and social obligation to provide health care to the public, just as it provides libraries and sanitation. But he takes the stance that the public option, where the government would provide health insurance coverage, will not be as effective as it is claimed to be.

“The public option as it stands now, even if it gets through, is bad. It’s inadequate,” he said. It would offer one government plan among all of the current health insurance options.

“It’s not going to be competitive [with insurance companies], and that’s exactly the point. It has become meaningless. If the whole thing fails, it has the potential to set things way back,” Scheiner said.

Critical of the insurance industry, he said industry giants “profit from people’s misery.” And if they exist in a new health care environment, strict and precise regulation should be enforced to keep them financially in check. But Scheiner said he assumes his criticism of the President’s public option for health care explains why he was recently “disinvited” from attending a White House event the day before it was scheduled.

The White House did not respond to questions regarding Scheiner’s statements by the time of publication.

Scheiner’s advice for Obama is not to worry about pleasing constituencies for a presidential run in 2012 but rather to tackle tough issues and be a “one-term President,” if necessary.

“He doesn’t need people to love him, he’s being too timid. And it’s tough – this is a country that is basically conservative. But he should lead us,” Scheiner said.

Despite his already progressive tendencies, Scheiner said he is getting more radical as he ages. After Scheiner became more vocal with his political opinions in the backdrop of U.S. health care reform, the National Review at one point called him a socialist, he said.

“I consider that a badge of honor,” he added, chuckling. Scheiner also said he initially became a doctor for the idealism and romanticism of it all.

He recalled a defining moment in his career when he was called upon to save a man’s life. The man had collapsed due to a diabetic episode, and needed an injection to restore consciousness. Scheiner began running down the street, medicine in hand, and injected the life-saving antidote in the patient’s arm. This dramatic and theatrical event is exactly what Scheiner meant by romanticism, he said.

Days later, Scheiner received the same call, and again had to run to the scene to save the same man’s life. Scheiner heroically injected the medication, though a bit more disenchanted. Days later, Scheiner received another call about the same man, who had collapsed again. However, the repetition had taken its toll on his enthusiasm for being a hero.

“Even a fantasy can be overdone, I guess,” he said.

And Scheiner isn’t making plans to retire any time soon. Forever a competitor with his mentor, he jokingly said that he’ll stay in practice longer than Young, who retired at 85.

“I’ve done essentially everything you can possibly do in medicine,” he said.

“I walk around with a sandwich board that says ‘I’m a doctor.’ Whenever someone calls me ‘Mr. Scheiner,’ I sort of get shivers. My identity is as a physician, and that’s part of it’s going to be so hard for me to retire – I don’t know if there’s going to be anything left when they take away the ‘Dr.’”

http://news.medill.northwestern.edu/chicago/news.aspx?id=152733


Medicare buy-in?

Harry Reid: Democrats reach 'broad agreement'

By Carrie Budoff Brown & Patrick O’Connor
Politico
December 9, 2009

Senate Democrats have reached a “broad agreement” on a health reform bill, Majority Leader Harry Reid said Tuesday night — a plan that would replace the public option in the current Senate bill with a new national insurance plan offered by private insurers, and a chance for older Americans to “buy in” to Medicare.

To win over liberals disappointed at losing the public option, Democrats would allow older Americans starting at age 55 to buy into Medicare, the popular program for the aged. The Medicare expansion would be a significant victory for Democrats, who spent years pushing for it. The proposal would in effect create a public health insurance option for older Americans, since Medicare is government-funded and government-run.

http://www.politico.com/news/stories/1209/30371.html

Comment:

By Don McCanne, MD

The most efficient, most effective, and least expensive method of providing reasonably comprehensive health care for everyone would be to replace all current public and private financing programs with a single, improved Medicare program that covered absolutely everyone. Some have suggested that we can do this incrementally, with the first step being to allow individuals 55 and over to buy into Medicare. Is this a good idea?

Harvard professor Steffie Woolhandler provides us with some insight: “Lowering the eligibility age for Medicare to 55 only works if it is mandatory.  Otherwise it becomes the place where all the sickest patients get dumped.  That might be okay for the sick people since Medicare is often better and more secure than private coverage, but it would drive total health care costs (and premiums) up, not down.”

The current Medicare risk pool is composed of seniors with a high rate of chronic disease and with the expenses of end-of-life care, plus younger individuals with long-term disabilities. Since this is a very high cost population, the prorated premiums would be unaffordable for most individuals 55 thru 64. A separate risk pool would have to be established that would be limited to this age bracket. Unfortunately, 55 thru 64 is still the most expensive age sector of all individuals under 65 and so premiums would still be unaffordable for most, especially after you add in the impact of adverse selection as Steffie Woolhandler has described.

Suppose that a Medicare buy-in for those over 55 were to be established, and that higher government subsidies were provided to cover the higher costs, then what do you have? You have created a public option. Yet the reason being given for the Medicare buy-in is that it is a trade-off to get the progressives to agree to abandoning the public option.

So the agreement seems to be to eliminate the public option from consideration by establishing a public option. But is the proposal a public option that would allow everyone the opportunity to buy into Medicare? Apparently not. After all, this is Congress at work.

Although details have not been released, it appears that this Medicare buy-in would be limited by the same rules already proposed for the public option. Individuals who already are eligible for employer-sponsored coverage, Medicare, or Medicaid would not be eligible to participate in the insurance exchange, yet the Medicare buy-in would not be available outside of the exchange (except perhaps during a transition before the exchange is established). Thus the net effect of this buy-in is to further limit the public option only to those 55 and over who meet all other qualifications for the exchange – a ratcheted-down version of the public option.

An elective buy-in for Medicare will only add to the perpetuation of inequities, fragmentation, administrative inefficiencies, inadequate fiscal supervision and other deficiencies that plague our health care financing system. Adding to our dysfunctional system only compounds the dysfunction. We need to replace the system with an efficient single payer model.

Could we do that in incremental steps by first moving absolutely everyone over 55 into our existing Medicare program? Yes, but why would we do that? There would be complex transitional issues in changing this sector from a revenue source for Medicare into both a revenue source and an expense as they become beneficiaries of the program. Another increment could be MediKids for all children, though that would involve other transitional issues. Then how soon would we phase in everyone else, with yet still more transitional issues?

Incremental steps increase the complexities and costs of the transition while delaying access for many who already have impaired access and financial burdens caused  by our dysfunctional system.

A single, disruptive transition would actually be more efficient administratively, while lowering transitional costs. Much more important, a single transition would ensure that no person would have to wait any longer to access the care that he or she needs merely because of an inability to pay for that care.

If we advocate for less than we need, we’ll end up with cheap chits that will eventually be traded away, and then what are we left with?

INTERVIEW: Dr. Andy Coates

Selling out health care reform

By Ashley Smith
December 9, 2009

The battle for health care reform is heating up in Congress. The House has already passed one bill, and the Senate is debating another version. But as Dr. Andy Coates explains, both bills will fail in solving the health care crisis–and, in fact, place a greater financial burden than ever on working people.

Coates is a member of Physicians for a National Health Program (PNHP), co-chair of Single Payer New York and a steward in the Public Employees Federation in New York. He talked to Ashley Smith about what’s wrong with the health care proposals in Washington.

We’ve heard lots of hype from the Democrats about the House and Senate bills. What’s in these two bills, and what will they mean for workers?

The crux of each bill is compulsory private health insurance. The government will use its power to compel every individual to purchase private health insurance, or enroll in Medicaid. The bills don’t make private health insurance affordable; they propose to subsidize private insurance premiums for those who live on modest means.

For example, the House bill will subsidize the premiums of those whose income is 400 percent of the federal poverty level and below. Taxpayers would pay for this. But it would still mean that people who earn 200 percent to 400 percent of the federal poverty level would have to pay 8 to 12 percent of their income for private insurance premiums, or pay a fine and stay uninsured.

That would be the so-called “choice.” For the uninsured, paying for expensive insurance would amount to an enormous wage cut. And then they’ll get skimpy coverage, with high co-pays, high deductibles and all those other onerous and unworkable measures that come with very expensive private insurance.

One of the justifications that Obama and the Democrats used for these bills is that they will control the cost of health care. Are they telling the truth?

TOTAL HEALTH care spending will not be brought under control by either of these bills. It will not bend the cost curve. As health care costs continue to increase dramatically, the crisis of unaffordable health care will continue, for ourselves and our families, with increased out-of-pocket costs, new mandatory premium payments and ongoing medical bankruptcies, will remain acute.

What about the so-called public option? What impact will it have on the health care system?

THE PROPOSALS for the public option as they stand are meaningless from the point of view of reform, and ridiculous as a way to influence the insurance market. There are so many compromises, it might be renamed the incredible shrinking public option. And also, as a TV talking point, it has often eclipsed a focus on what’s really in the bill.

But I think that there’s more fundamental point. The public option was never a proposal for workable reform. It’s actually a neoliberal concept. Marie Gottschalk, a professor at the University of Pennsylvania, has written an article in the new Socialist Register 2010 entitled “U.S. Health Reform and the Stockholm Syndrome.”

She argues that when it comes to health reform, American reformers are like hostages who identify with, and even defend, their captors. I heard her speak in New York, where she said it seemed that if a window opened to permit real health reform, many “reformers” wouldn’t even try to climb out.

What do you mean that the public option is in fact a neoliberal proposal?

The public option idea is basically that the insurance market will will magically meet our needs, as long as there is consumer choice and fair competition. This is the ideology popularized by Ronald Reagan. If only a government agency could be added alongside these giant, highly profitable insurers with their oligopoly control, then the marketplace would magically reform itself. Does that make any sense?

The insurance market rewards insurers that avoid paying for the care of sick. The public option would have to play by the same rules and compete on the same market. So in the best-case scenario, the public option would tend to enroll the sickest patients, and, in turn, would have higher, not lower, expenses. The Congressional Budget Office recently made this very point in a report on the House bill.

So a successful public insurer next to the private companies might instead put us on the fast track to permanent two-tiered health care, a deplorable trend already well underway.

But most likely of all, if enacted, the public option would turn out nationally just as it has in Maine–a failure, not a reform. In Maine, a state-funded public insurance called DirigoChoice has been around since 2003. Since then, it has enrolled fewer than 10 percent of the uninsured, it has not done a thing to control costs, and this year, it faces a fiscal crisis that threatens its future existence

What impact will these bills have on the health care crisis?

IMMEDIATELY ON the passage of the bill, very little would change. There is some insurance regulation, but we should note that this is regulation the industry itself proposed.

For instance, the insurance companies will have to stop rescissions–arbitrary cancellation of policies that come usually with the “coincidence” of the patient getting sick. But they can still cancel policies if the policyholder commits “fraud”–or if you simply can’t pay your premiums. And over the decade, the insurers stand to gain tens of millions of new customers and hundreds of billions in taxpayer subsidies.

So I think that passage of the bill is virtually irrelevant to the everyday crisis. The main features in the House bill are not scheduled to start until 2013, and those in the Senate bill won’t start until 2014. Then it still won’t lessen disparities, or guarantee access to everyone, or improve the quality of care, or reduce costs. In fact, the main things in the bill have already failed at the state level, including the public option, including mandatory insurance.

For most people, health insurance will still be tied to their jobs, right?

Yes. When you lose your job, you will still lose your health insurance. Even worse, illness can lead to job loss and loss of insurance. Not just for the patient. If someone in your family gets very sick, the illness can cause you to miss work, too–going to appointments, to chemotherapy, waiting after surgery, coming home from the hospital, going to the pharmacy, going back to the hospital.

In such situations, people often lose their jobs in the United States. That’s the purpose of the Family Medical Leave Act. But even so, in our insane system, people lose their health insurance because they have no paycheck. These cruelties will remain a fact of life. Can we swallow such a bitter pill with a bit of tonic that more of the people who lose their jobs will now be eligible for Medicaid? I don’t think so.

Would it be better if no bill passes than one of the proposals in Congress today?

Single Payer New York, the coalition that I am a co-chair of, had a steering committee discussion a few months back. It was our opinion at that time that it would be better to keep arguing for single payer, and not take a position on a bill that hadn’t come out. More recently, Single Payer New York put out an unequivocal statement that recommends a “no” vote. We have also applauded Rep. Eric Massa of western New York for his principled vote against the House bill.

Personally, I think we should embrace any dialogue that advances the grassroots, kitchen-table debate about health care in this country.

The costs and hassles of health care are breaking working-class families. Prescriptions are not affordable, appointments can’t be had, our insurance is tied to our job or our spouse, millions of people are impacted by bankruptcy and Medicaid is a dis
aster. Too often, a personal crisis, health care amounts to an accumulating social crisis. The Democratic bills now in the Congress are no solution.

The single-payer movement had attracted Democratic support in the House for a bill known as HR 676 that would have established a single-payer system. Leaders among these Democrats promised that there would at least be votes on single payer. Why didn’t they deliver?

Forgive me for the long story here, but what happened this year was really remarkable and very positive. How many people are on full-time paid staff for single payer in the whole country? Less than a dozen or so, if that? Yet, there was a year of sustained mobilization, starting before Obama’s election, that grew and grew, from local, volunteer organizing.

The AFL-CIO convention passed a resolution this fall that endorsed single payer and the broader concept of social insurance, building on support for HR 676 within the unions. And then the Democratic Party leadership had to maneuver and spin all year long, trying to keep single payer off the table. These are a testament to the strength and energy of the grassroots inside and outside the AFL-CIO.

Back at the end of July, New York Congressman Anthony Weiner and six other HR 676 co-sponsors, brought into the Energy and Commerce Committee an amendment to substitute the text of HR 676 for the House bill. The leadership needed to get the main bill out of committee that day, the day before the summer recess. One day earlier, about a thousand people visited Congress and rallied outside the Capitol for single payer.

So while Nancy Pelosi and Henry Waxman, the committee chair, didn’t want to have a debate on single payer in the committee, neither could they simply push it aside. So Pelosi offered Weiner a deal. If he withdrew the amendment in committee, she would let him put it on the floor of the House for a debate and vote.

Weiner took the deal, but it was the single-payer grassroots who really called Nancy Pelosi’s bluff. We recognized that a floor vote–a losing vote–would be a historic precedent, not just that single payer would get to the floor of the House for the first time, but that the grassroots movement would be the force to put it there. Plus we hoped to see members of the House of Representatives stand for single payer and be counted. We wanted to know who our true friends were, with an eye on the 2010 elections.

So a campaign of lobbying, picketing and protesting commenced, from dozens of local organizations and a handful of national organizations. It brought to Congress hundreds of thousands of phone calls and faxes and e-mails, maybe millions–far more than anyone would have predicted. Protests grew vigorous. In fact, over 150 people were arrested in nonviolent civil disobedience actions at insurance companies and at congressional offices, including Nancy Pelosi’s San Francisco office.

Weiner, an ambitious guy, jumped in with a bit of pizzazz. He got on television, and at one point turned the tables on the interviewer by asking what it was that insurance companies added to health care. Single payer helped his stature. But the week that the House bill came up, Weiner published a piece on the Huffington Post that was all about the public option, with no mention of single payer.

Earlier, we had expressed our dismay because he wanted to change some of the HR 676 language to leave out the undocumented immigrants–changing “residents” to “citizens” in the amendment. On the other hand, to his credit, he worked to get his single-payer amendment to the floor up to the very end. And Pelosi never would have negotiated with Weiner without the grassroots heat, charming though Weiner might be.

In fact, the day before the vote, there was a full-page ad by the AFL-CIO and eight unions, including the California Nurses Association, in Roll Call calling for a “yes” vote on the Weiner Amendment. By this point, the Democratic Party leadership must have been surprised and frustrated that they had to keep finding new ways to keep single payer off the table. We heard rumors that even the White House had helped squelch the amendment vote.

In a curlicue twist, late on the Thursday before the Saturday House vote, Congressmen Dennis Kucinich and John Conyers together issued a letter saying that the Weiner amendment would be “tantamount to driving the movement over a cliff.” A losing vote for single payer on the House floor would hurt the cause, they said.

Their opinion stood in direct contradiction to the single-payer advocates who saw the efforts demanding the amendment as historic and imperative. Nancy Pelosi must have been overjoyed, for the letter gave her a new excuse to knock single payer off the table.

Pelosi also made an argument that in retrospect seems like pure chutzpah. She said that if a single-payer amendment came to the floor, she might also have to allow an amendment to restrict abortion rights to the floor. So we were to be mollified by the thought that if the single-payer amendment was withdrawn, at least women’s rights would be protected.

But we know how that turned out. We asked for health reform, and they gave us an abortion ban. Is that the true state of the Democratic Party today? To get the Democrats own “Blue Dog” right wing to vote for “health reform,” largely conceived and written by the insurance companies, they had to trade away women’s rights? Good grief.

Meanwhile, Kucinich had another amendment that would make it slightly easier for single payer to be enacted state by state. The Kucinich amendment came through the Education and Labor committee, where Kucinich got it passed with help from Republicans, but it wasn’t included in the bill. This amendment, too, was the focus of grassroots action–and is still.

He has since been fighting to get the state-by-state amendment back into the final legislation, with some success, getting the Progressive Caucus to endorse the idea. After Kucinich voted against bill, he issued a clear and powerful statement explaining his vote by saying the private insurance companies are the problem, not the solution.

What’s the lesson of this experience?

We just found out that Bernie Sanders will put a substitute single-payer amendment before the Senate, with at least two other senators promising to vote for it. But when the dust settled in the House, only two representatives, Dennis Kucinich and Eric Massa, voted against the bill because it wasn’t single payer. Two. The rest went with the Democratic Party leadership and voted for the bill–abortion ban and all. Evidently, this is what it means to be a progressive Democrat in Congress today.

It also tells us that we need to build a bigger grassroots movement. We are learning that the Democratic Representatives–and I daresay the Republicans, too–will respond to a grassroots mass movement, but we have to build that movement. No one will do it for us. As we do so, we must maintain our independence from elected officials. We have to continue to pressure them, sure–but our eyes should be on the grassroots, not the Democratic Party. I think that’s the most important lesson.

We might also remember that single payer will be won when it becomes a mainstream demand. So the goal of the movement should be to make our proposal the litmus test for the entire nation–left, right and center. The whole country simply must have a health system built upon the principle of solidarity. What other kind of society would we want to live in?

What’s the way forward for the single-payer movement?

What we need above all else is confidence. Our demand is popular, workable and just. We learned this year that there really is a social movement for single payer coming into being. We should be telling our advocates this: if you keep doing what you have been doing, we will win single payer. All year long, we have had the attention of the Congress and the White House. Much as they wanted to, they could not shake us.

It
‘s really up to us. We can build this movement. The health care crisis will persist in spite of the Democrats’ 10-year plan. With unemployment still rising and possibilities for a frank political crisis emerging, we might soon find a situation in which something has simply got to give. We need to learn to articulate broader benefits of single-payer reform as an economic rescue and as personal liberation for working people.

Our grassroots single-payer movement will also grow by learning to fight on related issues. For example, in Braddock, Pa., the western Pennsylvania single-payer activists have gotten involved in defending a community hospital from closing. The University of Pittsburgh Medical Center–itself an insurance company by the way, and a massive corporation with a millionaire CEO–bought up the health care infrastructure in the area, including Braddock Hospital.

If we had single payer, we wouldn’t have this corporate medicine, building a new hospital in the wealthy suburb and closing the hospital in the old city. If we had single payer, health care priorities would be planned to meet the needs of the community, not the corporate bottom line.

The single-payer movement needs to join local struggles like this one and articulate how single payer would help solve these problems. That’s how we will be able to forge out of a nascent movement a force that can overwhelm the opposition to single payer in Washington, D.C.

Medicare buy-in?

Harry Reid: Democrats reach ‘broad agreement’

By Carrie Budoff Brown & Patrick O’Connor
Politico
December 9, 2009
Senate Democrats have reached a “broad agreement” on a health reform bill, Majority Leader Harry Reid said Tuesday night — a plan that would replace the public option in the current Senate bill with a new national insurance plan offered by private insurers, and a chance for older Americans to “buy in” to Medicare.
To win over liberals disappointed at losing the public option, Democrats would allow older Americans starting at age 55 to buy into Medicare, the popular program for the aged. The Medicare expansion would be a significant victory for Democrats, who spent years pushing for it. The proposal would in effect create a public health insurance option for older Americans, since Medicare is government-funded and government-run.
http://www.politico.com/news/stories/1209/30371.html

The most efficient, most effective, and least expensive method of providing reasonably comprehensive health care for everyone would be to replace all current public and private financing programs with a single, improved Medicare program that covered absolutely everyone. Some have suggested that we can do this incrementally, with the first step being to allow individuals 55 and over to buy into Medicare. Is this a good idea?
Harvard professor Steffie Woolhandler provides us with some insight: “Lowering the eligibility age for Medicare to 55 only works if it is mandatory. Otherwise it becomes the place where all the sickest patients get dumped. That might be okay for the sick people since Medicare is often better and more secure than private coverage, but it would drive total health care costs (and premiums) up, not down.”
The current Medicare risk pool is composed of seniors with a high rate of chronic disease and with the expenses of end-of-life care, plus younger individuals with long-term disabilities. Since this is a very high cost population, the prorated premiums would be unaffordable for most individuals 55 thru 64. A separate risk pool would have to be established that would be limited to this age bracket. Unfortunately, 55 thru 64 is still the most expensive age sector of all individuals under 65 and so premiums would still be unaffordable for most, especially after you add in the impact of adverse selection as Steffie Woolhandler has described.
Suppose that a Medicare buy-in for those over 55 were to be established, and that higher government subsidies were provided to cover the higher costs, then what do you have? You have created a public option. Yet the reason being given for the Medicare buy-in is that it is a trade-off to get the progressives to agree to abandoning the public option.
So the agreement seems to be to eliminate the public option from consideration by establishing a public option. But is the proposal a public option that would allow everyone the opportunity to buy into Medicare? Apparently not. After all, this is Congress at work.
Although details have not been released, it appears that this Medicare buy-in would be limited by the same rules already proposed for the public option. Individuals who already are eligible for employer-sponsored coverage, Medicare, or Medicaid would not be eligible to participate in the insurance exchange, yet the Medicare buy-in would not be available outside of the exchange (except perhaps during a transition before the exchange is established). Thus the net effect of this buy-in is to further limit the public option only to those 55 and over who meet all other qualifications for the exchange – a ratcheted-down version of the public option.
An elective buy-in for Medicare will only add to the perpetuation of inequities, fragmentation, administrative inefficiencies, inadequate fiscal supervision and other deficiencies that plague our health care financing system. Adding to our dysfunctional system only compounds the dysfunction. We need to replace the system with an efficient single payer model.
Could we do that in incremental steps by first moving absolutely everyone over 55 into our existing Medicare program? Yes, but why would we do that? There would be complex transitional issues in changing this sector from a revenue source for Medicare into both a revenue source and an expense as they become beneficiaries of the program. Another increment could be MediKids for all children, though that would involve other transitional issues. Then how soon would we phase in everyone else, with yet still more transitional issues?
Incremental steps increase the complexities and costs of the transition while delaying access for many who already have impaired access and financial burdens caused by our dysfunctional system.
A single, disruptive transition would actually be more efficient administratively, while lowering transitional costs. Much more important, a single transition would ensure that no person would have to wait any longer to access the care that he or she needs merely because of an inability to pay for that care.
If we advocate for less than we need, we’ll end up with cheap chits that will eventually be traded away, and then what are we left with?