PNHP

Protest Held Outside Senator McConnell’s 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.

‘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