PNHP

Paying for community health centers

Paying for community health centers

Using Primary Care to Bend the Curve: Estimating the Impact of a Health Center Expansion on Health Care Costs

By Leighton Ku, PhD, MPH, Patrick Richard, PhD, Avi Dor, PhD, Ellen Tan, MSc, Peter Shin, PhD, MPH, Sara Rosenbaum, JD
The George Washington University
School of Public Health and Health Services
Geiger Gibson / RCHN Community Health Foundation Research Collaborative
September 1, 2009
This research brief, the third in a series examining the link between national health reform proposals and community health centers, estimates the cost savings that would be realized by making important investments in non-profit health centers as an element of national health reform.
These projected savings to the nationā€™s health care costs become possible because of the insurance reforms on which they build, supplemented by a direct health center investment. Health insurance coverage expansions, coupled with investments in the nationā€™s primary health care infrastructure, can spur high quality and sustainable primary health care in medically underserved rural, urban, and suburban communities, and help bend the curve of health care cost growth.
Under the health reform proposals, a large number of people will gain insurance coverage from the health insurance exchanges, which will primarily offer private plans (although the House bill also offers a public plan option). As reported earlier, private insurance plans tend to pay health centers considerably less than the actual costs of providing care at health centers; data from the 2007 Uniform Data System indicate that private insurance underpays by about 43 percent. One option under health reform would be to require plans offering care under the exchange to pay health centers according to the prospective payment system (PPS) used in both Medicaid and Medicare, which comes much closer to paying full costs. In 2007, Medicaid payments were about 15 percent below health centersā€™ estimated costs.
As has been demonstrated by a number of studies, in addition to this one, health centers are a cost-effective means to furnish primary health care, which can lead to better health and lower health care expenditures. Investments in health centers can serve as a complement to health reform efforts to expand the number of people with health insurance, by ensuring that there is an increased availability of primary health care providers to serve the newly insured, as well as those who remain uninsured. This will be particularly important in medically underserved areas where there is already an insufficient supply of primary care providers. Thus, this is a case in which the national economic value of the investment is further enhanced by its ability to bring better health to the nationā€™s most underserved communities.
http://www.gwumc.edu/sphhs/departments/healthpolicy/dhp_publications/pub_uploads/dhpPublication_61D685D5-5056-9D20-3DDB6CDE10382393.pdf

Regardless of what proposals for health care reform are adopted, it is essential that financing be included for non-profit community health centers in underserved rural, urban and suburban communities. Would these centers be better served by health insurance exchanges and their private plans, or by a public financing program?
Although the insurance industry whines that public plans would provide unfair competition because they pay less than private plans, what is the record with community health centers? Unfortunately, Medicaid does underpay – by about 14 percent below the health centers’ estimated costs. But the private plans, which the members of Congress are so diligently protecting, are underpaying by about 43 percent!
There are two financing considerations for community health centers: 1) capital investments to build and expand the facilities, and 2) operating expenses, including payment for health care services.
Capital investments can be authorized through various legislative efforts, including as a component of the current health care reform legislation. But such efforts tend to be sporadic and not always well aligned with need. In contrast, the single payer model separately budgets capital improvements, providing more coordinated capital allocations based on community need. It ensures a perpetual resource that is responsive to fluctuating needs.
For operating expenses, the thousands of private health plans each do whatever they can to avoid paying health care costs. Community health centers serving vulnerable populations do not have the clout to demand that their expenses be met by the private insurers. Medicaid, a chronically underfunded welfare program, comes much closer, but still falls short. In contrast, a single payer system is designed to pay for the legitimate costs of appropriate health care. The community health centers would be served much better by an improved Medicare-like plan that covers everyone.
Community health centers have strong bipartisan support. Now if only we could could get our legislators to agree on adopting an efficient and equitable system of financing the centers…

Mad as hell across the country

Andrea Hektor reports on the plans of Oregon doctors and single-payer advocates to take their cause on the road.

September 1, 2009

A SMALL group of Oregon-based doctors and their supporters is getting ready for a cross-country tour to demand health care reform that will actually work to end the crisis–a government-run single-payer system that would cover everyone and cut out the private insurance industry.

The doctors’ “Care-A-Van” will start out September 8 on a journey from Portland, Ore., to Washington, D.C.

The trip will include town hall meetings on health care along the way. But these forums won’t be like the ones sponsored by Washington politicians, where right-wingers denounced all reform and Democratic legislators attempted to defend their proposals. Even before those town halls occurred, the Democrats conceded on a series of crucial questions, leaving their legislation “toothless” and giving the insurance industry everything it could have hoped for.

In contrast, the town halls organized for the six physicians, who call themselves the “Mad As Hell Doctors,” will seek to educate people about single-payer and get people involved in the movement fighting for a rational health care system.

As Dr. Paul Hochfield, the lead Mad As Hell Doctor and producer of the documentary Health, Money, and Fear, said in a statement, “We’re mad as hell because our health care system is run by people who profit from illness. The rest of the civilized world has test-driven single-payer, and it works. But elected officials in America won’t even allow a discussion.”

With millions in the U.S. uninsured and millions more with coverage that would likely stick them with enough bills to land them in bankruptcy court were they ever to have a serious medical emergency, the vast majority of the U.S. public supports some type of global government-run system for all citizens.

Yet the term “universal health care” has been expropriated by Democrats to mean “mandated coverage”–something like the health care scheme imposed in Massachusetts in 2004 that requires all residents to purchase some form of coverage, likely from a private company, or face tax penalties.

So while many people see the need for reform, the debate about health care among elected officials and in the corporate-controlled–and insurance-industry friendly–mainstream media has skewed people’s idea of what single-payer, “everybody in, nobody out” health care coverage.

Getting real information about single-payer out there is half the reason for the Mad As Hell Care-A-Van, according to Dr. Mike Huntington, a radiologist from Corvallis, Ore., who will be on the trip. As Huntington put it:

People need to understand what single-payer is–and isn’t. It isn’t socialism, any more than police and fire are socialism. And it doesn’t require any more money.

Simply put, single-payer is a way to take the current premium payments that go to a thousand different private insurance companies, and redirect them into a single, public fund that insures everyone. That’s all it is. But when we do this, lots of wonderful things happen, not the least of which is to save Americans $500 billion a year, starting day one. That’s billion–with a “b.” America needs this information. That’s why we’re taking the tour.

The other motive behind the tour is to get people involved in activism. “We’re doing this because we care,” said Dr. Gene Uphoff, a retired family physician from Portland. “The time to demand single-payer in America is now. We may not get another opportunity for real change like this in our lifetime. Washington needs to hear all of us right now.”

Every move the Mad as Hell Doctors make will be videotaped, and then edited and uploaded to the Internet that same day. The uploaded segments will be promoted on social networking web sites such as Facebook, Twitter, YouTube, MySpace and elsewhere–giving Mad As Hell Doctors Tour followers the opportunity to follow their stories in real time.

The tour will end on September 30 in Washington, D.C. with a plan for thousands of cars to pull up for a protest in front of the White House, where the Mad As Hell Doctors hope to meet with President Barack Obama to discuss real healthcare reform.

“This is not a campaign,” the Mad As Hell Doctors said in a press release. “In campaigns, there are spectators. This is a movement. Everybody plays.”

These doctors are right–right to be mad, right that we need a real debate about health care, and right that it’s going to take a movement to win single-payer.

The Public Option: Doomed to Fail

The Nation
Letters
July 29, 2009

Regarding your editorial “Public Option Now!” (July 20/27): a public option won’t fix the mainstream Democrats’ flawed healthcare reform proposals. Only a single-payer reform would make universal, first dollar coverage affordable. It would save about $400 billion annually on bureaucracy and rein in costs over the long term through global budgeting and rational health planning.

Even a public plan option far more robust than anything on the table in Washington would forgo most of these savings, making comprehensive coverage unaffordable. While a public plan might cut into private insurers’ roughly $10 billion in yearly profits (which is why they hate it), that’s only 10 percent of their overhead. They spend much more tracking eligibility, collecting premiums, marketing to healthy (profitable) patients, demarketing to avoid the sick, and shifting costs to patients and providers. A competitive public plan couldn’t match the efficiency of Medicare, whose integration with Social Security allows automatic enrollment, disenrollment and premium collection.

Moreover, a hybrid plan would forgo hundreds of billions in administrative savings because hospitals and doctors would still have to maintain armies of administrators and billing clerks to joust with hundreds of insurers.

A kinder, gentler public plan would quickly fail in the healthcare marketplace. Insurers compete by not paying for care. Competition in health insurance is a race to the bottom, not the top. A public plan that did no marketing would soon be saddled with the sickest patients, whose high costs would overwhelm any administrative efficiencies and drive premiums to uncompetitive levels. Similarly, eschewing private insurers’ schemes that shift costs to patients and other payers would be a crippling competitive disadvantage. To survive, a public plan would have to imitate private plans’ bad behaviors.

A healthcare system dominated by private insurers cannot provide families with the affordable coverage they need. A public clone of private insurers won’t help.

David U. Himmelstein, MD
Steffie Woolhandler, MD, MPH
Sidney M. Wolfe, MD
Quentin Young, MD
Marcia Angell, MD

Cambridge, Mass.; Washington; Chicago

http://www.thenation.com/doc/20090817/letter

Focus on justice makes health solution obvious

By Paul DeMarco
Guest Columnist
The State (Columbia, S.C.)
Sept. 2, 2009

Although many have complained about the tenor of the current health care conversation, this is the way Americans have settled matters since the founding of the republic: Our national debates always have been more like full-throated arguments after a few beers than refined cocktail party dialogue.

When Americans disagree, hyperbolic claims come naturally and are greeted with cheers, groans, applause or derisive laughter — everything but surprise. But soon, very soon, if we are to get ourselves on the right track, we must quiet the nay-sayers and the fear-mongers and give the voices of wisdom the floor.

In previous times of crisis, the wisdom of our leaders has pointed us toward justice. We had President Lincoln to remind us of “the better angels of our nature,” President Kennedy to exhort us to put country above self and Dr. King to admonish us to “live together as brothers or perish together as fools.”

At its core, our health care debate is also about justice. Unlike most developed nations, we continue to treat health care as a commodity. We ration it (no nation has the resources to meet all its citizens’ health care needs), but we ration capriciously, by income and employment.

Ironically, the cure is right at our fingertips: Simply expand Medicare to all Americans. Canadians, who cover all their citizens with a system similar to our Medicare, point to it as a source of national pride. In the ’60s, they recognized that justice was the first principle to be addressed in health care; once they decided that no citizen should go without reasonable access to medical care, they were well-positioned to face the difficult but not insurmountable questions about what should be covered and how to pay for it. While it is clear that the Canadian system has its problems, there is little doubt that taken as a whole it is better for the average citizen. The Canadians achieve similar overall health outcomes as the United States while spending just over half what we spend.

Are there Canadian health horror stories? Certainly, but America has no lack of those herself. More to the point, anecdotes shouldn’t be the basis for health policy. The United States would have to address legitimate concerns such as waiting times and access to specialists if we adopted Medicare for all. But universal coverage will immediately improve the lot of the many hard-working small-business people with chronic diseases who are floundering without health insurance. My barber is a perfect example. He’s one of Main Street’s most solid citizens. His shop lights are already on when I drive by in the early morning, but he must rely on charity care because as an owner-operator, he can’t afford a health policy. His plight does not exist in Canada.

Americans are rightly skeptical of government and wary of our recent deficit spending. But the notion that publicly funded health care is a new and radical idea for us is nonsense. Medicare, Medicaid and the Veterans Administration are all federally funded single-payer systems that have been in place for decades.

U.S. Medicare alone covers 45 million people — 12 million more than the entire population of Canada. Some seniors are so comfortable with Medicare they seem to have forgotten it is publicly funded; at town meetings, they have argued against the public option as unacceptable government intrusion while at the same time singing the praises of Medicare. And although the empty claim that government-funded health care would be bloated, intrusive and inefficient has been repeated incessantly, the truth is that U.S. Medicare achieves satisfaction rates similar to private insurers while operating with roughly a third of their overhead.

President Obama has missed his opportunity to lead on this issue. Rather than framing the issue as one of justice and declaring it unacceptable for any American to go without decent health insurance, he has opted to placate the insurers, drug companies and for-profit hospitals whose focus on the bottom line has warped the system.

It’s hard to imagine that Dr. King would be satisfied with Obama’s half measures. Dr. King knew that justice often required bold action and sacrifice by the privileged. In the absence of a spokesman of his stature, the uninsured and we who stand with them must take up the mantle ourselves. Contact your representatives with the simple message: “I’m for Medicare for all.” Join Physicians for a National Health Program (anyone can join; you needn’t be a doctor). Fight for health care justice.

Dr. DeMarco, a Florence physician, is a member of Physicians for a National Health Program. Contact him at pvdemarco@bellsouth.net.

http://www.thestate.com/editorial-columns/story/925377.html

"Now Make Me Do It"

By Ralph Nader
CommonDreams.org
Published on Saturday, August 15, 2009

Never much of a fighter against abusive corporate power, Barack Obama is making it increasingly clear that right from his start as President, he wanted health insurance reform that received the approval of the giant drug and health insurance industries.

Earlier this year he started inviting top bosses of these companies for intimate confabs in the White House. Business Week magazine, which proclaimed recently that “The Health Insurers Have Already Won” reported that the CEO of UnitedHealth, Stephen J. Hemsley, met with the President half a dozen times.

These are the vendors. They and their campaign slush funds cannot be ignored in the power struggle over the legislation percolating in the Congress. One public result of these meetings was that the drug industry promised $80 billion in savings over ten years and the health insurance moguls promised $150 billion over the same decade. Mr. Obama trumpeted these declarations without indicating how these savings would be guaranteed, how the drug companies could navigate the antitrust laws and what was given to the health care industry by the White House in return.

We have now learned that one Obama promise was to continue the prohibition on Uncle Sam from bargaining for volume discounts on drugs that you the taxpayer have been paying for in the drug benefit program enacted in 2003.

Unknown is whether the health insurance companies were also promised continuation of Medicare Advantage with its 14% added taxpayer subsidy to induce the elderly to make the move out of public Medicare. Also unknown is whether the Medicare public option that Mr. Obama formerly espoused but since has wavered on has been put on the concession table.

The whole secret process is seedy and demonstrates cruel disregard for the millions of American who, whether in dire need of medical services or not, voted in “change we can believe in.”

By stark contrast, President Obama has never invited to the White House the leading consumer-patient champions in this country who favor full Medicare and free choice of physician and hospital-often called “a single payer” system. Open to the corporate barons who have failed decade after decade to deliver what patients need, the White House door is closed to the likes of Dr. Quentin Young-a founder of the Physicians for a National Health Program and an old Chicago friend of Obama’s, Dr. Sidney Wolfe, who heads Public Citizen’s Health Research Group, Drs. Marcia Angell, Stephanie Woolhandler, and David Himmelstein, who are nationally known and accomplished single payer advocates or Rose Ann DeMoro, executive director of the fast-growing California Nurses Association.

Mr. Obama even tried to exclude any advocate of a single payer system-previously favored by Obama and still favored by a majority of the American people, doctors and nurses-from his roundtable meetings convened to receive the views of different constituencies.

“Make me do it” was the advice of Franklin Delano Roosevelt to reformers when faced with legislation he desired but did not have the votes for in Congress. Mr. Obama is not exerting that plea for people power. Were he to do that, he would be encouraging daily public hearings in the Senate and the House on the bureaucratic waste, greed, overbilling, collusion, and fraud that many in the corporate world have inflicted with their costly, pay or die health care industry.

Such publicized hearings would keep him on the offensive. It would arouse the public and focus energies on the main problem-the corporatization of medicine. This commercialism has left tens of millions of people without health insurance, caused 20,000 fatalities a year, and cost Americans twice or more per capita than have full Medicare systems in western countries, which have better health outcomes than the U.S.

Further indication of Obama’s corporate dealings is that he never identified himself with a specific bill with a House and Senate number that he could rally the people around. No wonder people are confused, frustrated and angry. President Obama did not stand for an unambiguous proposal.

He thereby emboldened both the cash and carry Blue dog Democrats to rebel and the Republican yahoos to launch their lies and distortions via Rush Limbaugh and similar trash media.

Obama is about to make his biggest mistake to date by favoring the bipartisan deal his assistants are working out with Blue Dog Senator Max Baucus and his Republican counterparts on the Senate Finance Committee. This proposal has no public option, no consumer protections or restraints on the mayhem and skyrocketing charges of the so-called health care industry.

Already the less corporate-indentured bills being reported from the House Committee by Rep. Henry Waxman (D-CA) and his allies are getting short-shrift from a White House that clearly views the forthcoming Baucus-Grassley “compromise” as the “more practical” go-to legislation.

There is reliable word that the AFL-CIO will endorse whatever Obama approves, with the exceptions of the California Nurses Association and the Sheet Metal Workers’ union. The latter, through their president, Michael J. Sullivan, announced in late July that it was suspending all future campaign contributions to any candidate for Congress or the Presidency.

Already over sixty progressive members of the House, headed by Congresswoman Lynn Woolsey (D-CA) have declared opposition to these unacceptable compromises moving forward in both the House and the Senate.

So is gridlock around the corner? Will there be a health insurance reform of any stripe signed into law this year? It depends on the alliances that settle for the lowest corporate denominators being blocked by the unyielding principled stands of the progressives who want something that puts patients above the failed profiteering vendors.

The guess here is that Obama will sign anything which squirms through a cowardly Congress that cannot give to the American people in 2009 the health care system Congress stopped President Harry Truman from establishing in 1950.

It is up to the people of our country to “make him do it” whether this year or next. A mere one million immediate calls to members of Congress by one million assertive citizens will start sobering up these legislators who think they can get away with another sale of our public trust.

The Congressional switchboard is 202-224-3121. The full Medicare, single payer bill (backed by nearly ninety legislators) is H.R. 676. The go-to citizen group for your sustained engagement is singlepayeraction.org. The rest is up to you, the majority, who want to put the people first.

Ralph Nader is a consumer advocate, lawyer, and author. His most recent book is The Seventeen Traditions.

Paying for community health centers

Using Primary Care to Bend the Curve: Estimating the Impact of a Health Center Expansion on Health Care Costs

By Leighton Ku, PhD, MPH, Patrick Richard, PhD, Avi Dor, PhD, Ellen Tan, MSc, Peter Shin, PhD, MPH, Sara Rosenbaum, JD
The George Washington University
School of Public Health and Health Services
Geiger Gibson / RCHN Community Health Foundation Research Collaborative
September 1, 2009

This research brief, the third in a series examining the link between national health reform proposals and community health centers, estimates the cost savings that would be realized by making important investments in non-profit health centers as an element of national health reform.

These projected savings to the nationĆ¢ā‚¬ā„¢s health care costs become possible because of the insurance reforms on which they build, supplemented by a direct health center investment. Health insurance coverage expansions, coupled with investments in the nationĆ¢ā‚¬ā„¢s primary health care infrastructure, can spur high quality and sustainable primary health care in medically underserved rural, urban, and suburban communities, and help bend the curve of health care cost growth.

Under the health reform proposals, a large number of people will gain insurance coverage from the health insurance exchanges, which will primarily offer private plans (although the House bill also offers a public plan option). As reported earlier, private insurance plans tend to pay health centers considerably less than the actual costs of providing care at health centers; data from the 2007 Uniform Data System indicate that private insurance underpays by about 43 percent. One option under health reform would be to require plans offering care under the exchange to pay health centers according to the prospective payment system (PPS) used in both Medicaid and Medicare, which comes much closer to paying full costs. In 2007, Medicaid payments were about 15 percent below health centersĆ¢ā‚¬ā„¢ estimated costs.

As has been demonstrated by a number of studies, in addition to this one, health centers are a cost-effective means to furnish primary health care, which can lead to better health and lower health care expenditures. Investments in health centers can serve as a complement to health reform efforts to expand the number of people with health insurance, by ensuring that there is an increased availability of primary health care providers to serve the newly insured, as well as those who remain uninsured. This will be particularly important in medically underserved areas where there is already an insufficient supply of primary care providers. Thus, this is a case in which the national economic value of the investment is further enhanced by its ability to bring better health to the nationĆ¢ā‚¬ā„¢s most underserved communities.

http://www.gwumc.edu/sphhs/departments/healthpolicy/dhp_publications/pub_uploads/dhpPublication_61D685D5-5056-9D20-3DDB6CDE10382393.pdf

Comment:

By Don McCanne, MD

Regardless of what proposals for health care reform are adopted, it is essential that financing be included for non-profit community health centers in underserved rural, urban and suburban communities. Would these centers be better served by health insurance exchanges and their private plans, or by a public financing program?

Although the insurance industry whines that public plans would provide unfair competition because they pay less than private plans, what is the record with community health centers? Unfortunately, Medicaid does underpay – by about 14 percent below the health centers’ estimated costs. But the private plans, which the members of Congress are so diligently protecting, are underpaying by about 43 percent!

There are two financing considerations for community health centers: 1) capital investments to build and expand the facilities, and 2) operating expenses, including payment for health care services.

Capital investments can be authorized through various legislative efforts, including as a component of the current health care reform legislation. But such efforts tend to be sporadic and not always well aligned with need. In contrast, the single payer model separately budgets capital improvements, providing more coordinated capital allocations based on community need. It ensures a perpetual resource that is responsive to fluctuating needs.

For operating expenses, the thousands of private health plans each do whatever they can to avoid paying health care costs. Community health centers serving vulnerable populations do not have the clout to demand that their expenses be met by the private insurers. Medicaid, a chronically underfunded welfare program, comes much closer, but still falls short. In contrast, a single payer system is designed to pay for the legitimate costs of appropriate health care. The community health centers would be served much better by an improved Medicare-like plan that covers everyone.

Community health centers have strong bipartisan support. Now if only we could could get our legislators to agree on adopting an efficient and equitable system of financing the centers…

“Now Make Me Do It”

By Ralph Nader
CommonDreams.org
Published on Saturday, August 15, 2009

Never much of a fighter against abusive corporate power, Barack Obama is making it increasingly clear that right from his start as President, he wanted health insurance reform that received the approval of the giant drug and health insurance industries.

Earlier this year he started inviting top bosses of these companies for intimate confabs in the White House. Business Week magazine, which proclaimed recently that “The Health Insurers Have Already Won” reported that the CEO of UnitedHealth, Stephen J. Hemsley, met with the President half a dozen times.

These are the vendors. They and their campaign slush funds cannot be ignored in the power struggle over the legislation percolating in the Congress. One public result of these meetings was that the drug industry promised $80 billion in savings over ten years and the health insurance moguls promised $150 billion over the same decade. Mr. Obama trumpeted these declarations without indicating how these savings would be guaranteed, how the drug companies could navigate the antitrust laws and what was given to the health care industry by the White House in return.

We have now learned that one Obama promise was to continue the prohibition on Uncle Sam from bargaining for volume discounts on drugs that you the taxpayer have been paying for in the drug benefit program enacted in 2003.

Unknown is whether the health insurance companies were also promised continuation of Medicare Advantage with its 14% added taxpayer subsidy to induce the elderly to make the move out of public Medicare. Also unknown is whether the Medicare public option that Mr. Obama formerly espoused but since has wavered on has been put on the concession table.

The whole secret process is seedy and demonstrates cruel disregard for the millions of American who, whether in dire need of medical services or not, voted in “change we can believe in.”

By stark contrast, President Obama has never invited to the White House the leading consumer-patient champions in this country who favor full Medicare and free choice of physician and hospital-often called “a single payer” system. Open to the corporate barons who have failed decade after decade to deliver what patients need, the White House door is closed to the likes of Dr. Quentin Young-a founder of the Physicians for a National Health Program and an old Chicago friend of Obama’s, Dr. Sidney Wolfe, who heads Public Citizen’s Health Research Group, Drs. Marcia Angell, Stephanie Woolhandler, and David Himmelstein, who are nationally known and accomplished single payer advocates or Rose Ann DeMoro, executive director of the fast-growing California Nurses Association.

Mr. Obama even tried to exclude any advocate of a single payer system-previously favored by Obama and still favored by a majority of the American people, doctors and nurses-from his roundtable meetings convened to receive the views of different constituencies.

“Make me do it” was the advice of Franklin Delano Roosevelt to reformers when faced with legislation he desired but did not have the votes for in Congress. Mr. Obama is not exerting that plea for people power. Were he to do that, he would be encouraging daily public hearings in the Senate and the House on the bureaucratic waste, greed, overbilling, collusion, and fraud that many in the corporate world have inflicted with their costly, pay or die health care industry.

Such publicized hearings would keep him on the offensive. It would arouse the public and focus energies on the main problem-the corporatization of medicine. This commercialism has left tens of millions of people without health insurance, caused 20,000 fatalities a year, and cost Americans twice or more per capita than have full Medicare systems in western countries, which have better health outcomes than the U.S.

Further indication of Obama’s corporate dealings is that he never identified himself with a specific bill with a House and Senate number that he could rally the people around. No wonder people are confused, frustrated and angry. President Obama did not stand for an unambiguous proposal.

He thereby emboldened both the cash and carry Blue dog Democrats to rebel and the Republican yahoos to launch their lies and distortions via Rush Limbaugh and similar trash media.

Obama is about to make his biggest mistake to date by favoring the bipartisan deal his assistants are working out with Blue Dog Senator Max Baucus and his Republican counterparts on the Senate Finance Committee. This proposal has no public option, no consumer protections or restraints on the mayhem and skyrocketing charges of the so-called health care industry.

Already the less corporate-indentured bills being reported from the House Committee by Rep. Henry Waxman (D-CA) and his allies are getting short-shrift from a White House that clearly views the forthcoming Baucus-Grassley “compromise” as the “more practical” go-to legislation.

There is reliable word that the AFL-CIO will endorse whatever Obama approves, with the exceptions of the California Nurses Association and the Sheet Metal Workers’ union. The latter, through their president, Michael J. Sullivan, announced in late July that it was suspending all future campaign contributions to any candidate for Congress or the Presidency.

Already over sixty progressive members of the House, headed by Congresswoman Lynn Woolsey (D-CA) have declared opposition to these unacceptable compromises moving forward in both the House and the Senate.

So is gridlock around the corner? Will there be a health insurance reform of any stripe signed into law this year? It depends on the alliances that settle for the lowest corporate denominators being blocked by the unyielding principled stands of the progressives who want something that puts patients above the failed profiteering vendors.

The guess here is that Obama will sign anything which squirms through a cowardly Congress that cannot give to the American people in 2009 the health care system Congress stopped President Harry Truman from establishing in 1950.

It is up to the people of our country to “make him do it” whether this year or next. A mere one million immediate calls to members of Congress by one million assertive citizens will start sobering up these legislators who think they can get away with another sale of our public trust.

The Congressional switchboard is 202-224-3121. The full Medicare, single payer bill (backed by nearly ninety legislators) is H.R. 676. The go-to citizen group for your sustained engagement is singlepayeraction.org. The rest is up to you, the majority, who want to put the people first.

Ralph Nader is a consumer advocate, lawyer, and author. His most recent book is The Seventeen Traditions.

Over 2.2 million Californians have medical debt

Insured and in debt: Even with coverage Californians struggle to pay medical bills

UCLA Center for Health Policy Research
August 31, 2009
More than 2.2 million California adults report having medical debt.
1.4 million have medical debt despite having insurance.
Individuals with medical debt are twice as likely as those without debt to delay or forgo needed health care.
“That even insured people are forced to take on medical debt to pay for their health care is another glaring inadequacy in our current system of health insurance,” said E. Richard Brown, director of the UCLA Center for Health Policy Research and lead author of the report, “The State of Health Insurance in California.”
http://www.healthpolicy.ucla.edu/news_08312009.html
Full report (102 pages):
http://www.healthpolicy.ucla.edu/pubs/files/SHIC_RT_82009.pdf

Most individuals who are following health care reform are already aware of the fact that medical debt often contributes to personal bankruptcy, even for those who had been insured. This report adds to that data by demonstrating that medical debt is much more common than is reflected in the bankruptcy data, and is serious enough to have adverse consequences since it often results in individuals delaying or forgoing needed health care.
Two-thirds of Californians with medical debt were insured. The current proposal before Congress calls for a mandate to purchase private plans with very high premiums, with inadequate subsidies, and with an inadequate actuarial value which results in excessive out-of-pocket expenses. This flawed proposal would be a guarantee that medical debt and its adverse consequences shall remain a problem for far too many of us.
Members of Congress may feel that they have too much time and effort already invested in the current proposal to change course now. But that personal investment for a few hundred legislators is absolutely nothing compared to the impact that the legislation will have on the health care of over 307,000,000 of us. They need to start over – now – and do it right.

Over 2.2 million Californians have medical debt

Insured and in debt: Even with coverage Californians struggle to pay medical bills

UCLA Center for Health Policy Research
August 31, 2009

More than 2.2 million California adults report having medical debt.

1.4 million have medical debt despite having insurance.

Individuals with medical debt are twice as likely as those without debt to delay or forgo needed health care.

“That even insured people are forced to take on medical debt to pay for their health care is another glaring inadequacy in our current system of health insurance,” said E. Richard Brown, director of the UCLA Center for Health Policy Research and lead author of the report, “The State of Health Insurance in California.”

http://www.healthpolicy.ucla.edu/news_08312009.html

Full report (102 pages):
http://www.healthpolicy.ucla.edu/pubs/files/SHIC_RT_82009.pdf

Comment:

By Don McCanne, MD

Most individuals who are following health care reform are already aware of the fact that medical debt often contributes to personal bankruptcy, even for those who had been insured. This report adds to that data by demonstrating that medical debt is much more common than is reflected in the bankruptcy data, and is serious enough to have adverse consequences since it often results in individuals delaying or forgoing needed health care.

Two-thirds of Californians with medical debt were insured. The current proposal before Congress calls for a mandate to purchase private plans with very high premiums, with inadequate subsidies, and with an inadequate actuarial value which results in excessive out-of-pocket expenses. This flawed proposal would be a guarantee that medical debt and its adverse consequences shall remain a problem for far too many of us.

Members of Congress may feel that they have too much time and effort already invested in the current proposal to change course now. But that personal investment for a few hundred legislators is absolutely nothing compared to the impact that the legislation will have on the health care of over 307,000,000 of us. They need to start over – now – and do it right.

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Don McCanne, MD

(PNHP Senior Health Policy Fellow) Dr. McCanne is a family physician in San Clemente, California. For three decades, Dr. McCanne has allotted one-half of his practice hours to indigent patients. He has written extensively in the lay press on single payer and patient-oriented health care, often using the concept of ā€œUniversal Medicareā€ as a model for single payer that the public can understand and support.

Paul Y. Song, MD

Dr. Paul Song was most recently on the faculty of the Samuel Oschin Cancer Center at Cedars Sinai Medical Center and currently sees Medicaid and uninsured patients at Dignity California Hospital.

Dr. Song is the past President of Physicians for a National Health Program ā€“ California. He served as the co-chair of the Campaign for a Healthy California from 2017-2018 and was the very first visiting fellow on health care policy in the California Department of Insurance in 2013.

He is the chief operating officer/chief medical officer of NKMax America, Inc., a subsidiary of South Korean-based ATGen Global, where he oversees all translational research and clinical programs. He is also the chief medical officer of Hawkeye Bio.

Dr. Song graduated with honors from the University of Chicago and received his medical degree from George Washington University. He completed his residency in radiation oncology at the University of Chicago where he served as chief resident and completed a brachytherapy fellowship at the Institute Gustave Roussy in Villejuif, France. He was also awarded an ASTRO research fellowship in 1995 for his research in radiation-inducible gene therapy.

Dr. Song serves on the national board of Physicians for a National Health Program, Healthcare Now, and Progressive Democrats of America.

Ana Malinow, MD, MSHCPM, FAAP

Dr. Ana Malinow is a professor of pediatrics at the University of California-San Francisco. She was previously associate residency program director at Childrenā€™s Hospital of Pittsburgh of UPMC. Prior to moving to Pittsburgh, Dr. Malinow was associate professor of pediatrics at Baylor College of Medicine and attending physician in the pediatric emergency and ambulatory center at Ben Taub General Hospital, where most of her patients were uninsured. Dr. Malinow is the recipient of numerous teaching awards, including for grand rounds presentations on health care. She was named one of Houstonā€™s top female physicians by Health and Fitness Sports Magazine.

Born in Buenos Aires, Argentina, Dr. Malinow earned a bachelorā€™s degree from the University of California at Davis and a masterā€™s degree in creative writing before completing her medical education at Case Western Reserve University. She completed residency in pediatrics at Rainbow Babies and Childrenā€™s Hospital. She also holds a masterā€™s degree in health care policy and management from Carnegie Mellon University.

Dr. Malinow is a past president of Physicians for a National Health Program and co-founder of Health Care for all Texas, a grassroots organization that promotes single-payer national health insurance. She is also co-founder of Doctors for Change, an organization of health care professionals that organize for improved access to health care in Houston and Harris county.

Henry Abrons, MD, MPH

Dr. Abrons is a national board adviser to Physicians for a National Health Program and a past president of PNHP California. He is a retired physician specializing in Pulmonary and Critical Care Medicine. He has trained and worked in public hospitals in New York City, Chicago, West Virginia, and Oakland.

Kathleen Healey, MD

Dr. Kathleen Healey practiced as a board certified otolaryngologist in the Napa Valley for many years. She spent 10 years in the U.S. Navy, including two years as a flight surgeon, then started a private solo practice in St. Helena, CA. Her practice moved to Napa, CA, where she served as the first female Chief of Staff at Queen of the Valley Medical Center. She later joined Queen of the Valley Medical Associates as a practicing otolaryngologist and as medical director. Retired from clinical practice, Dr. Healey currently is the co-chair of the Napa County chapter of Physicians for a National Health Program, and co-chair of the state chapter, PNHP-CA.

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For more information, see www.madashelldoctors.com/

IT'S THE INSURANCE COMPANIES, STUPID!

Rules rein in Medicare Advantage marketing

By Tom Murphy
Associated Press
Regulators clamped down last fall on shady sales practices for privately run Medicare health insurance for the elderly.
But customers and advocate groups say the plans’ confusing nature still leaves room for pitches bordering on the deceptive, and abuses still crop up.
Medicare Advantage plans are privately run versions of the government’s Medicare program, which provides health coverage for the elderly and disabled. The government subsidizes these plans, and the industry has developed what can be a mind-numbing array of them.
Seniors report being pressured with unsolicited phone calls or home visits that are clearly prohibited. Some have signed up for plans that didn’t include their longtime doctors or hit them with unexpected costs, things they learn weeks later.
CMS learns every year about areas that need more vigilance, said Timothy Hill, deputy director for the Center for Drug and Health Plan Choice.
http://abcnews.go.com/Business/wireStory?id=8446040

And…

Some question private Medicare plans’ advantage

By Matt Sedensky
Associated Press
Seniors have flocked by the millions to Medicare Advantage, privately run plans offered as an alternative to traditional, government-run Medicare.
In the debate on overhauling the U.S. health care system, Advantage has been criticized as an example of a broken system that costs too much, confuses enrollees and suffers from a lack of oversight.
But even many backers acknowledge one of its toughest problems is few seniors understand the essential difference in private plans: Even services covered by traditional Medicare that doctors deem medically necessary routinely need the insurers’ advance approval and are sometimes denied.
Participants have been denied visits to specialists, rehabilitation to help them walk again and countless other services they’d be entitled to under traditional Medicare.
“Every decision is based on not what’s right for the patient, but what’s right for the bottom line,” said Dr. Michael Sedrish, who coordinates HMO payments for Medisys Health Network, which runs three New York City hospitals.
With basic Medicare, seniors generally know what sort of coverage they’re getting. That’s not the case with the roughly 7,000 Medicare Advantage plans, where one person’s coverage could be completely different from a next door neighbor’s.
A 2008 Government Accountability Office report found wide differences in enrollee costs depending on the plan, including home health service costs that could be up to 84 percent more than traditional Medicare.
“The plans tell them they have the same coverage,” said Delores Bowman, who handles calls to the Medicare Rights Center, “and they don’t.”
http://www.washingtonpost.com/wp-dyn/content/article/2009/08/29/AR2009082900957.html

What’s beautiful about the Medicare Advantage program is that it has provided us with a real-life laboratory experiment which allows us to compare the functioning of highly-regulated private insurance plans as contrasted with the functioning of a public insurance program: traditional Medicare. The results are in, though that would be tough to ascertain if you simply observe the response of Congress.
What have we learned? The private plans take away the choice of health care providers that the traditional public program offers. The private plans insert intrusive interventions between the patient and the physician – interventions that are not found in the public plans. Private plans divert more resources to excessive, wasteful administrative services while increasing the administrative burden on the health care providers and on the public stewards who must provide oversight of our tax dollars that are diverted to this industry. Private plans also provide more entry points for the criminal element to cheat the taxpayers, patients, and providers. And for this we are paying far more of our tax dollars than we do in the traditional Medicare program for comparable levels of care. The obvious lesson is that we should dump the private plans.
What has Congress learned? They have decided that we should provide more subsidies to the private plans so that they can expand their markets!? And they have apparently decided that we will not even have a genuine public plan because it would provide unfair competition to the private plans because of Medicare’s greater efficiency and lower costs!?
It is true that a fragmented, multi-payer system is much more expensive and much less equitable, leaving too many exposed to suffering and financial hardship. But our Medicare Advantage experiment has demonstrated that it is the private plans that must be jettisoned, and it is Medicare that must be granted to everyone after modest, appropriate reengineering so that it works even better than it does now.
We need to send this urgent message to Congress and the administration, immediately:
IT’S THE INSURANCE COMPANIES, STUPID!