By Bill Boyarsky
Truthdig
Sept. 3, 2009

While the media are transfixed by all the screaming in town halls and on television, the real work of health care reform is being done in secret by congressional staff technocrats, government bureaucrats, health industry lobbyists and sometimes even a member of the Senate or House.

The controversy over the so-called public option is a prime example of what is happening. Under this arrangement, government health insurance plans are supposed to compete with those offered by private insurance companies, with the hope of forcing the private companies to lower prices and expand benefits. Advocates of this scheme offer it as an alternative to what’s known as universal medical care, Medicare for all or “single payer,” which would eliminate the role of insurance companies altogether in favor of a government-only plan. Many liberals say such far-reaching reform is unattainable. As a compromise, they support the public option.

The fight over the public option has occupied much of the media coverage, but left unsaid is the fact that weeks of behind-the-scenes negotiations have weakened the public option proposal to the point that it is hardly an option at all.

I discussed the matter with Rep. Dennis Kucinich, D-Ohio. Kucinich favors universal health insurance coverage, not the public option. So do I.

A health care reform bill was approved by the House Energy and Commerce Committee in July. Kucinich said that a final version–the real bill–is now being rewritten and will be presented to committee chairs and other leaders, who will bring the revised version to the House floor. “It’s happening now,” he said. “It’s being done by the leadership, and we [members of Congress] don’t know what’s going on.”

Kucinich is the author of an amendment to the House bill that would ease federal barriers to states wanting to enact universal care plans of their own. Legislators are engaged in such efforts in California, Colorado, Illinois, Minnesota, Montana, New Mexico, New York, Ohio, Pennsylvania and Washington. He told me it “was one of the few provisions in a badly flawed bill that could provide benefits.”

Kucinich suggested I read articles written by health insurance expert Kip Sullivan on the Web site of Physicians for a National Health Program, which advocates government-run universal health care. Sullivan, he said, has figured out the real story.

Sullivan writes that public option advocates once promised a program as far-reaching as Medicare but “now promote something entirely different. To make matters worse, they have not told the public they have backpedaled. The campaign for the ‘public option’ resembles the classic bait-and-switch scam: Tell your customers you’ve got one thing for sale, when in fact you are selling something very different.”

Sullivan documents how the public option has been watered down since Jacob Hacker, now a political science professor at the University of California at Berkeley, proposed it several years ago. Hacker first estimated that 129 million would be covered, drawn by its generous terms. But the public option plans now before Congress would cover no more than 10 million, Sullivan said. Reducing subsidies to low-income people has cut the number covered, while limits on private insurance benefits have been eased.

In addition, the public option would actually be run by insurance companies such as Blue Cross, acting as contractors for the federal government. What is everyone arguing over? Heads they win, tails they win.

Referring to a bill approved by the Senate Health, Education, Labor and Pension Committee, Sullivan writes that the language of these provisions is so complex “it requires at least two readings to understand it.” The language of this and the other bills is no doubt designed to be purposely incomprehensible to most lawmakers, who will receive the final bill only at the last moment. The bills certainly are not being written to be understood by the general public.

Another important issue being decided in private is what precisely will Americans get from the new plan. “What level of subsidies [will] be available to make coverage more affordable for people?” asked Drew Altman, president of the Henry J. Kaiser Family Foundation. “What kind of coverage will people receive, and will it meet the public’s expectations?”

Kucinich doesn’t like the secret process. Neither does a newspaper that seldom, if ever, agrees with him on anything: The Wall Street Journal. Noting that President Barack Obama has complained that critics have misrepresented him, the paper said, “Who’s to know what’s reality and what’s a myth when the public and Members of Congress aren’t able to read a bill that would restructure one-seventh of our economy.”

So far, the loser in this game of backroom politics is the consumer or, in this case, the patient. The winner is the medical care industry.

President Obama is scheduled to speak to Congress on Wednesday on the issue. He’ll have to assure the rest of us that we’ll be winners, too.

http://www.truthdig.com/report/item/20090903_dont_be_fooled_by_the_public_option/?ln

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

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

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.

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.