PNHP

Poisoning thought with words

Poisoning thought with words

"American Values" -- A Smoke Screen in the Debate on Health Care Reform

By Allan S. Brett, M.D.
The New England Journal of Medicine
July 29, 2009

Amid all the rhetoric about health care reform, one claim has emerged as a trump card designed to preserve the current patchwork of private and public insurance and to stop discussion of a government-sponsored single-payer system in its tracks: the claim that single-payer health care — a Canadian-style Medicare-for-all system — is antithetical to “American values.” The idea that American values dictate a particular approach to health care reform is often stated explicitly, and it is implicit in the generalization that “Americans want” a particular system. The underlying premise is that an identifiable set of American values point incontrovertibly to a health care system anchored by the private insurance industry. Remarkably, this premise has received very little scrutiny.

Americans have been misled by the rhetoric about choice. In contrast with the single-payer option, a system with multiple private insurers would continue to restrict one dimension of choice (selection of physicians) and perpetuate a choice most people would consider irrational (wasteful spending on administrative overhead).

A closely related rhetorical device — the idea that Americans or American values are “unique” — also deserves attention… What is relevant is whether a solution works, not whether it is unique. Indeed, the aspect of the current U.S. system that is truly unique among developed countries is its failure to cover everyone — hardly something to brag about.

Policymakers debating health care reform should stop hiding behind the smoke screen of “American values.” Discussions dominated by references to uniquely American individualism, uniquely American solutions, or narrowly defined conceptions of choice tell us more about the political and economic interests of the discussants than about the interests of the Americans they claim to represent. In an increasingly diverse country that has a widening gap between rich and poor, a more promising approach is to start with the questions that matter to everyone: Will the system care for us when we’re sick and help prevent illness when we’re well? Will we have access to medical care throughout our lives without risking financial ruin? Will we be able to navigate the system easily, without jumping through unnecessary hoops or encountering excessive red tape? Will health care spending be managed wisely? Health care reformers owe Americans a system that best addresses these questions — not one that merely pays lip service to ill-defined “American values.”

http://healthcarereform.nejm.org/?p=1245

Comment:

By Don McCanne,

Click on the link above now. At the bottom of this article you will find another link to the full PDF version (2 pages). Download it now. It will be a very important resource during the August recess when tens of millions of dollars will be spent to keep our thought processes suppressed by the poisonous rhetoric of carefully-crafted nice words – a process that has permeated our national dialogue on health reform. It is ideas, not words, that count.

BREAKING NEWS: Speaker Pelosi promises floor vote on single payer

Liberals will get single-payer vote on House floor

By Mike Soraghan
The Hill
July 31, 2009

Seeking to dampen liberal anger about deals cut with centrists, Energy and Commerce Committee Chairman Henry Waxman (D-Calif.) said House leaders have agreed to allow a floor vote on a government-run, single-payer system.

“A lot of members on our committee want a vote on that,” said Waxman said in an interview. “I believe their wishes will be accommodated.”

Rep. Anthony Weiner (D-N.Y.) offered a single-payer amendment in the Energy and Commerce Committee on Friday, but withdrew it after Waxman said House Speaker Nancy Pelosi (D-Calif.) had promised a floor vote.

http://thehill.com/leading-the-news/liberals-will-get-single-payer-vote-on-house-floor-2009-07-31.html

The Weiner single payer amendment:
http://energycommerce.house.gov/Press_111/20090731/hr3200_weiner_1.pdf

Comment:

By Don McCanne, MD

Call out the troops. We have work to do!

Want more choice? Pick single-payer

By Ann Settgast and Elizabeth Frost
Opinion Pioneer Press (St. Paul, Minn.) 07/30/2009

The health care reform debate is reaching a feverish pitch. As physicians, we are troubled by the direction the debate has taken. Whether via a public option or a mandate to purchase insurance, the proposals on the table aim to cover more, but not all Americans. They build on the structure of our broken system — one that ranks as the most costly, fragmented and bureaucratic in the world.

President Barack Obama acknowledged in his national address last week that a single-payer system, because of automatic enrollment, is the only way to cover all Americans. We agree, and we encourage him to re-embrace this solution to the health care crisis. Single-payer is the only option that will actually work.

Mainstream media coverage of the health care debate is confusing. Conventional wisdom leads us to believe there are only two culprits responsible for skyrocketing costs — doctors and patients. Doctors order too many unnecessary tests, while patients demand too much care. As doctors, we acknowledge that overtreatment of patients guided by improper incentives occurs, and must be addressed.

There are also patients who overuse care. However, this problem is minuscule compared to well-documented underuse. In its most extreme form, this underuse leads to death for more than 18,000 Americans annually as revealed in a sobering 2002 Institute of Medicine report. Blaming doctors and blaming patients ignores the giant health care elephant in the room: private insurance.

Of every health care dollar spent in the United States, 31 cents is spent on administration (more than double that of other industrialized nations).

This enormous waste comes from our unique multi-payer financing structure based on private health insurance.

So we are wary of proposals that seek to simply expand private insurance. Such expansion may decrease our embarrassing numbers of uninsured, but it will not help the insecurely insured — a group to which we all belong, even those of us who “like what we have.”

Private insurance has been likened to an umbrella that melts in the rain. Consider the study released last month in the American Journal of Medicine revealing that 62 percent of all personal bankruptcies are related to medical bills. More astonishing is that 77 percent of Americans who go bankrupt due to medical bills had insurance when they became ill.

Because it is a business, private insurance has, at its core, the bottom line. In his recent testimony before a U.S. Senate committee, Wendell Potter, former head of communications at Cigna, reported, “Members of Congress and the public have good reason to question the honesty and trustworthiness of the insurance industry. Insurers make promises they have no intention of keeping.”

The only way to succeed in the insurance business is to selectively recruit healthy patients or to deny coverage to patients when they become sick. As professionals who strive to make sick people well, we find this model for our system illogical and fatally flawed.

Elimination of U.S.-style private insurance has been a prerequisite to achieving universal health care in every other industrialized nation. One must ask, “What if the rest of the world is right?” Only under single-payer can we eliminate the administrative waste spent on billing hundreds of payers and the sizeable overhead of the private insurance industry.

These overhead dollars are spent marketing, underwriting, lobbying and fighting claims — none of which makes our patients healthier. Elimination of this administrative waste would save more than $400 billion annually, enough to cover the uninsured and improve coverage for the remainder. There is enough money in the system. We do not need more money — we need a new system.

As physicians, we are obligated to use evidence-based medicine in our decision-making. The reform debate must be held to the same standard. Ample evidence, including studies by the Congressional Budget Office and the Government Accountability Office, have concluded single-payer can assure universal coverage while saving money.

For those who suggest we would lose choice under single-payer, we ask, choice of what? Choice of insurance plan — yes. Choice of doctor and hospital — no. A high-quality system is not one in which our patients choose their insurance plan, but one in which they choose their doctor.

Single-payer is the only reform option that actually expands choice.

Bringing private insurance or a public option to more Americans retains limited provider networks and restricted choice.

For those who say single-payer is socialized medicine and worry that government bureaucrats will suddenly begin making health care decisions, one only needs to remember that single-payer is publicly financed but privately delivered. Medical decisions should be made by patients and doctors alone.

Medicare is an example of a single-payer system.

For those who say competition among insurers is needed to keep costs down, we say the experiment must end. It has been tried, and it has failed.

While it is trendy to refer to patients as consumers who need to exercise more personal responsibility, we believe health care is a public good, not a commodity that can be bought and sold like a flat-screen TV.

For those who ask whether something is better than nothing (i.e., implementation of a public option), we again look at the evidence. Multiple states have tried to patch their systems with piecemeal reforms over the past two decades. None has produced universal coverage while controlling costs.

Given the magnitude of these difficult economic times, including a $1.8 trillion deficit for 2009 and rising unemployment, it is high time to reconsider the most fiscally conservative and financially sustainable option for reform.

Ann Settgast and Elizabeth Frost are primary-care physicians practicing in the Twin Cities. Gillian Schivone, a third-year medical student at the University of Minnesota, also contributed to this column. They serve on the steering committee of the Minnesota chapter of Physicians for a National Health Program (www.pnhp.org). Write to them by e-mail at pnhpminnesota@gmail.com. http://www.twincities.com/opinion/ci_12949586?nclick_check=1

Obama's former doctor critical of White House health care plan

From Jim Acosta
CNN
July 30, 2009

WASHINGTON (CNN) — President Obama often talks about all of the forces lining up against his health care plan. But there’s one critic who has remained relatively mum in the debate.

David Scheiner, a Chicago, Illinois-based doctor, has taken a hard look at the president’s prescription for health care reform and sees bad medicine.

“This isn’t that kind of health care program that I think is going to work,” he said.

So what makes Scheiner so special? He was Obama’s personal physician for 22 years, and voted for the former Illinois senator in the 2008 presidential election.

Scheiner thinks the president’s plan doesn’t go far enough.

“If I had to say the single one thing which is the worst part of it, is that private insurers continue to be a part of the health scheme,” he said. “Everybody keeps saying we don’t want the government getting involved in health care. [But] the government is involved in Medicare, and it works.”

Scheiner would rather see the nation adopt a single-payer system like the ones in Canada and Europe. The financing system relies on one “payer” — which could be a government-run agency — to fund all health care costs billed by doctors, hospitals and other health professionals.

The benefits, advocates say, is that pricey administrative costs are cut, resulting in large savings to patients.

It’s something that an up-and-coming coming state Sen. Obama talked about six years ago.

“I happen to be a proponent of a single-payer universal health care plan. … But as all of you know, we may not get there immediately, because first we’ve got to take back the White House, and we’ve got take back the Senate, and we’ve got to take back the House,” Obama said in 2003.

But that position evolved during the campaign.

“If I were designing a system from scratch, then I’d probably set up a single-payer system. But the problem is we’re not starting from scratch,” Obama said in Albuquerque, New Mexico, in August 2008.

Now, the president favors giving Americans the option of joining a government-run plan that would compete with private insurers. Video Watch more on the health care debate »

“Nobody is talking about some government takeover of health care. I’m tired of hearing that,” Obama said in Raleigh, North Carolina, on Thursday.

But Scheiner says that nobody has seen the details of that option, making it a hard sell for the president.

“We don’t even fully know what the public option is going to be. If the public option is too good, patients who are sick will flock to it, and I’m not sure it will be able to support itself.”

Scheiner almost had a chance to confront the president with his concerns. He was invited to a recent televised town hall meeting with Obama, but he says he was dropped from the program.

“I just hope that the Congress, the American public and the president will hear some of my words,” he said. “We’ve got to do something better.”
advertisement

Scheiner will finally get a chance to have his say Friday. He and other doctors who support a single-payer system are gathering in Washington to meet with lawmakers and rally supporters.

He may not be the president’s doctor anymore, but Scheiner says he’s trying to save the patient before it’s too late.

http://www.cnn.com/2009/POLITICS/07/30/obama.doctor/index.html

Obama’s former doctor critical of White House health care plan

From Jim Acosta
CNN
July 30, 2009

WASHINGTON (CNN) — President Obama often talks about all of the forces lining up against his health care plan. But there’s one critic who has remained relatively mum in the debate.

David Scheiner, a Chicago, Illinois-based doctor, has taken a hard look at the president’s prescription for health care reform and sees bad medicine.

“This isn’t that kind of health care program that I think is going to work,” he said.

So what makes Scheiner so special? He was Obama’s personal physician for 22 years, and voted for the former Illinois senator in the 2008 presidential election.

Scheiner thinks the president’s plan doesn’t go far enough.

“If I had to say the single one thing which is the worst part of it, is that private insurers continue to be a part of the health scheme,” he said. “Everybody keeps saying we don’t want the government getting involved in health care. [But] the government is involved in Medicare, and it works.”

Scheiner would rather see the nation adopt a single-payer system like the ones in Canada and Europe. The financing system relies on one “payer” — which could be a government-run agency — to fund all health care costs billed by doctors, hospitals and other health professionals.

The benefits, advocates say, is that pricey administrative costs are cut, resulting in large savings to patients.

It’s something that an up-and-coming coming state Sen. Obama talked about six years ago.

“I happen to be a proponent of a single-payer universal health care plan. … But as all of you know, we may not get there immediately, because first we’ve got to take back the White House, and we’ve got take back the Senate, and we’ve got to take back the House,” Obama said in 2003.

But that position evolved during the campaign.

“If I were designing a system from scratch, then I’d probably set up a single-payer system. But the problem is we’re not starting from scratch,” Obama said in Albuquerque, New Mexico, in August 2008.

Now, the president favors giving Americans the option of joining a government-run plan that would compete with private insurers. Video Watch more on the health care debate »

“Nobody is talking about some government takeover of health care. I’m tired of hearing that,” Obama said in Raleigh, North Carolina, on Thursday.

But Scheiner says that nobody has seen the details of that option, making it a hard sell for the president.

“We don’t even fully know what the public option is going to be. If the public option is too good, patients who are sick will flock to it, and I’m not sure it will be able to support itself.”

Scheiner almost had a chance to confront the president with his concerns. He was invited to a recent televised town hall meeting with Obama, but he says he was dropped from the program.

“I just hope that the Congress, the American public and the president will hear some of my words,” he said. “We’ve got to do something better.”
advertisement

Scheiner will finally get a chance to have his say Friday. He and other doctors who support a single-payer system are gathering in Washington to meet with lawmakers and rally supporters.

He may not be the president’s doctor anymore, but Scheiner says he’s trying to save the patient before it’s too late.

http://www.cnn.com/2009/POLITICS/07/30/obama.doctor/index.html

It's Medicare's 44th Birthday!

Dear Healthcare-NOW! Supporter:

Today, single-payer supporters from all over the country are celebrating the 44th birthday of one of the nation’s most popular public programs: Medicare.

On this anniversary of Medicare, we are calling for an end to a wasteful private health financing model based on earning profits through the restriction and denial of needed health care.

Take Action

It’s Medicare’s 44th Birthday! Call Congress today!

Tell them we want improved and expanded Medicare for all (national, single-payer healthcare).

Call the Capitol Switchboard at 866-338-1015.

This could be done through the passage of HR 676, “Expanded and Improved Medicare for All,” or S 703, “American Health Security Act.”

We need your help in telling members of Congress that the people want single-payer now.

Please, call your Senators and Representative today.

If you don’t know your Congress Members, or want to email them rather than call, go to www.VoteSmart.org. Otherwise, call the Capitol Switchboard at 866-338-1015.

Make these four requests:

1. If you haven’t, cosponsor single-payer legislation today. (HR 676 for Reps. and S. 703 for Senators)

2. Join Senators Schumer, Harkin, and Sanders in asking the CBO to score single-payer legislation. Past cost-benefit analyses (including from the CBO) reflect the cost neutrality of a single-payer system, and savings of healthcare dollars overall.

3. Vote for single-payer amendments to current legislation going through House and Senate committees. The grassroots movement is closely watching the outcomes of the votes on single-payer amendments. This will be documented and remembered in the midterm elections.

4. Refuse to accept campaign contributions from the healthcare industry and support publicly funded elections. The receipt of healthcare industry dollars is a conflict of interest as you vote on healthcare policy.

We are greatly concerned that the current legislation will not be universal, protect individuals from bankrupting medical bills, or guarantee needed healthcare to people. Even with proposed private insurance reform, the quality of coverage available will vary significantly depending on ability to pay, which is flagrantly discriminatory. Healthcare is not a product, it is a necessity, and all deserve equal access to care. In addition, there are no realistic cost-containment measures.

A single-payer system of publicly-financed and privately-delivered care solves all of these issues and provides true health security. It is the only proposal that is both socially and fiscally responsible.

Thanks for all that you do,

Healthcare-NOW! National Staff

It’s Medicare’s 44th Birthday!

Dear Healthcare-NOW! Supporter:

Today, single-payer supporters from all over the country are celebrating the 44th birthday of one of the nation’s most popular public programs: Medicare.

On this anniversary of Medicare, we are calling for an end to a wasteful private health financing model based on earning profits through the restriction and denial of needed health care.

Take Action

It’s Medicare’s 44th Birthday! Call Congress today!

Tell them we want improved and expanded Medicare for all (national, single-payer healthcare).

Call the Capitol Switchboard at 866-338-1015.

This could be done through the passage of HR 676, “Expanded and Improved Medicare for All,” or S 703, “American Health Security Act.”

We need your help in telling members of Congress that the people want single-payer now.

Please, call your Senators and Representative today.

If you don’t know your Congress Members, or want to email them rather than call, go to www.VoteSmart.org. Otherwise, call the Capitol Switchboard at 866-338-1015.

Make these four requests:

1. If you haven’t, cosponsor single-payer legislation today. (HR 676 for Reps. and S. 703 for Senators)

2. Join Senators Schumer, Harkin, and Sanders in asking the CBO to score single-payer legislation. Past cost-benefit analyses (including from the CBO) reflect the cost neutrality of a single-payer system, and savings of healthcare dollars overall.

3. Vote for single-payer amendments to current legislation going through House and Senate committees. The grassroots movement is closely watching the outcomes of the votes on single-payer amendments. This will be documented and remembered in the midterm elections.

4. Refuse to accept campaign contributions from the healthcare industry and support publicly funded elections. The receipt of healthcare industry dollars is a conflict of interest as you vote on healthcare policy.

We are greatly concerned that the current legislation will not be universal, protect individuals from bankrupting medical bills, or guarantee needed healthcare to people. Even with proposed private insurance reform, the quality of coverage available will vary significantly depending on ability to pay, which is flagrantly discriminatory. Healthcare is not a product, it is a necessity, and all deserve equal access to care. In addition, there are no realistic cost-containment measures.

A single-payer system of publicly-financed and privately-delivered care solves all of these issues and provides true health security. It is the only proposal that is both socially and fiscally responsible.

Thanks for all that you do,

Healthcare-NOW! National Staff

President Obama's hardship waivers

TIME’s Exclusive Interview with President Obama

By Karen Tumulty
TIME
July 29, 2009
Karen Tumulty: But some things have changed. I mean, for instance you were very much against an individual mandate. Could you describe how your thinking has evolved on this issue…
President Obama: I feel pretty good that I’ve been pretty consistent on this. The individual mandate is probably the one area where I basically changed my mind. The more deeply I got into the issue, the more I felt that the dangers of adverse selection justified us creating a system that shares responsibility, as long as we were actually making health insurance affordable and there was a hardship waiver for those who, even with generous subsidies, couldn’t afford it. And that remains my position.
Karen Tumulty: What about — you mentioned that subsidies have to be there. What’s — you’re hearing now — 300% [that the government would provide assistance to people earning up to 300% of poverty]. Is that enough? Is that really —
President Obama: Until I actually see the numbers, I don’t want to give a definitive answer on that. I do think that if we can figure out what is a fair, appropriate percentage of your income that you’re paying on health care, and peg it — peg subsidies so that it’s meeting that test, potentially with some regional variation then we’ll get it right. And I think that the committees are working on that. That’s the kind of detail that we had anticipated working through in conference. If it turns out that Congress just can’t get there and that’s the holdup, then we’ll give a very definitive idea of where we need to go on it.
http://www.time.com/time/politics/article/0,8599,1913410-1,00.html

Detail? Figuring out how to make insurance affordable if it is to protect families from the financial burden of the $16,771 already being spent on average for health care? 300 percent of poverty? 400 percent of poverty?
Play with the numbers all you want. Using the model of reform selected by the President and Congress automatically limits the total subsidies to an amount that will not increase the deficit in the federal budget. Even if the majority of employers continue to displace wage or salary increases in exchange for health benefits, the number of hardship waivers issued will have to be much larger than most are projecting. If employers finally bail out, the majority of us would require hardship waivers.
You don’t believe me? Do the numbers, starting with the amount of money they propose to spend on subsidies.

President Obama's hardship waivers

TIME's Exclusive Interview with President Obama

By Karen Tumulty
TIME
July 29, 2009

Karen Tumulty: But some things have changed. I mean, for instance you were very much against an individual mandate. Could you describe how your thinking has evolved on this issue…

President Obama: I feel pretty good that I’ve been pretty consistent on this. The individual mandate is probably the one area where I basically changed my mind. The more deeply I got into the issue, the more I felt that the dangers of adverse selection justified us creating a system that shares responsibility, as long as we were actually making health insurance affordable and there was a hardship waiver for those who, even with generous subsidies, couldn’t afford it. And that remains my position.

Karen Tumulty: What about — you mentioned that subsidies have to be there. What’s — you’re hearing now — 300% [that the government would provide assistance to people earning up to 300% of poverty]. Is that enough? Is that really —

President Obama: Until I actually see the numbers, I don’t want to give a definitive answer on that. I do think that if we can figure out what is a fair, appropriate percentage of your income that you’re paying on health care, and peg it — peg subsidies so that it’s meeting that test, potentially with some regional variation then we’ll get it right. And I think that the committees are working on that. That’s the kind of detail that we had anticipated working through in conference. If it turns out that Congress just can’t get there and that’s the holdup, then we’ll give a very definitive idea of where we need to go on it.

http://www.time.com/time/politics/article/0,8599,1913410-1,00.html

Comment:

By Don McCanne, MD

Detail? Figuring out how to make insurance affordable if it is to protect families from the financial burden of the $16,771 already being spent on average for health care? 300 percent of poverty? 400 percent of poverty?

Play with the numbers all you want. Using the model of reform selected by the President and Congress automatically limits the total subsidies to an amount that will not increase the deficit in the federal budget. Even if the majority of employers continue to displace wage or salary increases in exchange for health benefits, the number of hardship waivers issued will have to be much larger than most are projecting. If employers finally bail out, the majority of us would require hardship waivers.

You don’t believe me? Do the numbers, starting with the amount of money they propose to spend on subsidies.

Single-payer system cuts barriers to care

By Beth Cardosi
TheSunNews
Wed, Jul. 29, 2009

I’m a physician in South Carolina. I have firsthand experience regarding our broken, wasteful health care system.

On a daily basis I care for the uninsured who have no jobs (often because of layoffs or illness) and have no money or access to health care providers. These people often come to the emergency departments with minor issues that could be handled simply as an outpatient if there were a place for them to be treated, or they are seen with life-threatening illnesses because they couldn’t receive the proper treatment for their chronic illness (i.e. high blood pressure and diabetes) or couldn’t receive preventive care and now have untreatable cancer. These people show up where the care is the most expensive because they won’t get turned away.

But what I find happening more these days is that these numbers are growing. People often have jobs that don’t cover health care, or it’s too expensive for the small-business owner to afford (small businesses are paying twice what large businesses pay for the same coverage). People can’t afford their medications or even their co-payments for office visits if they are lucky enough to have insurance.

I believe America should join the rest of the developed world and provide a single-payer system. I left private practice because I spent hours doing paperwork for insurance companies, was on the phone trying to get tests paid for and had to change medications all the time because insurance would not pay for them. The amount of bureaucracy is nothing for patients with Medicare compared with private health insurance companies. Insurance companies have entire departments whose only function is to find ways to deny payment. Conversely, hospitals have entire departments trying to get paid from insurance companies – now that is a waste of precious resources. Nonmedical insurance company staff, not government, stand between the doctor and their patient’s care.

So, why are people afraid to change the health care system? Not only do people fear change (even in a dysfunctional system) but because media is bombarding them with how bad and expensive a public option or single-payer program would be. Who pays for those ads and funds our political leaders? The same companies who are making huge profits on the suffering of people – and I ask you: If our health care system is so great, why are we 17th in the world for infant mortality and 30th in the world for life expectancy?

I believe our health care system can be cured by taking the profit motive out of the system – like other countries do. This will make it affordable, cheaper and provide access for all. Imagine a country where you can get care without showing your insurance card first.

The writer lives in Myrtle Beach.

http://www.thesunnews.com/opinion/story/1001358.html