PNHP

Steve Burd’s magic elixir

Steve Burd’s magic elixir

How Safeway Is Cutting Health-Care Costs: Market-based solutions can reduce the national health-care bill by 40%

By Steven A. Burd, CEO of Safeway Inc.
The Wall Street Journal
June 12, 2009

As with most employers, Safeway’s employees pay a portion of their own health care through premiums, co-pays and deductibles. The big difference between Safeway and most employers is that we have pronounced differences in premiums that reflect each covered member’s behaviors. Our plan utilizes a provision in the 1996 Health Insurance Portability and Accountability Act that permits employers to differentiate premiums based on behaviors. Currently we are focused on tobacco usage, healthy weight, blood pressure and cholesterol levels.

Safeway’s Healthy Measures program is completely voluntary and currently covers 74% of the insured nonunion work force. Employees are tested for the four measures cited above and receive premium discounts off a “base level” premium for each test they pass. Data is collected by outside parties and not shared with company management. If they pass all four tests, annual premiums are reduced $780 for individuals and $1,560 for families.

During this four-year period, we have kept our per capita health-care costs flat (that includes both the employee and the employer portion), while most American companies’ costs have increased 38% over the same four years.

While comprehensive health-care reform needs to address a number of other key issues, we believe that personal responsibility and financial incentives are the path to a healthier America. By our calculation, if the nation had adopted our approach in 2005, the nation’s direct health-care bill would be $550 billion less than it is today.

http://online.wsj.com/article/SB124476804026308603.html

And…

Preventive health plan may prevent cost increases

By Victoria Colliver
San Francisco Chronicle
February 11, 2007

Safeway chief executive Steve Burd has turned into an evangelist of sorts, spreading the lower-cost, better-health gospel to other business executives around the country.

Starting in January 2006, Safeway began offering a new plan to its 30,000 nonunion employees.

The plan, administered by Cigna Corp., is the lowest-premium option for nonunion employees, but it comes with a high deductible. To encourage enrollment, Safeway offered the plan last year for 22 to 30 percent less than what employees were paying for Cigna’s preferred provider organization option.

The company said its program focuses more on rewards for good behavior than penalties for bad. For example, smokers who agreed to fill out the questionnaire and try to quit smoking saw no increase in their 2007 premiums.

Virtually all the savings generated in the program’s first year came from changing the plan design, Burd said. But even if the company manages to keep spending flat, Burd noted, Safeway will remain ahead of the trend.

http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2007/02/11/BUG02O20R81.DTL

And…

Mr. Burd Goes to Washington

By Kimberley A. Strassel
The Wall Street Journal
June 19, 2009

Mr. Burd explains that the “cure for today’s ills is simply removing the obstacles to a free health-care market.”

The Safeway plan has two main parts that work in tandem. The first involves giving employees a financial stake in the system. Safeway demolished the traditional PPOs and HMOs that encourage consumers to be cavalier about costs. The company deposits $1,000 each year into a “health reimbursement account,” which workers can use to pay for care. The next $1,000 in expenses is the employee’s responsibility. After that, employees pay 20% of costs up to a $4,000 maximum.

The second part of Safeway’s plan… Safeway’s “Healthy Measures” program, which is voluntary. Employees are tested for smoking, weight, blood pressure and cholesterol. Every area they “pass” results in a reduction in their premium, of as much as $1,560 for a family, a year.

When I ask Mr. Burd what he hopes to accomplish here, he is blunt that one goal is to prevent a “public option” that would only “piggyback on the experience of Medicare.” It’s a “Trojan Horse” that will steer people to government and ultimately squeeze out innovative programs like his.

He’s also working to ensure that any health-care bill contains provisions that would replicate or encourage Safeway’s success. That includes changing current law so that he can offer even steeper premium discounts for good behavior.

http://online.wsj.com/article/SB124536722522229323.html

And…

Just Rewards? Healthy Workers Might Get Bigger Insurance Breaks

By Mary Agnes Carey
Kaiser Health News
July 28, 2009

The discounts are being pushed by Steve Burd, the chief executive officer of Safeway Inc., who has met with several lawmakers on Capitol Hill and says that rewarding healthy behavior has helped keep his firm’s health care costs flat while other companies’ have skyrocketed.

Health care overhaul legislation passed by the Senate Health, Education, Labor and Pensions Committee would allow employers to increase those discounts to 30 percent and up to 50 percent if the secretaries of Labor, Health and Human Services and Treasury agree. A House proposal would allow employers to charge workers who participate in wellness programs 50 percent less than workers who don’t.

“If you give one person a discount, someone else is going to end up paying more,” said Paul Cotton, senior legislative representative, federal affairs, at AARP, one of more than 60 groups that’s fighting the provision. “So the people who aren’t able to change their behavior or participate in the program will end up paying more. Our fear is that premiums will become unaffordable for people who can’t change their behavior.”

By Safeway’s calculations, “if the nation had adopted our approach in 2005, the nation’s direct health-care bill would be $550 billion less than it is today,” Burd wrote in a June 12 op-ed in the Wall Street Journal. Critics of Burd’s data have said (that) has not been independently verified. A Safeway spokeswoman acknowledged that there has been no independent analysis, but “we were able to see savings clearly and immediately the first year we implemented the program.”

http://www.kaiserhealthnews.org/Stories/2009/July/28/Prevention.aspx

Comment:

By Don McCanne, MD

Safeway’s Steve Burd has been making the rounds in Washington and elsewhere claiming that his program would reduce our national health care bill by $550 billion, even though there is absolutely no verification of that.

So what is his program? It has two parts: 1) changing from traditional coverage to a high deductible plan with 20 percent coinsurance, and 2) premium reductions for better health.

Changing to consumer-directed high-deductible plans, with coinsurance replacing copays, reduces the amount that Safeway pays for its health benefit programs, but it does so by shifting more costs to the employees in out-of-pocket expenses, and by reducing the amount of health care received, no matter how beneficial. Since most health care spending is not subject to the negative impact of deductibles, the impact on our total national health spending would be negligible. So where is the $550 billion savings?

Reducing premiums for healthier employees automatically results in higher premiums for employees with health problems who are in the same risk pool. Hypertension, hypercholesterolemia, and a higher body mass index are problems that are much more complex than simple lifestyle choices. Health insurance is already unaffordable for the majority of us, and pushing premiums higher for those who have have greater health care needs is unsound policy, assuming that our goal is affordable health care for everyone.

Even if financial incentives were capable of reversing hypertension, hypercholesterolemia, and obesity, it would take many years – decades – to see a benefit in the form of lower national health care spending. Steve Burd’s claim that he has dramatically reduced costs in just a couple of years by shifting more out-of-pocket expenses to the less healthy employees is a crock!

Let’s say it like it is. When Steve Burd says that his program would save the nation $550 billion, he is lying. And he needs to be called on it.

His primary goal is to convince Congress that it needs to block the public option. The Senate Finance Committee decided this week that the reform bill will exclude the public option. Score one for Burd.

His other goal is to take care of his lower-cost healthy employees while punishing those with health care problems. Both the Senate HELP bill and the House Tri-Committee bill would shift even more of the premiums from the healthy to those with health problems than has Burd with his Safeway program. Score two for Burd!

It’s seems like a waste of time to even talk about Burd’s dishonest bull. But we have to, because Congress is converting his bull into our policy. At the same time, Congress is pushing aside the policies that would enable all of us to have affordable access to health care.

I only wish my anger were more contagious. The nation needs a massive epidemic of anger right now.

Diagnosing Proposals for Healthcare Reform

Click here to watch the interview.

Bill Moyers sits down with Trudy Lieberman, director of the health and medical reporting program at the CUNY Graduate School of Journalism, and Marcia Angell, senior lecturer in social medicine at Harvard Medical School and former editor in chief of the New England Journal of Medicine

Transcript

BILL MOYERS: Welcome to the Journal.

Push finally came to shove in Washington this week as the battle over health care reform escalated from scattered sniper fire into all-out combat.

REP. STEVE KING: Socialized medicine produces rationing of care

PRESIDENT BARACK OBAMA: One of the plans that we’ve talked about is a public option

MALE REPORTER: You’ve been pushing Congress to pass health care reform by August. Why the rush?

MICHAEL STEELE: $239 billion to the deficit by 2019.

REP. LOUISE GOHMERT: We’re talking about a nightmare for the American people.

KATIE COURIC: It’s not going to add to the deficit?

PRESIDENT BARACK OBAMA: It will not add to the deficit

REP. LOUISE GOHMERT: It is insane

BILL MOYERS: If this all seems to be getting more and more confusing, well join the club. It’s hard to see what’s happening through all the gunsmoke.

The Republicans have more than health care reform in their bomb sights — they want a loss for Obama so crushing it will bring the administration to its knees and restore Republican control of Congress after next year’s elections. In the words of Republican Senator Jim DeMint, “If we’re able to stop Obama on this, it will be his Waterloo. It will break him.”

The Waterloo of DeMint’s metaphor, of course, was the battle in 1815 that ended Napoleon Bonaparte’s rule as Emperor of France — a humiliating defeat and a turning point in European history. Right-wingers like Glenn Beck see Obama as Napoleon, an emperor who must be stopped.

GLENN BECK: I mean, this guy is practically an imperial president now. When he starts to lose and people start to question him and push him back against the wall, he’s not going to know how to react.”

BILL MOYERS: The Republican strategy is almost identical to the way they turned health care into Waterloo for Bill and Hillary Clinton in 1993.

HARRY: Find more you like in the President’s plan?

LOUISE: Yeah.

HARRY: And?

LOUISE: It just doesn’t have the choice we want. Look at this.

BILL MOYERS:Back then, one of their chief propagandists, William Kristol, urged his party to block any health care plan for fear Democrats would be seen as, quote “…the generous protector of middle-class interests.” Now he’s telling the G.O.P. to “Go for the kill…throw the kitchen sink [at it]…drive a stake through its heart… we need to start over.”

So in lockstep are the Republicans that when strategist Alex Castellanos issued a memo on the battle plan, party chairman Michael Steele echoed it word for word in a speech at Washington’s National Press Club.

Castellanos: “Slow down, Mr. President. We can’t afford to get health care wrong.”

MICHAEL STEELE: “Slow down, Mr. President. We can’t afford to get health care wrong.”

BILL MOYERS: Castellanos: “The old, top-down Washington-centered system the Democrats propose will empower Washington to restrict the cures and treatments your doctor can prescribe for you.”

MICHAEL STEELE: “The old top-down Washington-centered system the Democrats propose is designed to grow Washington’s power to restrict the cures and treatments your doctor can prescribe for you.”

BILL MOYERS: Castellanos: “President Obama is experimenting with America, too much, too soon, and too fast.”

MICHAEL STEELE: Your experiment promotes — proposes too much, too soon, too fast.

BILL MOYERS: As the Republicans fired away, big business stepped up the attack, too, their lobbying and advertising guns blazing. In certain key states where members of Congress remain on the fence, the airwaves are vibrating with television commercials aimed at shifting hearts and minds away from any change that might threaten profits.

[ADVERTISEMENT SOT]: What will happen to your family’s health care if Washington runs it?

[ADVERTISEMENT SOT]: Now Washington wants to bring Canadian-style health care to the US.

BILL MOYERS: President Obama rejected the Republicans’ Waterloo metaphor, but mounted a massive media counteroffensive of his own.

PRESIDENT BARACK OBAMA: Another Republican senator, that defeating health care reform is about breaking me. So let me be clear. This isn’t about me.

I have great health insurance, and so does every member of Congress. This debate is about the letters I read when I sit in the Oval Office every day, and the stories I hear at town hall meetings… I’m the President. And I think this has to get done.

BILL MOYERS: But the President’s already stepped on booby traps of his own making, and minefields laid by his own party, especially when the Congressional Budget Office reported that his reforms, instead of controlling costs, would send the national debt further into the stratosphere.

Meanwhile, supporters who want to scrap the present system for fundamental change are staring glumly through the fog of war at a battlefield in total disarray. They fear that in the White House’s desire to get a bill — any bill — passed by Congress, it will have been so compromised, so bent to favor the big interests, that it will be less Waterloo than water down, a steady diluting of what they’d hoped for, or America needs.

The big drug companies are already so pleased with what they’ve been promised that they’ve brought back Harry and Louise — the make-believe TV couple who helped take down the Clinton health care plan.

LOUISE: Because everyday more and more people are finding out that they can’t afford healthcare.

BILL MOYERS: But this time they’re in favor of reform…

LOUISE: Coverage people can afford. Coverage they can get…

BILL MOYERS: Could it be that Harry and Louise are happier because this time, they’re in on the deal?

What to make of all this? I’ve asked two expert analysts of health care to help me out.

Trudy Lieberman covers health care reform for the Columbia Journalism Review and directs the health and medicine reporting program at the City University of New York’s Graduate School of
Journalism.

Marcia Angell, a physician herself, is Senior Lecturer in the Department of Social Medicine at Harvard University Medical School and was the first woman Editor-in-Chief of the New England Journal of Medicine. She, too, has written widely and often about health care reform.

Welcome to both of you.

MARCIA ANGELL: Thank you.

TRUDY LIEBERMAN: Thank you.

BILL MOYERS: So, Trudy Lieberman, is it Waterloo or no Waterloo, is that the question?

TRUDY LIEBERMAN: Waterloo for who? Whether it’s a Waterloo for the American people, who aren’t going to or may not get a resolution of this, and they certainly do need some help along the way with health care. Or is it, say, a political question for the President?

BILL MOYERS: Well, the Republicans have made it this week, clearly and sharply, a political challenge to him.

TRUDY LIEBERMAN: I think it’s going to be interesting to see what happens. A lot of people have said this is a do or die issue for the President. That’s certainly— that rhetoric certainly hadn’t been coming up really before the last several weeks.

MARCIA ANGELL: And I would say, on the politics first, that it is something of a Waterloo. In the sense that if he doesn’t get it right he’s going to be President for three more years. And the chickens will come home to roost.

BILL MOYERS: How so?

MARCIA ANGELL: So— well, it can— the failure can show up before he’s out the door. And then he’s got a real problem. He was right in his press conference, when he talked about cost as the central issue. And he said, if we don’t control cost, not only will the health system continue to disintegrate, but it’ll drag the whole economy down with it.

What he has essentially advocated is throwing more money into the current system. He’s treating the symptom and he’s not treating the underlying cause of our problem. Our problem is that we spend two and a half times as much per person on health care as other advanced countries, the average of other advanced countries. And we don’t get our money’s worth. So, now he says, okay, this is a terribly inefficient, wasteful system. Let’s throw some money into it.

BILL MOYERS: Into the same system?

MARCIA ANGELL: Into the same system. That’s his problem. The other problem, in the press conference, was that he was trying to mobilize public support for a bill, and we don’t know what that bill is.

TRUDY LIEBERMAN: I want to get to that point, because he’s been vague right from the very beginning on this point. We have not known exactly what the Obama health plan has been. Even though the headline writers, and the press has been talking about his health care overhaul for months. And so, I like to step back and say, “Well, what exactly is he talking about? What exactly does he mean?” And he has not been clear on that.

BILL MOYERS: You said he’s been AWOL, AW-O-L-

TRUDY LIEBERMAN: Yes.

BILL MOYERS: —on details.

TRUDY LIEBERMAN: He has been out to lunch on this. And I think that’s a deliberate strategy on the part of the White House.

MARCIA ANGELL: Yes.

TRUDY LIEBERMAN: What they had done is learn from what they call the Clinton mistakes in ‘93-’94. And what happened then is that Hillary came out with this big 1 thousand-page bill, although we have now another 1 thousand-page bill. And let the special interest groups sort of pick it apart. This time, they decided not to do that. That they would be deliberately vague about this. And stay as vague as they could be until push came to shove.

And so basically, it’s my belief that this whole discussion about health care reform is flying over the heads of the American people. They know about reform, but they don’t know— they know the words reform, but they don’t know what they mean at all.

BILL MOYERS: I had the same reaction you did to that press conference. And I woke up Thursday morning after the press conference, to the headline of “The New York Times” that read, “President Seeks Public Support On Health Care.” And in the margin of the Times I said, “Does the public know what is in this health care—”

MARCIA ANGELL: He doesn’t know. Nobody knows. One thing we—

BILL MOYERS: Well, somebody has to know. They keep talking about it.

MARCIA ANGELL: Well, he says, let Congress do it. In their wisdom, they’ll come out with something, and I will give you a few feel-good principles. And then we’ll wait and see what happens. Because he doesn’t want his fingerprints on it if it fails.

TRUDY LIEBERMAN: I feel the American people need to know what is in that bill. And what’s in the bill is an individual mandate that is going to require all Americans with a few exceptions, to carry health insurance. And that means if you do not get insurance from Medicare or Medicaid or your employer. You’re going to have to go out and buy health insurance.

And that is a lot of money for most people because most of them would buy it now if they could afford it. About 85 percent of the uninsured require subsidies, because they can’t afford it. And I think this is going to come up as a big surprise to people to realize they’re going to have to buy insurance from private insurance companies or face a tax penalty.

MARCIA ANGELL: Well, that goes to the cause of the problem. We are the only advanced country in the world that has chosen to leave health care to the tender mercies of a panoply of for-profit businesses, whose purpose is to maximize income and not to provide health. And that’s exactly what they do.

BILL MOYERS: The President, as you were saying a moment ago, is saying to everybody who’s not covered, we’re going to mandate that you exercise that right. We’re going to mandate that you buy some form—

MARCIA ANGELL: We’re going to deliver the private insurance companies a captive market. That’s right. And they love that.

BILL MOYERS: Say that again.

MARCIA ANGELL: They love that.

BILL MOYERS: The— his policy does what? His program?

MARCIA ANGELL: Delivers to the private insurance industry a captive market.

BILL MOYERS: By the mandate.

MARCIA ANGELL: By the mandate.

BILL MOYERS: It says “Marcia Angell, you’ve got to—”

MARCIA ANGELL: For whatever price they want to charge. Right. And so, this will increase costs. And let me tell you what he’s running into, and he’d like to be able to pull a rabbit out
of the hat, but he won’t be able to. If you leave this profit-oriented system in place, you can’t both control costs and increase coverage. You inevitably, if you try to increase coverage, increase costs. The only answer, the only answer, and he said it at the beginning of his press conference, is a single payer system. In his first sentence, he said, that is the only way to cover everyone.

BILL MOYERS: But he’s also said, if we were starting the system from scratch, we could have single payer. But we’re not starting this system from scratch.

MARCIA ANGELL: You know, you don’t pour more money into a failing system. You convert.

BILL MOYERS: I saw back in the spring— the chief lobbyist for the Big Pharma industry, Billy Tauzin, used to be a member of Congress. He was on CNBC. And he was in support of this bill, whatever this bill is. Because it would broaden the industry’s customer base by providing subsidies for people to buy—

MARCIA ANGELL: Exactly.

BILL MOYERS: More coverage from the private insurers.

TRUDY LIEBERMAN: At whatever price they want to charge. It will be a bonanza for the health insurance industry. And a bonanza for the pharmaceutical industry. And for the doctors, too. Because the doctors are going to get more paying patients, because people will now have this ticket, this insurance card, that they can whip out when they need medical services.

BILL MOYERS: So, does this explain why Harry and Louise, who were around 15 years ago to help defeat Bill Clinton’s health plan, Bill and Hillary Clinton’s health plan, are back now in support? Seemingly to be in support?

MARCIA ANGELL: You bet it does. You bet it does.

BILL MOYERS: Let me show you the commercials that’s been running now, watch closely.

HARRY: Well, it looks like we may finally get health care reform.

LOUISE: It’s about time. Because everyday more and more people are finding they can’t afford health care.

HARRY: Or they’re losing coverage?

LOUISE: We need good coverage people can afford. Coverage they can get—

HARRY: Even if they have a pre-existing condition.

LOUISE: And coverage they can keep if they change jobs.

HARRY: Or lose their jobs. Sounds simple enough.

LOUISE: A little more cooperation, a little less politics. We can get the job done this time.

BILL MOYERS: Wouldn’t that make you think that Big Pharma is supporting health care reform?

TRUDY LIEBERMAN: That’s exactly—

MARCIA ANGELL: Yes, yes.

TRUDY LIEBERMAN: That’s what they’re supposed to be—

BILL MOYERS: But on their terms, right?

MARCIA ANGELL: On their terms. Exactly. Exactly.

TRUDY LIEBERMAN: This is what those ads are supposed to do. They’re supposed to make the ordinary person believe that they’re good guys this time around.

BILL MOYERS: And on their terms means what for them?

MARCIA ANGELL: Well, they can charge whatever they want. That there will be no bargaining. That—

TRUDY LIEBERMAN: Medicare.

MARCIA ANGELL: That Medicare Part D will not bargain for lower prices. There’ll be no formularies. You know, even this thing about the pharmaceutical industry is going to kick in $80 billion over ten—

BILL MOYERS: Have we heard—

MARCIA ANGELL: —years. That the President mentioned in the press conference.

TRUDY LIEBERMAN: Only if health care passes. So.

MARCIA ANGELL: First this is $8 billion a year for the pharmaceutical industry. This is chump change. And second, it’s only for brand-name drugs. So, in a sense, it’s a subsidy for the most expensive drugs.

BILL MOYERS: Do you believe the health care industry when it tells President Obama that “we will voluntarily cut costs”?

MARCIA ANGELL: No. I mean, these are investor owned businesses. If they behave like charities, heads would roll in the executive suites. They are there to maximize profits. And that’s exactly what they do.

TRUDY LIEBERMAN: What’s happened now is that the industries have gotten pretty much what they want out of the bills that are going forward.

And so, they need to build public support. They need to make everybody in the public realize that they actually are wearing white hats in this one. But behind the scenes, they are lobbying ferociously against the public plan, against cuts in doctors fees, against all kinds of things that they don’t want. And for that they’re using a different sort of lobbying tactic. All of these are communications or lobbying strategies that they know how to do and they are very excellent at doing them.

MARCIA ANGELL: It’s clear that they can turn it to their advantage.

TRUDY LIEBERMAN: Right.

MARCIA ANGELL: That nobody is really trying to break their— except the single payer people — their death grip on the system. And here you have hundreds of for profit insurance companies that maximize their income by denying care to the people who need it most. And that’s the insurance system. That’s how we pay for health care.

But you also have to look at how we deliver health care. And we deliver that, primarily or largely, in for-profit facilities — businesses, hospitals — whose interest is in delivering only profitable care. So, we have a system that’s through and through, in both the payment system and the delivery system, is oriented toward profits. Neither the Senate nor the House is doing anything to change that.

BILL MOYERS: The President says there will be a public option in my bill that will compete with the private insurance. To bring the cost down.

TRUDY LIEBERMAN: That’s—

BILL MOYERS: That’s what he said.

TRUDY LIEBERMAN: That’s what he says. Again, we get back to the detail question and the particulars, which are so absent in this whole discussion. We don’t know what a public plan will look like. And even if there’s going to be a public plan. The insurers don’t want it. It’s not clear that the doctors want it. And the pharmaceutical companies don’t want it.

So my question is, are they working behind the scenes to make sure this doesn’t happen? My guess is— my answer is, they proba
bly are.

MARCIA ANGELL: A lot is said about how the public wants to cling to what it has. What I’m finding is something that confirms the polls that have been done. Showing that something like two-thirds of the public would favor a Canadian style or a Medicare for all style single payer system.

The same is true of physicians, now. About 60 percent of physicians favor Medicare for all, or a single payer system. So, what is against it? The pharmaceutical and the insurance industries are the biggest lobbies in Washington. They spend millions and millions on influential members of Congress. And the amount that they are spending now to the Chairman of the relevant health committees has increased enormously in the past few months.

BILL MOYERS: Just the other day the Chamber of Commerce began running an advertising campaign. And the Chamber says a new government run plan will undermine employer sponsored coverage and eventually lead to a government takeover of the health care system.

MARCIA ANGELL: Like Medicare.

BILL MOYERS: Alright. That will limit—

MARCIA ANGELL: That’s scary.

BILL MOYERS: That will limit patients’ choices. I mean, isn’t that proving to be a convincing argument with the public? That seems to be—

MARCIA ANGELL: Well, it’s phony, of course.

BILL MOYERS: Phony?

MARCIA ANGELL: It’s phony, in the sense that Medicare is a single payer system, embedded within our larger market-based system. You have totally free choice of a physician in Medicare. You don’t in most employer-sponsored private plans. Canada, totally free choice of doctors. So, this is simply not true.

BILL MOYERS: Let me show you both a couple of clips from the House floor recently. And get your comments on them. These are two Congressmen who are opposed to any kind of national insurance or general coverage. Look at this.

REP. STEVE KING: They’re going to save money by rationing care, getting you in a long line, places like Canada and the United Kingdom and Europe. People die when they’re in line.

REP LOUIE GOHMERT: One in five people have to die because they went to socialized medicine! Now I’ve got three daughters and a wife. I would hate to think that among five women, one of them is going to die because we go to socialized care and we have to have these long lists to get a mammogram. Once you find it to get treatment. It’s insane.

TRUDY LIEBERMAN: We’ve heard these arguments since 1948. And what amazes me — they opposed a national health system under President Truman. So, that notion, that conventional wisdom in America is pretty ingrained and pretty deep. What they fail to say here is that people are waiting in line in

John Geyman's "The Cancer Generation"

The Cancer Generation: Baby Boomers Facing a Perfect Storm

by John Geyman
Common Courage Press
You can be sure that cancer will be a part of your life. You’ll either get it – nearly half of all men and more than a third of women will. Or you’ll have a close friend who gets it, or be the child of someone who gets it, or the spouse of someone who has it, or in the worst case scenario, be the parent of a child struggling with cancer. You cannot help but stand on the battlefield of the war against cancer. How America wages this war is leaving an indelible mark on your life.
Cancer is now on track to replace heart disease as America’s leading cause of death within the next few years. This is a fight we have to win. Are we winning? And if we are off target, what changes are imperative for victory? Everything we discuss here focuses on these two questions.
So What Will Happen?
Lives hang in the balance on the answer to this question. The future down our current path is crystal clear – and devastating. Deregulated markets and the corrosive effects of profits over service over many years have brought U.S. health care to a crisis point. Because of soaring costs, patients with cancer are finding effective care increasingly unaffordable. Health care has entered a perfect storm, and it is certain to get much worse without real reform. Our primary care infrastructure is collapsing. ERs are overwhelmed, the ranks of the unemployed are rising quickly, adding to the numbers of uninsured. The economy has tanked, the federal deficit is massive, many states are forced to cut Medicaid to the bone, and our presumed safety net is falling apart.
Meanwhile, market stakeholders increase their efforts to maintain the status quo. The private insurance industry calls for the government to change tax policy and keep the subsidies flowing so that insurers can continue to rake off their profits from the system while offloading sicker and lower-income patients onto public programs.
http://www.commoncouragepress.com/index.cfm?action=book&bookid=398

No topic could serve as a better proxy for the deficiencies in the financing and delivery of health care in the United States than the ever increasing prevalence and expense of cancer. In The Cancer Generation, John Geyman describes the tragic and costly impact of the cancer burden, but then provides us with hope by describing a plan that would reduce these burdens of cancer.
His eight-point plan for one-tier cancer care stresses not only the importance of single payer national health insurance, Medicare for all, but also describes the great power that our own public national health program would have to strengthen our health care system, enabling everyone to have affordable access to high-quality cancer care if and when needed.

John Geyman's "The Cancer Generation"

The Cancer Generation: Baby Boomers Facing a Perfect Storm

by John Geyman
Common Courage Press

You can be sure that cancer will be a part of your life. You’ll either get it – nearly half of all men and more than a third of women will. Or you’ll have a close friend who gets it, or be the child of someone who gets it, or the spouse of someone who has it, or in the worst case scenario, be the parent of a child struggling with cancer. You cannot help but stand on the battlefield of the war against cancer. How America wages this war is leaving an indelible mark on your life.

Cancer is now on track to replace heart disease as America’s leading cause of death within the next few years. This is a fight we have to win. Are we winning? And if we are off target, what changes are imperative for victory? Everything we discuss here focuses on these two questions.

So What Will Happen?

Lives hang in the balance on the answer to this question. The future down our current path is crystal clear – and devastating. Deregulated markets and the corrosive effects of profits over service over many years have brought U.S. health care to a crisis point. Because of soaring costs, patients with cancer are finding effective care increasingly unaffordable. Health care has entered a perfect storm, and it is certain to get much worse without real reform. Our primary care infrastructure is collapsing. ERs are overwhelmed, the ranks of the unemployed are rising quickly, adding to the numbers of uninsured. The economy has tanked, the federal deficit is massive, many states are forced to cut Medicaid to the bone, and our presumed safety net is falling apart.

Meanwhile, market stakeholders increase their efforts to maintain the status quo. The private insurance industry calls for the government to change tax policy and keep the subsidies flowing so that insurers can continue to rake off their profits from the system while offloading sicker and lower-income patients onto public programs.

http://www.commoncouragepress.com/index.cfm?action=book&bookid=398

Comment:

By Don McCanne, MD

No topic could serve as a better proxy for the deficiencies in the financing and delivery of health care in the United States than the ever increasing prevalence and expense of cancer. In The Cancer Generation, John Geyman describes the tragic and costly impact of the cancer burden, but then provides us with hope by describing a plan that would reduce these burdens of cancer.

His eight-point plan for one-tier cancer care stresses not only the importance of single payer national health insurance, Medicare for all, but also describes the great power that our own public national health program would have to strengthen our health care system, enabling everyone to have affordable access to high-quality cancer care if and when needed.

Many inconvenient truths on health care

By Dr. Stephen Sokol
Sun Journal (Lewiston, Maine)
Jul 26, 2009

Health care in America is a shambles and will, like a critically ill patient, likely collapse if not properly and promptly attended to.

We are told we have the best health care in the world, yet when we are ranked by the World Health Organization, we are 37 of 137 countries, just above Cuba and well below the United Kingdom and Canada, both of whom have single-payer systems. In the same ranking, we are 32nd in the world in infant mortality, 24th in life expectancy and 54th in fairness, which measures equality of access and quality of health care across religion, race or ability to pay.

Almost 50 million Americans are uninsured and a similar number are underinsured, 75 percent of whom are employed. Thirteen percent of Mainers live below the poverty level and over 9 percent lack health insurance. A similar number are underinsured. The Institute of Medicine of the National Academy of Sciences has shown that 50 Americans die daily because of lack of health insurance. Imagine if that figure were the fatalities of our troops in Iraq and Afghanistan. Yet we expended 17 percent of our gross national product, $2.4 trillion, on health care in 2007, twice as much as most other industrialized nations and still achieved significantly lower quality. We are now in the throes of a severe recession and more Americans, as they lose their jobs, lose their health insurance. Medical bills cause 60 percent of bankruptcies and 75 percent of these folks are insured.

Why? Private insurance companies are driven by profit and expend 16 percent of their income on overhead and therefore are stringent about what they will and will not cover. Most people with underlying common chronic problems such as hypertension and diabetes are excluded. In contrast, Medicare spends 2.1 percent and Canada 1.2 percent on overhead and there are no exclusions. We spend over $7,000 per-person, per-year, while Canada spends $2,500 and achieves better results.

We have been told that free market forces and competition will correct these problems, yet since the inception of the private health insurance sector during World War II, costs have only accelerated. When you have a heart attack or appendicitis, it is hard to shop around for price. These companies are not market-driven. They are for-profit. Keeping the present system of myriad private insurers only guarantees the status quo.

Remember the health care sector spent $450.7 million on lobbying alone in 2007 — and that was not to ensure equal access for all. Pharmaceutical companies spent over $14 billion on advertising, not only to doctors but to everyone. Remember the slogan on those TV ads, “Ask your doctor if … is right for you.” Some of those very drugs are quite hazardous. Hospitals, purporting to exist only to guarantee us excellent care, spend enormous amounts in competition for their “market share.” Just check the ads on TV and in the newspapers. Sadly, doctors have also joined in.

A single-payer system would eliminate many of these inequities by significantly reducing overhead, regulating costs and eliminating much of this frivolous waste. Good examples of excess here in Lewiston are the presence of three CT scanners, two MRI scanners and a part-time PET scanner, more hardware than available in any developing nation. Excess equipment ensures excess procedures.

We also now have a cardiac surgical unit, which cost millions, while there is one of the best in the country 40 miles down the road. A criticism of a single-payer system has been long waiting times. Having had personal experience in Canada and Germany, I can state no critically ill or urgent patient has been refused immediate, excellent care. Unlike here, where over 300,000 yearly are denied access, no one is turned away because of inability to pay as there is true universal coverage.

In 1995, Taiwan changed from a U.S. type system in which only 60 percent of the people were covered to a single payer system. By 2001, 97 percent were covered with only a minimal increase in cost.

I agree with the Founding Fathers, who believed that “all men were created equal” and that we all had “certain unalienable Rights, that among these are Life, Liberty and the Pursuit of Happiness.” Now I wonder how preserving these rights are possible for those of us who are sick and cannot get proper care. A single-payer system similar to Medicare, which has made a huge impact on the health of the elderly, can achieve these ends and keeps with the values that America and Americans espouse.

Health care is a right for all, not a commodity for the privileged.

Dr. Stephen Sokol is an assistant professor of geriatric medicine at the University of New England and a volunteer with Doctors Without Borders and the International Rescue Committee. He lives in Lewiston.

http://www.sunjournal.com/node/35624/

Single-payer system required for real reform

Tucson Citizen
Arizona Voices
Published: 07.27.2009

President Obama’s push to make minor changes to U.S. health-care policy has the demagogues out in full force.

Conservative talk radio is all aquiver about Obama’s and the Democrats’ efforts to cram “socialized medicine” down the throats of the U.S. public.

Republican senators and representatives are making speeches about how passing Obama’s health-care plan will be the end of the world as we know it, which is the same thing Obama and the Democrats say will happen if the plan isn’t passed now.

It’s all horse puckey.

It’s much ado about nothing because Obama’s plan doesn’t do much.

Though Obama is touting his plan as major reform, it’s not. It’s tinkering on the margins.

The stated goal is to provide health insurance to about 46 million Americans who don’t have any. Except most analyses of Obama’s plan show that it comes up about 16 million people short.

It also does little to fix many of the things that are wrong with the system, such as runaway costs, monopolistic drug pricing, exorbitant malpractice insurance premiums and Byzantine rules and laws that vary from state to state, to name a few.

If Obama was really serious about reforming the entire system he could simply say that he wants to make Medicare available to everyone.

It would take a tax increase to pay for it but that increase would be equal to or less than the hundreds of billions of dollars Americans already spend each year on insurance premiums, deductibles and copays.

And some of the tax increase would be offset by businesses being freed from the burden of paying insurance premiums for their workers and the need for large human resources staff to handle employee benefits claims.

Imagine the economic stimulus if businesses suddenly had hundreds of billions of dollars a year to spend on salaries, new employees, plant expansions and the like instead of paying all that money to health insurance companies.

Extending Medicare to everyone also would help reduce costs because doctors’ offices and hospitals would no longer need enormous billing departments to process the claims for dozens of different health plans.

As for socialized medicine, about 120 million Americans, or about 1 in 3, already get their health care or insurance paid for or subsidized by taxpayers:

* 59 million Medicaid recipients
* 44 million Medicare recipients
* 10 million state and local government employees
* 6 million U.S. military veterans
* 2.5 million active U.S. military personnel
* And 2.3 million federal and state prisoners

Adding the rest of the country to the list is only fair.

True reform must start with a single-payer system. From there, other problems and cost elevators can be tackled one at a time.

But that kind of reform will never happen. The health-care industrial complex makes sure it crushes any government action that puts its billions of dollars in annual profits at risk.

Which is why Obama crafted this goofy plan that appears to do much but does very little in terms of reform.

So as the blowhards try to froth the masses into a lather about the destruction of the American way of life, pay no attention.

Our health-care system will still suck no matter the outcome.

More’s the pity.

Testimony of Steffie Woolhandler, M.D., M.P.H., on medical bankruptcy

Before the Subcommittee on Administrative and Commercial Law
House Judiciary Committee
July 28, 2009

Mr. Chairman, members of the Committee. I’m Steffie Woolhandler. I am a primary care doctor in Cambridge, Massachusetts, and professor of medicine at Harvard. I am also senior author of two studies on medical causes of bankruptcy, one published in Health Affairs in 2005, and the latest in the August 2009 issue of the American Journal of Medicine. Both studies were done in collaboration with colleagues at Harvard Law School and Ohio University.

In our most recent study, medical bills and illness contributed to 62.1 percent of all personal bankruptcies. Between 2001 and 2007, the proportion of all bankruptcies attributable to medical problems rose by 49.6 percent. The striking conclusion from our study is that private health insurance is a defective product that leaves millions of middle-class families vulnerable to financial ruin. Unfortunately, the health reform plan now under consideration in the House would do little to address this grave problem.

We found that most of the medical bankruptcy were middle class — before their financial crisis hit. Two-thirds were homeowners and three-fifths had gone to college. In many cases, high medical bills were part of a cascade of problems that resulted from illness, along with lost income as illness forced a breadwinner to lose time from work. Often illness led to job loss, and with it the loss of health insurance.

The overwhelming majority of those bankrupted by illness in our study had health insurance. Seventy-eight percent were insured at the start of the bankrupting illness; 60.3 percent who had private coverage. These families had done everything right. They worked hard, paid their premiums and thought they were covered. Yet when illness hit they found themselves unprotected, ruined by co-payments, deductibles and bills for uncovered services like home care and physical therapy. Medically bankrupt families with private insurance ran up uncovered medical bills that averaged $17,749.

Our study raises a warning flag that leaving most Americans to rely on private insurance plans means leaving them unprotected. And a public plan option that mimics the rules and coverage of private plans won’t help.

In Massachusetts, we have three years of experience with the kind of plan the House is now debating, and it’s a sad experience. Reform hasn’t made care affordable for the middle class, and it has decimated the safety net that the poor continue to rely on. In 2007, only 5.4 percent of Massachusetts were uninsured — the lowest in the nation. Yet, medical problems underlay 3 out of 5 bankruptcies — the same proportion as in the rest of the country.

In our state, failure to buy insurance is illegal, punishable by a $1,000 fine — as big a fine as for beating your wife or making a terrorist threat. For a middle-income 56-year-old, the cheapest coverage available through the Connector — the state’s insurance exchange — costs $4,900 for a policy with a $2,000 deductible before it pays for any care, and a 20 percent co-payment after that. A diabetic with such coverage is almost certain to lay out $10,000 each year for medical care. In two years he’d accumulate $20,000 in medical bills — more than the amount that bankrupted the average family in our study. This kind of insurance — sold with the stamp of approval of the Connector — is a cruel joke which Congress should not repeat.

And for everyone financially ruined by illness, many more suffer physically because they don’t get the care they need. Access to an insurance policy is not the same thing as access to health care. By 2008, only 3 percent remained uninsured in Massachusetts, yet among those WITH health insurance, 18 percent skipped care because they couldn’t afford it. Moreover, those unable to afford care find safety net hospitals and clinics shuttered. Our governor and Legislature — desperate to keep the reform afloat as costs escalate more rapidly than predicted — have drained funds from the safety net.

Reform needs to replace the defective private insurance that most families have with insurance that is always there, and that covers all medically necessary care without co-payments or deductibles. That’s the kind of coverage people in other wealthy nations get through single-payer national health insurance. Only single-payer national health insurance can make universal, comprehensive coverage affordable by saving the hundreds of billions we now waste on insurance overhead and bureaucracy . In nations like Canada that have single payer health plans, medical bankruptcy is rare. You have a historic opportunity to make real reform happen this year. But overwhelming evidence indicates that the reform you seem poised to pass will fail to protect American families.

Public Option Advocates: Time to Come Home to Single Payer

By Mark Dunlea
Executive Director, Hunger Action Network of NYS
Co-chair, Single Payer New York

As the various public option proposals in Congress for national health care reform become weaker every day, there is still time for its proponents to support what they really believe in: a single payer, Medicare for all type program.

The architects of creating a “public option” as part of the push for national universal health care have always admitted that a single payer Medicare for All type programs was the best solution for America. It does the best job in controlling costs by eliminating the waste and bureaucracy of private health insurance while guaranteeing that every American would receive quality health care and have freedom of choice in selecting whom to receive health care services from.

The public option advocates — well-funded public interest groups and unions used to insider political wheeling and dealing — argued that the lesson from the 1993 defeat of the Clinton plan was that insurance companies were too powerful to defeat. Thus they had to abandon the best solution, single payer, to instead craft a proposal that would have a chance of passage by ensuring a continued large role for the present for-profit health insurance industry.

Their solution was to create an “800 pound gorilla” in the form of a public health insurance system that would provide quality and affordable health care coverage to more than one hundred million Americans. It would be large enough to operate efficiently and achieve cost savings. They argued that by setting up a fair fight between a public option and the private for-profit health insurance companies, over time the advantages of the public option — no profit margins, reduced paperwork and administrative costs, less marketing costs — would become clear. The public option would grow stronger, and under the best case scenario, either we would move to a single payer system or private for-profit health insurance would become a boutique industry serving the rich.

Before either House of Congress has adopted a specific plan, the public option 800 pound gorilla has turned into a five pound Chihuahua. And with four months or more of intense negotiations to take place among the nation’s power players before a final deal is reached, the public option will only get weaker.

The only clear winner in the process will be insurance companies. Americans will be mandated to purchase health insurance — or pay a fine. Insurance companies’ revenues — and profits — will increase under the Congressional plans. The mandate that everyone purchase insurance is one of the few consensus positions; the fight instead is over how taxpayers, employees and employers will have to pay for it.

Single payer advocates have always contended that public option proponents, despite their commitment to Machiavellian politics, were naive politically.

First, public option advocates violated the basic rule of negotiation by significantly weakening their opening position (i.e., dropping single payer for a public option) without getting any concessions in exchange. In addition, by calling for a major continued role for private for-profit health insurance, public option proponents also removed what should have been a key focus on the health care debate, namely that it was in the public interest to eliminate our present insurance system

Second, there was the real question of whether a public option would actually accomplish what its proponents claimed. The history of similar approaches at the state level in recent decades was quite bad. Doctors and hospitals would still have to keep in place their expensive billing and cost-tracking systems to deal with the various insurance programs.

Third, it was quite clear to everyone but its proponents that a “robust” public option was going to generate significant political opposition from the insurance industry. Like most industries, it would oppose anything that sought major cuts in its market share. Unlike single payer, which had the evidence of both Medicare and most of the other industrial nations to prove that it would work, the insurance industry would have a much easier time challenging the claims of benefits of a public option. State plans which had tried similar approaches had all crashed and burned, largely due to its failure to control costs. In addition, evidence from prior Congressional fights – say with Medicare – showed that rather than setting up a “fair fight” between the public option and insurance companies, Congress would likely seek to tilt the “competition” to favor the insurance companies.

So how has the public option fared so far in Congress?

When the “public option” campaign began, its proponents sought a huge “Medicare-like” program. Studies by the Lewin think tank group of the Hacker proposal estimated that it would enroll as many as 130 million people. Thus it would enjoy the advantages that make Medicare so efficient — large size, low provider payment rates (about 20% less than what private insurance pays) and low overhead (2 to 3%).

Today, the “public options” outlined in the Democrats’ legislation, according to the Congressional Budget Office, might enroll 10 million people and will have virtually no effect on health care costs. The program is so small it would have no impact by itself on reducing the number of the uninsured. The main House bill would delay establishing a public option until 2013 — conveniently after the next Presidential election — and would require it to follow the same rules (drawbacks) of private insurance. The ability of workers and others who presently have insurance to move into a public option program is significantly restricted.

Hacker had proposed jump-starting the public option plan by moving all or most of uninsured people as well as Medicaid and SCHIP enrollees into it. Starting with a huge population would reduce its startup, administrative and marketing costs and give it the ability to negotiate lower premiums. Under the present Congressional proposals, it starts with no one, which will greatly increase its initial overhead and marketing costs while largely eliminating its ability to cut costs through lower premium.

The power and political campaign activities of the public option proponents means that many liberal Congresspeople feel obligated to insist that a public option be included in the final bill. It will a public option primarily in name only, especially since so few people ever understood the details of the initial proposal. Meanwhile, the Republicans and right wingers are using the “public option” as a focal point of their criticism of Congressional efforts for universal health care, claiming it is socialism and a first step to single payer, an effort to drive insurance companies out of business. Rather than saying “yes, we want to eliminate private health insurance”, Congress instead seeks to deflate these attacks by doing more to subsidize and strengthen insurance companies.

An additional problem is that Congress is largely equating access to quality health care with having insurance. Yet neither private health insurance nor even public programs like Medicaid guarantee that you will actually obtain health services. We see this in the fact that 77% of Americans who go bankrupt due to high health care bills had health insurance. The co-pays, deductibles, exclusions, prior approval and restrictions on out of network services that come with insurance all impede access to health care. Many Medicaid patients, due to lower physician reimbursement rates, have a difficult time accessing health services outside of a clinic setting. It is quite possible that the public option will experience some if not all of these problems.

Public option proponents started with good intentions. It is time for them to admit that their vision for a public option has been rejected by Congress. Hopefully they will rejoin the movement for single payer health care and fight to establish health care as a human right in America.

Plugging Single Payer…Sort Of

By Steven T. Jones
SFGB Politics on-line
July 23, 2009 01:06 PM

As President Barack Obama held a prime time news conference yesterday to boost his health care reform efforts, he tried to recast the imperative as saving the system for the average American rather than focusing on the 45 million Americans without insurance. But in the process of defending his plan, he also subtly reinforced the need for the single-payer system, as discussed in our cover story this week.

When asked about the approximately 2 percent of Americans that will be left uncovered by the Democrats’ plan, Obama said, “I want to cover everybody. Now, the truth is unless you have what’s called a single-payer system in which everyone’s automatically covered, you’re probably not going to reach every single individual.”

As Peter Baker wrote in the New York Times online story yesterday, Obama didn’t explain why he doesn’t then support single-payer, but Baker wrote, “In the past, he has said such a system might be preferable if the country were inventing a new health care structure from scratch but he does not want to completely upend the current system, which does work for many or most Americans.”

Unfortunately, that final statement is bullshit. Polls show most Americans don’t like the current system (56 percent want “major health care reform” this year, 62 percent want more government control over health care, etc.), although right-wing and insurance industry propaganda have made them scared of the change that is needed to realize the president’s goals of holding down costs, emphasizing preventive care, and ensuring universal access to quality and affordable care.

Upending the current system is precisely what needs to happen.

Advocates Call on Governor Paterson to Highlight Savings from Single Payer Health Care for All — Projected to Save $20 Billion annually by 2019

Groups Want State Lawmakers to Hold Hearings on Long-Delayed Universal Health Care Study

July 28, 2009
For More Info: Mark Dunlea, 518-434-7371 xt 1#
Dr. Richard Propp, 518-482-0420

(Albany, NY) Universal health care advocates today called upon the State Legislature and the Governor to organize a series of public forums and hearings around the state on the recently released study of the most cost-effective way to provide health care to all New Yorkers.

The groups also called upon the Governor to propose a single payer universal health care system for New York. The Governor was a long time sponsor of single payer as a State Senator.

The long awaited study, released late last Friday, concludes that a single payer Medicare for All type program is the most cost-effective way to provide health care to all New Yorkers. (A copy of the report is at http://www.partnership4coverage.ny.gov/) There will be a rally in DC this Thursday, July 30th, the 44th birthday of Medicare, to call for a national single payer plan. Groups in Albany will rally at 5 PM at 90 State St., the offices of the state insurance lobby group.

“While we believe this report understates the savings from single payer and overstates the benefits from the public-private hybrid models, we are pleased that it finds that single payer is the most cost-effective approach to provide quality health care to all New Yorkers. We hope the Governor will widely publicize its findings to influence the national debate. Unlike the recent studies by the Congressional Budget Office, this report examined the impact of health care proposals on all segments, namely, taxpayers, consumers and employers,” said Mark Dunlea, Executive Director of Hunger Action Network and Co-Chair of Single Payer New York.

Hunger Action Network, along with Rekindling Reform, led the NY Universal Health Care Options Campaign that sought state funding to study the costs associated with various approaches to universal health care.

The report found that savings from single payer substantially increase over time. By 2019, the Urban Institute concludes that single payer would save $20 billion annually based on the report’s projected 6% annual increase in baseline health care cost ($130 billion for single payer vs. $150.25 billion for present system). Single payer would cost $28 billion less annually than the public-private hybrid (e.g., expand public programs like Medicaid, a small public option, and a mandate to obtain insurance). The hybrid model had been a favorite of Governor Spitzer and his health care advisors.

Single payer would also cost $19 billion less annually by 2019 than the NY Health Plus proposal by Assembly Health Committee Chair Richard Gottfried. NY Health Plus would automatically enroll all New Yorkers in Family Health Plus; however, employers could decide to opt out to purchase private insurances and a tax subsidy would be provided.

A similar report by the Lewin Group for the State of California concluded that a state single payer system would reduce spending below projected levels by an average of $34 billion annually over a ten-year period. Studies done in five other states also found that single payer was the most cost-effective approach to universal health care.

“The Urban Institute report clearly shows that adequate health care for every New Yorker is achievable. Now we need the will to make it happen,” said Robb Smith, Executive Director of Interfaith Impact of New York State. “Health care for everyone is a fundamental moral issue. It is a human right that gets at the very foundation of what it means to be human and live in community.”

“The effort to guarantee quality health care to all Americans is a daunting challenge that has defeated Presidents and Congress a half-dozen times over the last sixty years,” noted Dr. Richard Propp, Chair of the Capital District Alliance for Universal Health Care. “Trying to re-organize and improve one-sixth of the national economy is a complicated task. It is important that health care reform be a transparent and participatory process, where New Yorkers can find out what is going on and have their voices heard. We call upon the Governor, Assemblymember Gottfried, Senators Breslin and Duane, to hold hearings in the next few months across this state on this important report,” he added.

The groups want Congress to adopt a national single payer health care system this year such as HR 676 (Conyers) or S703 (Sanders). If Congress fails to act, they want the state to be able to start its own single payer system. The Canadian single payer system initially started at the province level. Ten Congress members from New York are single payer sponsors. More than half of the State Assembly and a majority of State Senators have sponsored single payer legislation. Both houses recently passed resolutions calling upon Congress to enact HR 676.

The Urban Institute estimated a single payer / public health insurance for all (excluding senior citizens) would cost an additional $2.4 billion in its first year, while the other expansion models would cost around $6 billion extra. Total cost in the first year for single payer would be $86.3 billion. While government spending would increase, employers and individuals would save an equal amount while covering everyone.

Even though single payer was found to be the most cost effective, advocates contend that the study underestimated savings. The study estimated that the administrative savings from single payer would only be 10% over 10 years- the same percentage it estimated for the much smaller public option model under the hybrid model. No basis is given for this and other assumptions. Single payer advocates say savings should be much higher, especially if the program includes all residents including Medicare and elderly Medicaid participants. The Lewin group study for California estimated administrative savings of $20 billion annually. The study appears to ignore the tremendous savings and cost reductions that would be available to doctors and hospitals under a single payer plan since they would no longer have to deals with scores of insurance companies and their conflicting policies and paperwork. Even though the study did not include Medicaid under single payer, it decided to charge both single payer and NY Health Plus 18% higher premiums for Medicaid participants; while somewhat higher payments would be expected, no such cost allocation appears to have been charged to the hybrid proposals.

The Lewin group study in California also found more savings from the bulk purchasing of prescription drugs under a single payer system

. The study also appears not to factor in the reduction of health care costs that would result from having a health care system that covers everyone. Especially combined with preventive care, other countries have shown that it is much cheaper to operate a health care system that focuses on keeping healthy rather than on the American approach of spending more money to cure the sick. In addition, having a health care system that automatically covers everyone would also reduce the cost of other programs that deal with health care costs, such as automobile insurance (e.g., for bodily injury), workers compensation and medical malpractice.

The report admitted that most of the public-private hybrid models (18 variations were studied) that focuses on incremental changes would not achieve universal health care. However, the Urban Institute did claim 100% coverage when expansion of eligibility and subsidies for existing programs were combined with a
n insurance mandate and public option. Other studies by the CBO and the Lewin group of such models have all found uninsurance rates of at least 3 to 4%, with the real numbers of uninsured significantly higher (which impacts on emergency room care) due to excluded populations such as legal immigrants and undocumented workers.

President Obama stated at his health care national press conference last week that single payer was the only system that would provide 100% health care coverage.” Now, the truth is that unless you have a what’s called a single-payer system, in which everybody’s automatically covered, then you’re probably not going to reach every single individual,” said Obama.

“We waited two years for this report, more than 14 months than initially predicted. Just because the results didn’t support the positions of certain administrative officials wasn’t a legitimate reason to try to bury the findings by releasing it late on the Friday after the Senate’s two day end of session marathon. When the Governor’s office first held the hearings, they admitted they were stunned to find that most of the hundreds of consumers, doctors, nurses and researchers who spoke said single payer was best. Even though they directed the Urban Institute to study a dozen variations of their favorite approach, single payer came out best. We need the Governor to stand with the people and do what is best in providing quality health care to all New Yorkers,” added Mark Dunlea.

The report estimates that 10.5 million people (61.1% of the population) have health insurance coverage through employer-sponsored insurance. Medicare / CHIP / FHP covers 3.7 million people or 21.4%. About 250,000 (1.4%) are covered by the non-group market (including Healthy NY). An estimated 2.7 million are uninsured.

John Geyman’s “The Cancer Generation”

The Cancer Generation: Baby Boomers Facing a Perfect Storm

by John Geyman
Common Courage Press

You can be sure that cancer will be a part of your life. You’ll either get it – nearly half of all men and more than a third of women will. Or you’ll have a close friend who gets it, or be the child of someone who gets it, or the spouse of someone who has it, or in the worst case scenario, be the parent of a child struggling with cancer. You cannot help but stand on the battlefield of the war against cancer. How America wages this war is leaving an indelible mark on your life.

Cancer is now on track to replace heart disease as America’s leading cause of death within the next few years. This is a fight we have to win. Are we winning? And if we are off target, what changes are imperative for victory? Everything we discuss here focuses on these two questions.

So What Will Happen?

Lives hang in the balance on the answer to this question. The future down our current path is crystal clear – and devastating. Deregulated markets and the corrosive effects of profits over service over many years have brought U.S. health care to a crisis point. Because of soaring costs, patients with cancer are finding effective care increasingly unaffordable. Health care has entered a perfect storm, and it is certain to get much worse without real reform. Our primary care infrastructure is collapsing. ERs are overwhelmed, the ranks of the unemployed are rising quickly, adding to the numbers of uninsured. The economy has tanked, the federal deficit is massive, many states are forced to cut Medicaid to the bone, and our presumed safety net is falling apart.

Meanwhile, market stakeholders increase their efforts to maintain the status quo. The private insurance industry calls for the government to change tax policy and keep the subsidies flowing so that insurers can continue to rake off their profits from the system while offloading sicker and lower-income patients onto public programs.

http://www.commoncouragepress.com/index.cfm?action=book&bookid=398

Comment:

By Don McCanne, MD

No topic could serve as a better proxy for the deficiencies in the financing and delivery of health care in the United States than the ever increasing prevalence and expense of cancer. In The Cancer Generation, John Geyman describes the tragic and costly impact of the cancer burden, but then provides us with hope by describing a plan that would reduce these burdens of cancer.

His eight-point plan for one-tier cancer care stresses not only the importance of single payer national health insurance, Medicare for all, but also describes the great power that our own public national health program would have to strengthen our health care system, enabling everyone to have affordable access to high-quality cancer care if and when needed.

The Washington Post kills Blue Cross Blue Shield story

Research Firm Cited by GOP Is Owned by Health Insurer

By David S. Hilzenrath
The Washington Post
July 22, 2009

The political battle over health-care reform is waged largely with numbers, and few number-crunchers have shaped the debate as much as the Lewin Group, a consulting firm whose research has been widely cited by opponents of a public insurance option.

****

Lewin’s clients include the government and private groups with a variety of perspectives, including the Commonwealth Fund and the Heritage Foundation. A February report contained information that could be used to argue for a single-payer system, the approach most threatening to private insurers, Sheils noted.

But not all of the firm’s reports see the light of day. For example, a study for the Blue Cross Blue Shield Association was never released, Sheils said.

“Let’s just say, sometimes studies come out that don’t show exactly what the client wants to see. And in those instances, they have [the] option to bury the study — to not release it, rather,” Sheils said.

Asked to comment, Blue Cross Blue Shield Association spokesman Brett Lieberman said, “We’re still working with Lewin on a study, and, you know, we don’t talk about our studies until they’re done.”

In testimony last month to a House committee, Lewin disclosed its affiliation with UnitedHealth and Ingenix in its written submission, but in his oral testimony he did not bring it up until asked, according to a transcript.

****

http://www.washingtonpost.com/wp-dyn/content/article/2009/07/22/AR2009072202216.html

And…

Insurer-Owned Consulting Firm Often Cited in Health Debate

By David S. Hilzenrath
The Washington Post
July 23, 2009

In a revised version of the same article published the next day, the section appearing between the rows of asterisks was rewritten as follows:

****

Lewin’s clients include the government and groups with a variety of perspectives, including the Commonwealth Fund and the Heritage Foundation. A February report by the firm contained information that could be used to argue for a national system known as single-payer, the approach most threatening to insurers, Sheils noted.

But not all of Lewin’s reports see the light of day. “Let’s just say, sometimes studies come out that don’t show exactly what the client wants to see. And in those instances, they have [the] option to bury the study,” Sheils said.

****

http://www.washingtonpost.com/wp-dyn/content/article/2009/07/22/AR2009072203696.html

And…

A Sponsorship Scandal at The Post

By Andrew Alexander, Ombudsman
The Washington Post
July 12, 2009

The Washington Post’s ill-fated plan to sell sponsorships of off-the-record “salons” was an ethical lapse of monumental proportions.

Publisher Katharine Weymouth and Executive Editor Marcus Brauchli have now taken full responsibility for what was envisioned as a series of 11 intimate dinners to discuss public policy issues. For a fee of up to $25,000, underwriters were guaranteed a seat at the table with lawmakers, administration officials, think tank experts, business leaders and the heads of associations.

http://www.washingtonpost.com/wp-dyn/content/article/2009/07/11/AR2009071100290.html

Comment:

By Don McCanne, MD

Just as the Blue Cross Blue Shield Association killed a study by The Lewin Group that had findings that they didn’t want people to see, The Washington Post killed the reporting of the decision of Blue Cross Blue Shield to bury that study.

The Washington Post is attempting to recover from one of the most serious ethical lapses in the history of mainstream journalism – the selling of access to the publisher, reporters, and others so participants could “build crucial relationships with Washington Post news executives in a neutral and informal setting.”

What has The Washington Post learned? In their decision to manipulate the news on behalf of the private insurance industry during the intensive effort in Washington to reform health care, it’s clear that The Washington Post didn’t learn squat about journalism ethics.

They would have been more honest if they simply sold The Washington Post Company to Fox News. At least we would know with no uncertainty where they stood. Maybe we already do.