PNHP

Growth of employer-sponsored underinsurance

Growth of employer-sponsored underinsurance

Trends In Underinsurance And The Affordability Of Employer Coverage, 2004-2007

Employer coverage helps, but it does not shield workers from health care costs deemed “unaffordable” as a percentage of their incomes.
by Jon R. Gabel, Roland McDevitt, Ryan Lore, Jeremy Pickreign, Heidi Whitmore, and Tina Ding
Health Affairs
June 2, 2009
Based on simulated bill paying, this paper examines trends in comprehensiveness of coverage, out-of-pocket spending for medical services, underinsurance, and the affordability of employer-based insurance from 2004 to 2007. Data are from MarketScan medical claims and an annual survey of employer health benefits. Health plans covered slightly fewer expenses in 2007 than in 2004, but out-of-pocket spending grew more than one-third because of growth in overall health spending. For people at 200 percent of poverty, the percentage spending more than 10 percent of their income out of pocket on premiums plus services increased from 13 percent to 18 percent.
In the United States, if you are sick and earn a modest income, then you are probably underinsured – even if you have employer-based health coverage. In 2007, among people at 200 percent of poverty ($41,300 for a family of four in 2007) who were among the top 25 percent of spenders on health care services, 71 percent were underinsured.
http://content.healthaffairs.org/cgi/content/abstract/hlthaff.28.4.w595v1

And…

Cost Sharing In Medicaid And CHIP: How Does It Affect Out-Of-Pocket Spending?

by Thomas M. Selden, Genevieve M. Kenney, Matthew S. Pantell, and Joel Ruhter
Health Affairs
June 2, 2009
Rapidly rising spending has prompted debate about increasing cost sharing in Medicaid and the Children’s Health Insurance Program (CHIP). In this paper we assess the role of cost sharing in Medicaid and the CHIP and its potential financial burden on low-income families with children. We find that many families would face high health spending burdens even with minimal cost sharing for their publicly insured children. Adding even modest cost sharing for such children could greatly increase high financial burdens.
Our survey of state policies reveals that a growing number of states are using cost sharing in the form of premiums or copayments, or both, for services in their public coverage programs for children. Premiums and copayments vary greatly across states and generally increase with family income level. Most states have provisions that specify caps on family spending – generally at 5 percent of family income – and premiums are capped in most states for families with more than three children. Yet our analysis of state policies suggests that systems to track family spending and to ensure free access once caps have been reached are generally not well developed.
Higher cost sharing in public programs may reduce public spending. However, half of all publicly insured children in our analysis were poor, and even modest cost sharing can be burdensome for many poor families. Exempting poor children reduces budgetary savings unless much larger cost-sharing burdens are imposed on the remaining families. Optimal targeting of cost sharing is difficult, moreover, when family incomes fluctuate from month to month and when health needs, such as the presence of a an SHCN (Special Health Care Needs) child or a parent in poor health, vary so widely across families.
http://content.healthaffairs.org/cgi/content/abstract/hlthaff.28.4.w607v1

With the reform debate having been diverted to issues such as offering a public option, changing the tax status of employer-sponsored coverage, or mandating individuals to purchase insurance, little attention is being paid to some of the most fundamental flaws in our dysfunctional system of financing health care. One of the most important has been the ever-increasing incidence of underinsurance that has created financial hardship for individuals and families who do have health insurance coverage.
Underinsurance has long been a prime feature of the individual insurance market as insurers have continued to introduce innovations in an effort to keep their premiums competitive. These innovations inevitably shift more costs to individuals and families that actually have health care needs. In fact, one of the purposes of the proposed insurance exchanges would be to reduce underinsurance by offering individuals plans that are more comparable to the group plans of the employer-sponsored market. Is this an adequate response to this problem?
The Health Affairs article on underinsurance in the employer market answers that question. As the authors state, “In the United States, if you are sick and earn a modest income, then you are probably underinsured – even if you have employer-based health coverage.” The emphasis on slowing the cost of insurance (as opposed to the costs of health care) has extended from the individual market to the employer-sponsored market.
The perversity of this strategy is well exemplified by the expansion of cost-sharing policies in the programs designed to protect lower-income families – Medicaid and CHIP. As the authors of the Health Affairs article on cost sharing in these public programs state, “even modest cost sharing can be burdensome for many poor families.” To minimize the negative financial impact on families, it has been suggested that caps be placed on the total out-of-pocket spending for these families. The problem is that “systems to track family spending and to ensure free access once caps have been reached are generally not well developed.” Furthermore, “Optimal targeting of cost sharing is difficult, moreover, when family incomes fluctuate from month to month and when health needs… vary so widely across families.”
The latter is also true of employer-sponsored coverage. Now that underinsurance is a problem for the workforce, some system of capping out-of-pocket spending would be necessary. But because of ever-changing variables, an equitable and efficient system of caps would be almost impossible to design – not to mention the additional administrative efforts that would be required in our system already over-burdened with costly administrative excesses.
Is cost sharing really necessary? How much impact would it have on our total national health expenditures (NHE)? Keep in mind that 80 percent of health care is consumed by about 20 percent of the population. Most of that 80 percent of spending would fall into the category of catastrophic, and almost everyone agrees that catastrophic costs should be fully covered.
Cost sharing policies impact primarily the remaining 80 percent of us who have comparatively few health care needs. Even if cost sharing were fully effective in eliminating non-beneficial health care (it isn’t), how much would that save? Cost sharing might reduce spending by as much as 30 percent (a number in dispute), but at least half of that is for beneficial services. The 15 percent of marginal or non-beneficial services as a portion of the 20 percent of NHE spent on the 80 percent who are healthy would produce a savings of about 3 percent of our NHE.
Since cost sharing is a very imperfect policy, the net benefit would be no where near this ideal. Not only would cost sharing continue to pose barriers to beneficial health care services, it would continue to perpetuate the plague of underinsurance now permeating the employer-sponsored market. The net cost of eliminating cost sharing, thereby ensuring that everyone has the health care that they need without facing financial hardship, would be very small indeed.
But let’s not digress into policies that would impact our health and our finances. Let’s go back to the cat fight over a public option. The private insurance industry must be popping the champagne corks now that they have deceived us into thinking this non-issue is the reform debate that we must be engaged in. They won again, and this time they didn’t even need to bring out Harry and Louise.

Growth of employer-sponsored underinsurance

Trends In Underinsurance And The Affordability Of Employer Coverage, 2004-2007

Employer coverage helps, but it does not shield workers from health care costs deemed “unaffordable” as a percentage of their incomes.

by Jon R. Gabel, Roland McDevitt, Ryan Lore, Jeremy Pickreign, Heidi Whitmore, and Tina Ding
Health Affairs
June 2, 2009

Based on simulated bill paying, this paper examines trends in comprehensiveness of coverage, out-of-pocket spending for medical services, underinsurance, and the affordability of employer-based insurance from 2004 to 2007. Data are from MarketScan medical claims and an annual survey of employer health benefits. Health plans covered slightly fewer expenses in 2007 than in 2004, but out-of-pocket spending grew more than one-third because of growth in overall health spending. For people at 200 percent of poverty, the percentage spending more than 10 percent of their income out of pocket on premiums plus services increased from 13 percent to 18 percent.

In the United States, if you are sick and earn a modest income, then you are probably underinsured – even if you have employer-based health coverage. In 2007, among people at 200 percent of poverty ($41,300 for a family of four in 2007) who were among the top 25 percent of spenders on health care services, 71 percent were underinsured.

http://content.healthaffairs.org/cgi/content/abstract/hlthaff.28.4.w595v1

And…

Cost Sharing In Medicaid And CHIP: How Does It Affect Out-Of-Pocket Spending?

by Thomas M. Selden, Genevieve M. Kenney, Matthew S. Pantell, and Joel Ruhter
Health Affairs
June 2, 2009

Rapidly rising spending has prompted debate about increasing cost sharing in Medicaid and the Children’s Health Insurance Program (CHIP). In this paper we assess the role of cost sharing in Medicaid and the CHIP and its potential financial burden on low-income families with children. We find that many families would face high health spending burdens even with minimal cost sharing for their publicly insured children. Adding even modest cost sharing for such children could greatly increase high financial burdens.

Our survey of state policies reveals that a growing number of states are using cost sharing in the form of premiums or copayments, or both, for services in their public coverage programs for children. Premiums and copayments vary greatly across states and generally increase with family income level. Most states have provisions that specify caps on family spending – generally at 5 percent of family income – and premiums are capped in most states for families with more than three children. Yet our analysis of state policies suggests that systems to track family spending and to ensure free access once caps have been reached are generally not well developed.

Higher cost sharing in public programs may reduce public spending. However, half of all publicly insured children in our analysis were poor, and even modest cost sharing can be burdensome for many poor families. Exempting poor children reduces budgetary savings unless much larger cost-sharing burdens are imposed on the remaining families. Optimal targeting of cost sharing is difficult, moreover, when family incomes fluctuate from month to month and when health needs, such as the presence of a an SHCN (Special Health Care Needs) child or a parent in poor health, vary so widely across families.

http://content.healthaffairs.org/cgi/content/abstract/hlthaff.28.4.w607v1

Comment:

By Don McCanne, MD

With the reform debate having been diverted to issues such as offering a public option, changing the tax status of employer-sponsored coverage, or mandating individuals to purchase insurance, little attention is being paid to some of the most fundamental flaws in our dysfunctional system of financing health care. One of the most important has been the ever-increasing incidence of underinsurance that has created financial hardship for individuals and families who do have health insurance coverage.

Underinsurance has long been a prime feature of the individual insurance market as insurers have continued to introduce innovations in an effort to keep their premiums competitive. These innovations inevitably shift more costs to individuals and families that actually have health care needs. In fact, one of the purposes of the proposed insurance exchanges would be to reduce underinsurance by offering individuals plans that are more comparable to the group plans of the employer-sponsored market. Is this an adequate response to this problem?

The Health Affairs article on underinsurance in the employer market answers that question. As the authors state, “In the United States, if you are sick and earn a modest income, then you are probably underinsured – even if you have employer-based health coverage.” The emphasis on slowing the cost of insurance (as opposed to the costs of health care) has extended from the individual market to the employer-sponsored market.

The perversity of this strategy is well exemplified by the expansion of cost-sharing policies in the programs designed to protect lower-income families – Medicaid and CHIP. As the authors of the Health Affairs article on cost sharing in these public programs state, “even modest cost sharing can be burdensome for many poor families.” To minimize the negative financial impact on families, it has been suggested that caps be placed on the total out-of-pocket spending for these families. The problem is that “systems to track family spending and to ensure free access once caps have been reached are generally not well developed.” Furthermore, “Optimal targeting of cost sharing is difficult, moreover, when family incomes fluctuate from month to month and when health needs… vary so widely across families.”

The latter is also true of employer-sponsored coverage. Now that underinsurance is a problem for the workforce, some system of capping out-of-pocket spending would be necessary. But because of ever-changing variables, an equitable and efficient system of caps would be almost impossible to design – not to mention the additional administrative efforts that would be required in our system already over-burdened with costly administrative excesses.

Is cost sharing really necessary? How much impact would it have on our total national health expenditures (NHE)? Keep in mind that 80 percent of health care is consumed by about 20 percent of the population. Most of that 80 percent of spending would fall into the category of catastrophic, and almost everyone agrees that catastrophic costs should be fully covered.

Cost sharing policies impact primarily the remaining 80 percent of us who have comparatively few health care needs. Even if cost sharing were fully effective in eliminating non-beneficial health care (it isn’t), how much would that save? Cost sharing might reduce spending by as much as 30 percent (a number in dispute), but at least half of that is for beneficial services. The 15 percent of marginal or non-beneficial services as a portion of the 20 percent of NHE spent on the 80 percent who are healthy would produce a savings of about 3 percent of our NHE.

Since cost sharing is a very imperfect policy, the net benefit would be no where near this ideal. Not only would cost sharing continue to pose barriers to beneficial health care services, it would continue to perpetuate the plague of underinsurance now permeating the employer-sponsored market. The net cost of eliminating cost sharing, thereby ensuring that everyone has the health care that they need without facing financial hardship, would be very small indeed.

But let’s not digress into policies that would impact our health and our finances. Let’s go back to the cat fight over a public option. The private insurance industry must be popping the champagne corks now that they have deceived us into thinking this non-issue is the reform debate that we must be engaged in. They won again, and this time they didn’t even need to bring out Harry and Louise.

Baucus to meet with single-payer health care advocates

By JOHN S. ADAMS
Great Falls Tribune
June 1, 2009

HELENA — Sen. Max Baucus is set to meet with five single-payer health care advocates in Washington, D.C. this week.

Baucus, as chair of the powerful Senate Finance Committee, has made health care reform his top priority this session. However, Baucus has consistently said single-payer–a system in which the federal government acts as the nation’s sole health insurance provider–is of the table.

“For more than a year, Sen. Baucus has met with thousands of people, representing hundreds of views on how to reform our health care system,” Baucus spokesman Ty Matsdorf stated in an e-mail. “This meeting is no different. Max hopes to talk, and listen, to these folks to try and find the best way to make sure every Montanan has access to quality, affordable health care.”

Dr. Marcia Angell, former editor of the New England Journal of Medicine and a prominent single-payer advocate, is scheduled to attend the meeting.

Angell said the group plans to urge Baucus to give serious consideration to Congress’ two primary single-payer bills, S. 703, by Sen. Bernie Sanders, I-Vt., and H.R. 676, by Rep. John Conyers, D-Mich.

“We will make a case that there should be full hearings on Sanders’ bill and we’ll make the case that the (Congressional Budget Office) should cost-out the Sanders and Conyers bills,” Angell said in an interview Monday. “We’ll make the case that single-payer advocates should have a chance to meet with the president. We will argue for holding public hearings on health reform that include single payer witnesses.”

Thousands of Americans turn out to support single-payer healthcare!

Tim Carpenter, National Director
Progressive Democrats of America

Reports from the single-payer events, which took place on May 30 and the days leading up to it, are still rolling in, but we couldn’t wait to share the news with you. Read about the events in Seattle and Tacoma, Ohio, Rochester and Indiana. We’ll be posting more and invite you to send us your story, as well.

One thing is clear: more and more people are turning out in support of single-payer healthcare at rallies, marches, and forums–big and small. Pat yourself on the back! We’re seeing the fruits of our labor playing out in communities across the country.

The next step is for each of us to take the single-payer message to the Obama for America (OFA) “kickoff” meetings on June 6. Click here to find one near you. And, order your free professionally printed flyers–shipping charges apply–to take with you.

Polls show the strong support for single-payer, and the folks attending these events are friendly to the cause of real healthcare reform. This is a great opportunity to build support and send our message to President Obama.

I’m looking forward to reading more of your May 30 Single-payer Day of Action reports. Let us know about the June 6 OFA kickoff meetings, too.

In Solidarity.

Write Baucus to Hold Fair Hearings on Single Payer

ProsperityAgenda.US
Monday, June 1, 2009

Senator Max Baucus and the Finance Committee are feeling the pressure.

This Wednesday Sen. Baucus will meet with a delegation of leading single payer national health plan advocates.

The delegation includes: Dr. David Himmelstein, Associate Professor of Medicine at Harvard Medical School and co-founder of Physicians for a National Health Program (PNHP), Dr. Marcia Angell, Senior Lecturer, Harvard Medical School and former editor-in-chief of the New England Journal of Medicine, Dr. Oliver Fein, Associate Dean, Cornell Weill Medical School, and President of PNHP, Rose Ann DeMoro, executive director of the California Nurses Association, and Geri Jenkins, president of California Nurses Association.

But we know that a private meeting with single payer advocates does not mean that single payer is on the table or will get a fair hearing.

We are pleased Sen. Baucus is feeling the pressure and reacting but an off-the-record meeting is not enough. We want single payer on the table and really being considered. We know that on every measure: cost, patient choice, improved health care and covering all people — single payer wins every argument. It isn’t even a close question which is why a super majority of Americans support single payer — improved Medicare for all.

Please take action and write Senator Baucus and the Senate Finance Committee today. Tell them that while we appreciate a private meeting for single payer — that is not good enough. Single payer needs to be on the table, because with fair consideration single payer will be the health care plan adopted by the nation. Click here to send a letter now.

The multi-payer system that Senator Baucus is pushing will be a gift to the insurance industry that has so generously supported him throughout his political career. It will push, perhaps even force, people to buy insurance, it will subsidize the industry even more than it already is, it will not control costs indeed it will increase taxes to pay for insurance subsidies, and, if there is a public insurance option it will have so many strings attached that it will fail. This is not reform that provide health care to all at a price the nation can afford.

We’re making progress. Please take action now to keep the pressure on. Click here to take action.

It is time to put single payer on the table, indeed it is time to make it America’s national health policy. A private meeting should spur our movement to increase the pressure senators are feeling. We want real change not symbolic meetings.

Sincerely,

Kevin Zeese
Executive Director
ProsperityAgenda.US

ProsperityAgenda.US is a project of Campaign for Fresh Air and Clean Politics

ProsperityAgenda.US
2842 N. Calvert St.
Baltimore, MD 21218
443-708-8360

Health care activists lament single-payer snub

Victoria Colliver
San Francisco Chronicle
Saturday, May 30, 2009

Frustrated by the exclusion of government-financed medical care from the debate to revamp the nation’s troubled health system, advocates of a “single-payer” plan are increasingly turning to demonstrations and civil disobedience as a way to get their message across.

During Senate Finance Committee hearings May 5 and 12 on health reform, 13 doctors, nurses, lawyers and activists stood up to complain that no single-payer proponent had been invited to take part and were arrested for disrupting the proceedings.

On Friday in San Francisco, about 200 single-payer proponents held a rally in front of the Federal Building and headed in small groups to Rep. Nancy Pelosi’s office to urge the speaker of the House, who was in China, to back single-payer legislation and give its supporters a seat at the table of the health reform debate. The public appeals were part of a series of demonstrations being held in more than 50 U.S. cities over the next few days to encourage lawmakers to enact a single-payer plan.

Some advocates of a nationalized health plan are calling for activists to become even more militant.

“It’s the only way – direct confrontation with the people who are blocking what the majority of the American people want,” said Russell Mokhiber, the founder of the newly formed Single Payer Action.

“It’s about getting in people’s faces and being serious about the fact that 60 Americans are dying every day because of lack of health insurance,” said Mokhiber, who was arrested at the May 5 hearing and arraigned earlier this week in Washington.

Single payer unlikely

Reforming health care has become a focus of the Obama administration, with the president urging Congress to get legislation to his desk by the end of the year that would cover most of the nation’s 47 million uninsured. Whether that will happen remains to be seen, but whatever Congress passes is not likely to come in the form of a single-payer plan.

In a single-payer system, as envisioned by most advocates, the federal government would pay for basic medical care delivered by public and private health professionals. The money would come from taxes, and medical bills would go directly to a government insurance plan, similar to Medicare.

President Obama and lawmakers have proposed a form of “single-payer lite” – a government-administered plan people could buy into as an alternative to purchasing an individual policy offered by insurers. But single-payer supporters say this option doesn’t go far enough. They want private insurers completely out of the business of covering basic care, which they say could save nearly 30 percent in administrative costs.

That’s clearly not something the health insurance industry supports. Many of the nation’s largest insurers prefer a form of “universal” health care that would cover all Americans, while keeping them in business. They tend to avoid discussing the single-payer option largely because it hasn’t been included in the national debate.

Some statistics show the single-payer concept has grown in popularity as problems in the nation’s health care system have worsened. A CBS News/New York Times poll conducted in January found 59 percent of the 1,112 people surveyed said they supported government-provided national health insurance.

Physician support

Several groups, including the California Nurses Association and Physicians for a National Health Program, call for a single-payer option. While not supported by the American Medical Association, a nationalized health system got the backing of 59 percent of physicians in a poll published last year in the Annals of Internal Medicine.

The California Legislature has twice passed a state-level single-payer bill – in 2006 and 2008 – making it the first state to do so, but both times the effort was vetoed by Gov. Arnold Schwarzenegger. The legislation, authored by former state Sen. Sheila Kuehl, D-Santa Monica, has been reintroduced as by Sen. Mark Leno, D-San Francisco. Leno’s version is expected to meet the same fate as its predecessors.

Still, single payer has been largely dismissed from serious discussion on the national level as politically infeasible.

“It’s off the table in Washington because of the politics,” said Laurence Baker, associate professor of health research and policy at Stanford University.

Health insurers and drugmakers have contributed millions of dollars to members of Congress. One of the top recipients of that money, said Consumer Watchdog, an advocacy group based in Santa Monica, was Sen. Max Baucus, D-Montana, chairman of the Senate Finance Committee, who was running the hearings when the arrests took place this month. He accepted $413,000 in drug and health insurance campaign contributions during that time.

Many single-payer supporters interpret the resistance to the single-payer idea to be simply the result of a formidable lobbying effort by the health insurance and pharmaceutical industries, but Stanford’s Baker said the hurdles are more nuanced.

Distrust for government

Americans are clearly frustrated by the health care system. While some polls indicate that a majority of Americans favor single payer, some polls show a distrust of government’s ability to take over health care, he said. In a Kaiser Family Foundation poll released in April, just 35 percent of those surveyed expressed support for a government-run health system like Medicare.

As the debate continues, single-payer supporters have clearly ramped up their activity and tactics. The 50 demonstrations have been organized by a variety of groups including Healthcare-NOW!, Progressive Democrats of America and the Green Party.

But not all single-payer groups promote civil disobedience as a way to draw attention to the cause. Don Bechler, chairman and founder of Single Payer Now, a statewide advocacy group in San Francisco that helped organize the demonstrations, said he is more interested in drawing in more supporters than seeing people get arrested.

California nurse DeAnn McEwen didn’t set out to become one of the “Baucus 13,” the 13 arrested at the Senate Finance Committee hearings. She happened to be in Washington for a nurses’ union organizing committee meeting when she learned about the hearings.

McEwen, of Long Beach, a nurse for 35 years, said she felt compelled to speak out about the lack of a single-payer voice at the table.

“At that point, I felt I couldn’t be silent anymore because it was like I was seeing a gag, a hand covering the mouth of a victim,” McEwen said. “There’s therapy for the broken health care system, and any other reform that includes the insurance companies is not going to get us where we need to go in terms of providing equitable and fair coverage.”

E-mail Victoria Colliver at vcolliver@sfchronicle.com.

Conyers promises a fight to get health-care reform bill through Congress

By Tim Louis Macaluso
Rochester (NY) City Newspaper
May 31, 2009

To the Baby Boomers who packed the Rochester Museum and Science Center’s Eisenhart Auditorium last night, Representative John Conyers (D-MI) is something of a folk hero. He has pushed for health-care reform for more than a decade. In his soft-spoken Walt Disney-like voice, he said, “We’re at a crossroads in this country,” referring to the ailing US health-care system. Meeting President Barack Obama’s request for a bill he can sign into law by the end of this year that would reform health care is going to be difficult, he said.

Conyers is the author HR 676: The US National Healthcare Act, a single-payer approach to health-care reform. He was here to talk about the bill and the obstacles to getting it through the House and Senate at “Rochester Speaks Out.” The meeting also featured Representative Eric Massa (D-NY), actress and activist Mimi Kennedy, and University of Rochester professor Theodore Brown. Rochester was one of 50 cities nationwide holding similar meetings.

Conyers warned that just because Democrats hold power in the White House and control the House and the Senate, history shows that Democrats can’t be relied on for health-care reform any more than Republicans. Former President Bill Clinton and his wife, now Secretary of State Hillary Clinton, not only sought the wrong advice on crafting new legislation, they made it too complicated, Conyers said.

Obama, he said, is heading down a similar path.

“Some of the people in his Cabinet are not the smartest people,” Conyers said.

And he is worried that Democrats will not have the political will to stand up to opponents of single-payer care. Polling from mainstream media shows that the public knows that the health-care system doesn’t work, but is divided about action to correct it.

HR 676 has 75 co-sponsors, but there are Democrats who still have not signed on to the bill, including Rochester Representative Louise Slaughter. And some Democrats in Congress, Conyers said, are actively trying to block the bill.

Part of the reason similar bills have failed in the past, Kennedy said, is due to an attitude in American society that says, “Some people are going to suffer, probably due to their own self-inflicted misfortunes.” Many Americans seem to believe that the reason people don’t have health care is because they are unemployed or work low-skills jobs. More education is needed to help Americans shift away from a system that links health care to employers, Kennedy said.

Since taking office, Massa said that he has had 35 families come to him for help because a child or a parent was being denied life-saving medical care from insurance companies.

For more information on HR 676, go to www.pdagv.org

Baucus to Meet with Single Payer Advocates

SinglePayerAction.org
May 31, 2009

Guess who’s coming to dinner.

After months of proclaiming that single payer is off the table, Senator Max Baucus (D-Montana) has invited five key single payer advocates to meet with him in Washington, D.C. this week.

On Wednesday June 3, Senator Baucus will meet with Dr. David Himmelstein, Associate Professor of Medicine at Harvard Medical School and co-founder of Physicians for a National Health Program (PNHP), Dr. Marcia Angell, Senior Lecturer, Harvard Medical School and former editor-in-chief of the New England Journal of Medicine, Dr. Oliver Fein, Associate Dean, Cornell Weill Medical School, and President of PNHP, Rose Ann DeMoro, executive director of the California Nurses Association, and Geri Jenkins, president of California Nurses Association.

“Bowing to mounting pressure from single payer advocates around the nation, Senator Baucus has asked to meet with some representatives of the single payer movement,” Dr. Himmelstein said. “It’s the thirteen people who braved arrest at Senate Finance Committee hearing, the hundreds of single payer supporters who’ve shadowed Senator Baucus in his home state of Montana, and the thousands who have put pressure other members of Congress who have created this opening. We have no illusions that our discussions alone will persuade Senator Baucus to back a single payer bill. But the meeting is a clear indication that demonstrations and activism can move even our money-corrupted political culture.”

According to a recent analysis by the public interest group Consumer Watchdog, Senator Baucus, the leading architect of health reform in the Congress, has received more campaign contributions from the health insurance and pharmaceutical corporations than any other current Democratic member of the House or Senate.

According to the report, Senator Baucus received $183,750 from health insurance companies and $229,020 from drug companies in the last two election cycles.

During three recent Senate Finance Committee hearings on health care reform, Baucus invited 41 people to testify — not one of which was a single payer advocate.

This despite the fact that recent polls show that single payer is supported by a majority of Americans, doctors and health economists.

Baucus has been asked repeatedly in recent months to allow a single payer advocate to testify.

He has steadfastly refused.

“We’re keeping our eyes on the prize — enactment of a single payer, everybody in, nobody out, free choice of doctor and hospital health insurance system in the United States,” said Russell Mokhiber of Single Payer Action. “We won’t let up until single payer becomes a reality. And sooner or later single payer will become a reality because it’s the only system that is financially viable, that will cover all Americans, and that will end the nightmare of 60 Americans dying every day from lack of health insurance.”

“Senator Baucus has charged us with ‘disruption of Congress,'” said Mokhiber, who is one of thirteen citizens Baucus had arrested for demanding that single payer advocates be given a seat at the table. “But we are charging Baucus with corruption of Congress. We think we have a stronger case. And we hope to win the court case, break through the corrupt barriers in Congress and secure single payer for the American people.”

The next court date for the Baucus 13 is scheduled for June 22 before D.C. Superior Court Judge Harold L. Cushenberry.

Baucus Battered By Voters For Health Care Stand

By Ryan Grim
The Huffington Post
June 1, 2009

Sen. Max Baucus got some not-so friendly advice from his Montana constituents last week as he works to reform the health care system: You’re doing it all wrong.

Baucus, the chair of the Finance Committee and the leader of reform efforts in the Senate, scheduled 20 town hall meetings with constituents across the state to talk about the future of health care. The Senate was out of session, but Baucus, a Democrat, didn’t personally attend. Instead, he sent staff and a video-recorded message.

“I really want to hear from all of you,” Baucus said on the video, according to local media. “You’re my employers. You’re my bosses. You’re the people I work for. I’m just the hired hand. I want to hear what you want to see in any legislation we pass in Washington, D.C.”

He got what he asked for.

Five separate accounts of the meetings, published in four different local papers, show Montana voters were downright hostile to Baucus’ reform proposal. Baucus has been a staunch opponent of single-payer health care, a system in which the government would provide universal coverage.

Baucus has kept single-payer advocates out of negotiations and has yet to endorse a compromise proposal by Sen. Charles Schumer (D-N.Y.) that would give Americans the option of buying into a publicly run plan that would compete with private insurers.

That stance put his staffers up against a wall, facing angry constituents fed up by what they viewed as a lack of courage in Washington.

“Majority wants single-payer health care,” headlined an account in the Helena Independent Record.

At several of the events, Montanans’ ire was directed at Baucus chief of staff Jon Selib, who defended the employer-based coverage system that he estimated covers 150 million Americans.

“A lot of people like that,” Selib said.

When the time came for questions, [self-employed consultant Steve] McArthur stood up and asked a simple question. Looking across a standing-room-only crowd of about 275, he asked how many were happy with their employer-based health insurance.

Fewer than 10 people raised their hands.

“The [argument] is bogus,” McArthur said. “It’s not working for 95 percent of us.”

In fact, any mention of single-payer health care insurance brought raucous cheers and clapping. Any other solution to health care reform – including Baucus’ “balanced” plan that would create a mix of public and private plans – was received more coolly.

The bitter questioning led Selib to break some news at the meeting.

“If you think your insurance company is screwing you … then you’d have the option of going to the public plan,” Selib said. “Senator Baucus is fighting tooth and nail to include that in any final deal.”

Then he asked the standing-room-only audiences for comments — and got an earful, mostly on the whys, hows and whats of national health insurance as the preferred option.

Baucus’ staff repeatedly argued that 60 votes are needed to move a bill through the Senate and that single-payer, or an otherwise bold reform, simply wouldn’t pass. That wasn’t what they wanted to hear, said a story in the Missoulian, “Single-payer health care: Baucus keeps getting an earful.”

PABLO – Sen. Max Baucus’ insistence that consideration of a national single-payer health plan at this point will squander a golden opportunity for health care reform in the United States continues to be met with stiff resistance from many of his constituents.

“The word ‘insurance’ does not equal health care,” Janelle Kuechle of Polson said at a meeting here Thursday. “If I have to pay a $900 premium to have health insurance with a $10,000 deductible, that is not health care.”

“Congress ought to be representing us instead of the insurance lobby,” said retired school teacher John Oberlitner of Polson. “Max Baucus has stated it’s not feasible to pass a single-payer health plan, but one year ago people were saying it was not feasible that Obama could be elected our president.”

Voters in Livingston weren’t much warmer, recorded the Bozeman Daily Chronicle.

But many in the audience grilled a Baucus staffer on why they wouldn’t allow single-payer advocates to participate in roundtables held to form his plan. Several doctors were arrested for protesting that point in Washington two weeks ago during a Baucus-led discussion.

Judy Moor of Bozeman asked whether the big campaign dollars Baucus has received from the insurance industry was reason for suspicion.

“Single-payer advocates not giving up the fight,” observed the Great Falls Tribune.

Proponents of single-payer showed up en masse at the most well-attended meetings in Missoula, Hamilton, Anaconda, Dillon and Livingston to urge Baucus — the chairman of the Senate Finance Committee — to consider single-payer universal health care. Single payer — a system in which the government provides health insurance to all Americans — has been declared “off the table” by Baucus, Congress’ leading man on heath care reform.

Baucus isn’t pushing hard enough, said a Helena business owner, summing up the statewide wisdom. “Max is really making me mad now because he’s not really trying to change the system, he’s just trying to tweak it.”

Health reform plan is endorsed

Rep. Conyers urges single-payer system

By Laura Ungar
Louisville Courier-Journal
May 31, 2009

Despite resistance from President Barack Obama and some members of Congress, Rep. John Conyers of Michigan said yesterday he’ll keep fighting for a publicly financed, privately delivered “single payer” health-care system that covers all Americans.

“All who are ready to fight for what they believe is right in health care, raise your hand,” he told more than 150 people at the Making Health Care Happen single-payer seminar at Indiana University Southeast in New Albany. “You’re not gonna get it without a contest. And I’m looking forward to a contest.”

His talk was one of several planned throughout the country. It was partially funded by the Presbyterian Church (U.S.A.) and sponsored by Hoosiers for a Commonsense Health Plan, Kentuckians for Single Payer Healthcare and Physicians for a National Health Program.

Conyers, a Democrat serving his 21st term in the House, introduced a bill nine years ago — and every year since — to expand Medicare so that everyone would be covered regardless of employment, income or health. He said the measure, called H.R. 676, has 77 co-sponsors and the endorsement of more than 4,000 physicians.

But many political leaders and constituents oppose such single-payer proposals, with some expressing fear of big government and the rationing of care. And as the debate heats up nationally, even some who support the concept are saying it may not be politically feasible.

According to an Associated Press report, Obama said at a meeting in New Mexico that if he were building a health-care system from the ground up, he would favor a single-payer system. But he currently favors improving the existing system because many people are satisfied with it, he said.

Conyers said some members of Congress have told him privately that his bill will never pass because of corporate forces. “There’s nothing wrong with the bill,” he said they tell him. “We just aren’t ready for it.”

But Conyers disagreed. “Now is the time!” he said to applause.

Rep. John Yarmuth, D-3rd District, who was also at the seminar, said he strongly supports H.R. 676 and Conyers.

“One thing you learn the more you serve with John Conyers is he is always right,” Yarmuth said. “And where health-care reform is concerned, we know he is right.”

But Conyers acknowledged it will be difficult to win more support. In the meantime, he said he would support a compromise bill offering a private insurance option and a strong public option — as long as Congress has a hearing on his bill

Audience member Edith Kenna of Fort Wayne, Ind., said she doesn’t want a compromise.

Kenna, 62, a licensed clinical social worker, said her entrepreneur son has no insurance. And her 34-year-old daughter, a former kindergarten teacher, is facing the prospect of losing her COBRA insurance after a series of medical problems beginning with severe rheumatoid arthritis that put her in a wheelchair.

As a Conyers aide passed her, Kenna handed him a card with her daughter’s name and said, “She’s gonna die without H.R. 676.”

Costs are growing

About 46 million Americans lack health insurance, and even those who have it often find themselves underinsured. A Courier-Journal investigation last year found that skyrocketing deductibles, premiums and other issues are forcing an increasing number of families to choose between finances and health.

As health-care costs have grown, so has mainstream support for universal health care. Last year the U.S. Conference of Mayors passed a resolution in favor of Conyers’ bill. And according to an April New York Times/CBS News poll, 57 percent of respondents said they’d be willing to pay higher taxes so all Americans could have insurance they can’t lose.

But according to research released last year by consulting firm Watson Wyatt Worldwide, 84 percent of U.S. companies are either opposed to or “not very supportive of” a universal system such as a single-payer system.

And even some groups that favor covering the uninsured don’t want to go as far as single payer. For example, the Kentucky Medical Association, a professional organization for doctors, passed a resolution that keeps insurance companies in the equation.

In the public’s hands

Conyers said he’s unwilling to let anyone hold him or his bill’s supporters back.

“We have to make a decision: Are we going to get rolled or not?” he said.

At the end of the talk, he said he was leaving for a similar gathering in Rochester, N.Y., and asked if a few people wanted to join him. Kenna said she would.

Dr. Rob Stone, an emergency room doctor from Bloomington, Ind., said he sees the need for health-care reform every day. A couple of summers ago, he said, a man in his late 50s came in complaining of chest pain. Stone said the man told him that the pain had been worse two weeks earlier, but he didn’t see a doctor.

“I don’t have insurance,” Stone recalled him saying. “I was worried about the bill.” As a result, a piece of his heart had died.

Conyers said he’s heard many such stories but added that the future of U.S. health care is in the people’s hands.

“What kind of health-care bill are we gonna get? I’m here to predict you get the kind you deserve, not the kind you oughta have, not the kind you want,” he said. “It all depends on you.”

Reporter Laura Ungar can be reached at (502) 582-7190.

150 protest against private health insurers

Demonstrators urge universal care in U.S.

By Linsen Li
Louisville Courier-Journal
May 29, 2009

Margaret Sager of Floyds Knobs, Ind., took part in the downtown Louisville rally.

Brent Humes has not had health insurance for 15 years.

“At my past jobs, signing up for health insurance means cutting my paycheck in half,” said Humes, who is currently unemployed.

He was among about 150 people who gathered yesterday across from Humana’s downtown Louisville headquarters to protest private insurance companies.

The demonstration, organized by Kentuckians for Single Payer Healthcare and Physicians for a National Health Program, is part of a national effort to establish a universal health-care plan.

“Our purpose is to educate the public and politicians about how the single-payer plan is the best option,” said Dr. Ewell Scott, an internist in Morehead, Ky.

“A single, government-sponsored health-insurance company is more efficient and provides coverage for everyone,” Scott said. “It is by far and away the best solution to the country’s health-care problem.”

President Barack Obama has proposed widespread health-care reforms, but hasn’t advocated doing away with private insurance. He has called for a public health plan that could compete with private insurers. He also has proposed subsidies to help lower-income people buy coverage.

The differences between health-insurance companies and the protesters are smaller than they appear, said Jim Turner, a Humana spokesman.

“Our ultimate objective is to make health care affordable for everyone; in that sense Humana is in agreement with the protesters,” he said.

He added, however, that private health-insurance companies like Humana are here to stay.

“There will always be a need for public-private cooperation in the health-care system,” Turner said. “The government looks to the private sector for contributions such as innovation.”

While Humes said he has not been greatly affected so far by not having health insurance, he hopes to be insured once health care is more affordable.

“I suspect one day I will need it,” he said.

Single-payer topic dominates health-care listening sessions

By MIKE DENNISON
Billings Gazette
Wednesday, May 27, 2009

ANACONDA – In a packed meeting room today at Anaconda’s hospital, state worker and Butte resident Anna Dockter asked U.S. Sen. Max Baucus’ chief of staff the question on everyone’s mind: Why is national, public health insurance for all not being considered as a reform option?

“We’re all recounting our experiences with private health insurance,” she said. “We have pretty good insurance, and we’re still paying thousands of dollars (for our medical care.)”

John Selib, Baucus’ chief of staff in Washington, D.C., gave the same answer he gave four hours earlier at a similar meeting in Dillon: A national, “single-payer” health plan won’t pass Congress.

“There is a single-payer bill introduced in the Senate,” Selib said. “It does not have a single co-sponsor. There’s some pretty simple arithmetic you need to do. … It takes 60 votes to pass something in the Senate.”

Selib went on to say that Baucus, Montana’s senior senator and the national point man for health-care reform, wants the same thing that single-payer advocates want: broad-based, affordable health coverage for all Americans.

Insisting on single-payer as the only, best option could lead to no reform at all, while other approaches will accomplish much of what public-insurance advocates want, he said.

“Both (single-payer advocates) and Baucus believe that we need to do something to fix the system,” Selib said. “We have a chance to fix that now. … I think if it’s out there on the table, we should take it.”

Yet Selib’s protestations didn’t stop the questions and comments about single-payer, which is the technical term for national, taxpayer-financed health insurance for all.

“If you get a major illness in this country, plan to spend the next two years of your life sorting out the paperwork on what you end up paying,” said Sheila Roberts, a University of Montana-Western professor who attended the Dillon meeting. “If you get a major illness in Canada (which has a single-payer system), you go to the hospital and you don’t even sign anything. You go home and that’s it, it’s over.”

The Anaconda and Dillon meetings are among two dozen “listening sessions” that Baucus staffers are holding this week, primarily in small- and medium-sized towns across Montana.

Selib opening each meeting Wednesday with an explanation of the reform ideas supported and pursued by Baucus, a Democrat who chairs the powerful Senate Finance Committee. A health-care reform bill or bills are expected to be introduced by the end of June and on the Senate floor this summer, Selib said.

Ideas and principals supported by Baucus include health-insurance reforms that will make it easier for the uninsured to buy private insurance and a “public option” insurance plan offered by the government as competition for private insurers, he said.

“If you think your insurance company is screwing you … then you’d have the option of going to the public plan,” Selib said. “Senator Baucus is fighting tooth and nail to include that in any final deal.”

Then he asked the standing-room-only audiences for comments – and got an earful, mostly on the whys, hows and whats of national health insurance as the preferred option.

When someone asked what a single-payer system might cost, Selib said he didn’t know – and that prompted Mark Phillip, an engineer from Anaconda, to speak up from the back of the room at Anaconda Community Hospital.

“Doesn’t Canada spend 60 percent per capita (on health care) that we spend?” Phillip said. “That’s a pretty good estimate.”

Phillip said later that he had worked for 3 1/2 years in Alberta, and didn’t see any major problems with Canada’s system, where all citizens are covered by public health insurance.

Linda Lodden, a retired state worker from Anaconda, asked the crowd whether all Americans should have the same health care and same health insurance, including members of Congress and the president – essentially, a single-payer system. Nearly all hands in the audience went up.

Yet those who professed support for a national, single-payer system didn’t necessarily insist it’s the only way to go.

Mary Jo O’Rourke of Dillon, whose husband runs a dental clinic in town, urged Baucus to pass what reforms he could, and to make sure to include the “public option” insurance to compete with private insurance and to preserve regulations for small-business “associations” that buy group insurance.

“If we push so hard for a single-payer system, which is what I believe in … if we press so hard for that, then we may get nothing,” she said.