PNHP

Himmelstein and Woolhandler on a public plan option

Himmelstein and Woolhandler on a public plan option

Public Plan Option in a Market of Private Plans

By David Himmelstein, M.D. and Steffie Woolhandler, M.D., M.P.H.:
The “public plan option” won’t work to fix the health care system for two reasons.
1. It forgoes at least 84 percent of the administrative savings available through single payer. The public plan option would do nothing to streamline the administrative tasks (and costs) of hospitals, physicians offices, and nursing homes, which would still contend with multiple payers, and hence still need the complex cost tracking and billing apparatus that drives administrative costs. These unnecessary provider administrative costs account for the vast majority of bureaucratic waste. Hence, even if 95 percent of Americans who are currently privately insured were to join the public plan (and it had overhead costs at current Medicare levels), the savings on insurance overhead would amount to only 16 percent of the roughly $400 billion annually achievable through single payer — not enough to make reform affordable.
2. A quarter century of experience with public/private competition in the Medicare program demonstrates that the private plans will not allow a level playing field. Despite strict regulation, private insurers have successfully cherry picked healthier seniors, and have exploited regional health spending differences to their advantage. They have progressively undermined the public plan — which started as the single payer for seniors and has now become a funding mechanism for HMOs — and a place to dump the unprofitably ill. A public plan option does not lead toward single payer, but toward the segregation of patients, with profitable ones in private plans and unprofitable ones in the public plan.
www.pnhp.org

The option to purchase a public plan within a market of private health insurance plans would merely provide one more player in our inefficient, dysfunctional, fragmented, multi-payer system of financing health care, that is if the public option even survives the political process. It would leave in place the deficiencies that have resulted in very high costs with the poorest health care value of all nations (i.e., overpriced mediocrity in health care).
Those who believe that the people of this nation would have the wisdom to drop their private plans and join the government program are ignoring history. When Congress authorized private plans to compete with our existing public program, Medicare, many enrollees did just the opposite. One-fifth have left the traditional Medicare program and joined the private plans.
So why should we care? Why shouldn’t they have the right to choose private plans if they want them? We know that those private plans are wasting money, both in their own costs and the administrative burden they place on the delivery system, but what all too many don’t realize is that we are all paying for that waste because of the inherent structural deficiencies in our financing system. Plus we are being deprived of the reforms needed in our health care delivery system that our own single payer monopsony would bring us.
Single payer activists, don’t give up. As President Obama said in his press conference this week, “persistence!”

Himmelstein and Woolhandler on a public plan option

Public Plan Option in a Market of Private Plans

By David Himmelstein, M.D. and Steffie Woolhandler, M.D., M.P.H.:

The “public plan option” won’t work to fix the health care system for two reasons.

1. It forgoes at least 84 percent of the administrative savings available through single payer. The public plan option would do nothing to streamline the administrative tasks (and costs) of hospitals, physicians offices, and nursing homes, which would still contend with multiple payers, and hence still need the complex cost tracking and billing apparatus that drives administrative costs. These unnecessary provider administrative costs account for the vast majority of bureaucratic waste. Hence, even if 95 percent of Americans who are currently privately insured were to join the public plan (and it had overhead costs at current Medicare levels), the savings on insurance overhead would amount to only 16 percent of the roughly $400 billion annually achievable through single payer — not enough to make reform affordable.

2. A quarter century of experience with public/private competition in the Medicare program demonstrates that the private plans will not allow a level playing field. Despite strict regulation, private insurers have successfully cherry picked healthier seniors, and have exploited regional health spending differences to their advantage. They have progressively undermined the public plan — which started as the single payer for seniors and has now become a funding mechanism for HMOs — and a place to dump the unprofitably ill. A public plan option does not lead toward single payer, but toward the segregation of patients, with profitable ones in private plans and unprofitable ones in the public plan.

www.pnhp.org

Comment:

By Don McCanne, MD

The option to purchase a public plan within a market of private health insurance plans would merely provide one more player in our inefficient, dysfunctional, fragmented, multi-payer system of financing health care, that is if the public option even survives the political process. It would leave in place the deficiencies that have resulted in very high costs with the poorest health care value of all nations (i.e., overpriced mediocrity in health care).

Those who believe that the people of this nation would have the wisdom to drop their private plans and join the government program are ignoring history. When Congress authorized private plans to compete with our existing public program, Medicare, many enrollees did just the opposite. One-fifth have left the traditional Medicare program and joined the private plans.

So why should we care? Why shouldn’t they have the right to choose private plans if they want them? We know that those private plans are wasting money, both in their own costs and the administrative burden they place on the delivery system, but what all too many don’t realize is that we are all paying for that waste because of the inherent structural deficiencies in our financing system. Plus we are being deprived of the reforms needed in our health care delivery system that our own single payer monopsony would bring us.

Single payer activists, don’t give up. As President Obama said in his press conference this week, “persistence!”

Media Advisory: Single-payer supporters to rally at March 31 health forum in Greensboro

Physicians, nurses and health reform advocates to urge enactment of an improved 'Medicare for All,' decry outsized influence of corporate medicine at regional meeting

FOR IMMEDIATE RELEASE
March 26, 2009

Contacts:
Jonathan Kotch, M.D.
Mark Almberg, PNHP, (312) 782-6006, cell: (312) 622-0996, mark@pnhp.org

What

Press conference and rally to express support for single-payer national health insurance and to protest the “marginalization of majority opinion” at Tuesday’s White House Forum on Health Care Reform at the North Carolina A&T Alumni Foundation Event Center in Greensboro, at 9 a.m. EDT.

The health forum will be hosted by North Carolina Gov. Bev Perdue. Senior White House policy officials will participate and help moderate a discussion involving diverse stakeholders in health care reform, according to Perdue’s office.

Advocates of single-payer national health insurance, sometimes called an improved “Medicare for All,” will be inside and outside, urging that single payer be “on the table” as a full-fledged option for reform. They will also decry the outsized role of the private health insurance industry, Big Pharma, and other representatives of corporate medicine at the forum.

Physicians wearing their white coats and other health reform advocates will assert that national health insurance is being accorded a minor, marginalized role at the forum, even though surveys show two-thirds of Americans and 59 percent of U.S. physicians support it.

They will demand that the single-payer model be given pride of place in the health care debate in view of that model’s effectiveness in providing truly universal, comprehensive care; its ability to contain costs; and the fact that the annual savings in administrative costs — $400 billion — would mean that a U.S. single-payer system would require no increase in overall health spending.

The pro-single-payer rally is co-sponsored by Health Care for All NC, the state chapter of Physicians for a National Health Program (PNHP); Progressive Democrats of America and its local coalition partner, Progressive Democrats of North Carolina; and Healthcare-Now, a national grassroots coalition for single-payer health reform.

Dr. Jonathan Kotch said today: “The single-payer alternative to industry-driven proposals has been systematically ignored until PNHP and others took their message to the streets. It is only through direct action that the political and financial power of insurance, pharmaceutical and for-profit medical interests can be challenged. The majority of the people want single payer, and our message to the White House is, pay attention.”

Who

Jonathan Kotch, M.D., professor of maternal and child health, University of North Carolina at Chapel Hill
Miriam Thompson, M.S.W., Health Care for All – North Carolina
Carol Shores, M.D., an ear, nose and throat specialist in Chapel Hill

When

9 a.m. EDT, Tuesday, March 31

Where

North Carolina A&T Alumni Foundation Event Center, 200 N. Benbow Rd., Greensboro, N.C.

###

Physicians for a National Health Program (www.pnhp.org), a membership organization of over 16,000 physicians, supports a single-payer national health insurance program. PNHP is headquartered in Chicago and has chapters across the United States. To contact a physician-spokesperson in your area, contact info@pnhp.org or call (312) 782-6006.

Press Release: Single-payer health reform bill introduced in Senate

Would save $400 billion on bureaucracy, enough to cover all 46 million uninsured Americans

FOR IMMEDIATE RELEASE
March 26, 2009

Contacts:
Quentin Young, M.D., (312) 782-6006
Mark Almberg, (312) 782-6006, cell: (312) 622-0996, mark@pnhp.org

Challenging head-on the powerful private insurance and pharmaceutical industries, Vermont’s Sen. Bernie Sanders introduced a single-payer health reform bill, the American Health Security Act of 2009, S. 703, in the U.S. Senate Wednesday. The bill is the first to directly take on the powerful lobbies blocking universal health reform in the Senate since Sen. Paul Wellstone’s tragic death.

The single-payer approach embodied in Sanders’ new bill stands in sharp contrast to the reform models being offered by the White House and by key lawmakers like Senators Max Baucus (D-Mont.) and Edward Kennedy (D-Mass.). Their plans would preserve a central role for the private insurance industry, sacrificing both universal coverage and cost containment during the worst economic crisis since the Depression.

In contrast, Sanders’ new legislation would cover all of the 46 million Americans who currently lack coverage and improve benefits for all Americans by eliminating co-pays and deductibles and restoring free choice of physician. The most fiscally conservative option for reform, single payer slashes private insurance overhead and bureaucracy in medical settings, saving over $400 billion annually that can be redirected into clinical care.

“This is excellent news for the nation’s health,” said Dr. Quentin Young, national coordinator of Physicians for a National Health Program and a past president of the American Public Health Association. “There is now an affordable cure for our dysfunctional health care system. In the face of our present economic calamity, this is an urgent necessity.”

Highlights of the bill include the following:

* Patients go to any doctor or hospital of their choice.

* The program is paid for by combining current sources of government health spending into a single fund with modest new taxes amounting to less than what people now pay for insurance premiums and out-of-pocket expenses.

* Comprehensive benefits, including coverage for dental, mental health, and prescription drugs.

* While federally funded, the program is to be administered by the states.

* By eliminating the high overhead and profits of the private, investor-owned insurance industry, along with the burdensome paperwork imposed on physicians, hospitals and other providers, the plan saves at least $400 billion annually – enough money to provide comprehensive, quality care to all.

* Community health centers are fully funded, giving the 60 million Americans now living in rural and underserved areas access to care.

* To address the critical shortage of primary care physicians and dentists, the bill provides resources for the National Health Service Corps to train an additional 24,000 health professionals.

“We are confident that Sen. Sanders’ bill will accelerate the national drive for the only reform that we know will work,” Young said. “A majority of physicians endorse such an approach. Fifty-nine percent of U.S. physicians support national health insurance. Two-thirds of the public also supports such a remedy. We remember well that President Obama once acknowledged that single-payer national health insurance was the best way to go. It still is.”

Sanders, who serves on the Senate Committee on Health, Education, Labor, and Pensions, is a longtime advocate of fundamental health care reform. His new bill draws heavily upon the single-payer legislation introduced by the late Sen. Paul Wellstone (D-Minn.) in 1993, S. 491, and closely parallels similar legislation pending before the House, H.R. 1200, introduced by Rep. Jim McDermott (D-Wash.).

A single-payer bill introduced by Rep. John Conyers Jr. (D-Mich.), H.R. 676, obtained 93 co-sponsors in the House during the last session. It has been reintroduced in the new Congress as the U.S. National Health Care Act with the same bill number.

A copy of the bill is available here. (PDF)

Physicians for a National Health Program, a membership organization of over 16,000 physicians, supports a single-payer national health insurance program. To contact a physician-spokesperson in your area, call (312) 782-6006 or visit www.pnhp.org/stateactions.

Culling dependent coverage a great return on investment

Employers getting more strict on health-care eligibility

By Steve Twedt
Pittsburgh Post-Gazette
March 25, 2009
Facing a difficult economy and running short of ways to reduce health-care costs, employers are becoming more aggressive about checking the eligibility of their workers’ dependents.
A Watson Wyatt survey of 489 employers this month for the National Business Group on Health found that audit reviews are the fastest growing change that companies are making to their health-care programs, well ahead of health risk appraisals or improving case management.
During an eligibility audit, employees are asked to document that family members on their health plans are eligible for coverage. They may be required to produce marriage certificates, proof of college enrollment or tax forms. Ex-spouses are not eligible. Nor are sickly uncles who live with the family. Stepchildren may not be eligible either, depending on the plan.
The appeal of eligibility audits is that they almost guarantee hard-dollar savings — with estimates of ineligible dependents typically in the 5 to 12 percent range — and they often can pay for themselves within a year.
“We have completed dependent eligibility audits for over 50 employers and we have yet to have a case where the employer did not receive a return on investment of over 300 percent within one year. Many times it is well over 1,000 percent,” said Michael Browning of Chapman Kelly, Inc., consultants in Jeffersonville, Ind.
Pittsburgh-based Daniel Priga, a principal with Mercer consulting, said the firm “conservatively” estimates a $1,900 savings per year for every ineligible dependent taken off the books. Such a return “is hard to find in today’s environment.”
http://www.post-gazette.com/pg/09084/957986-28.stm

Doing eligibility audits of dependents covered by employer-sponsored plans is yet one more example wherein our current dysfunctional system of financing health care actually promotes administrative waste. A rational system uses administrative services efficiently to pay for the health care that patients need. In the United States, much of the administrative cost of health care financing is due to efforts to avoid paying for health care.
Only in the United States do we consider that taking health insurance away from individuals to be a “return on investment.”

Culling dependent coverage a great return on investment

Employers getting more strict on health-care eligibility

By Steve Twedt
Pittsburgh Post-Gazette
March 25, 2009

Facing a difficult economy and running short of ways to reduce health-care costs, employers are becoming more aggressive about checking the eligibility of their workers’ dependents.

A Watson Wyatt survey of 489 employers this month for the National Business Group on Health found that audit reviews are the fastest growing change that companies are making to their health-care programs, well ahead of health risk appraisals or improving case management.

During an eligibility audit, employees are asked to document that family members on their health plans are eligible for coverage. They may be required to produce marriage certificates, proof of college enrollment or tax forms. Ex-spouses are not eligible. Nor are sickly uncles who live with the family. Stepchildren may not be eligible either, depending on the plan.

The appeal of eligibility audits is that they almost guarantee hard-dollar savings — with estimates of ineligible dependents typically in the 5 to 12 percent range — and they often can pay for themselves within a year.

“We have completed dependent eligibility audits for over 50 employers and we have yet to have a case where the employer did not receive a return on investment of over 300 percent within one year. Many times it is well over 1,000 percent,” said Michael Browning of Chapman Kelly, Inc., consultants in Jeffersonville, Ind.

Pittsburgh-based Daniel Priga, a principal with Mercer consulting, said the firm “conservatively” estimates a $1,900 savings per year for every ineligible dependent taken off the books. Such a return “is hard to find in today’s environment.”

http://www.post-gazette.com/pg/09084/957986-28.stm

Comment:

By Don McCanne, MD

Doing eligibility audits of dependents covered by employer-sponsored plans is yet one more example wherein our current dysfunctional system of financing health care actually promotes administrative waste. A rational system uses administrative services efficiently to pay for the health care that patients need. In the United States, much of the administrative cost of health care financing is due to efforts to avoid paying for health care.

Only in the United States do we consider that taking health insurance away from individuals to be a “return on investment.”

Health care for all, but how?

Forum panelists promote single-payer system

By John McVey
The Journal (WV)
March 25, 2009

SHEPHERDSTOWN — The panelists at the “Health Care for All – How?” forum Tuesday evening started with the premise that the way Americans pay for health care needs to be changed.

Their question was, “How do we get there from here?”

Dr. Margaret Flowers of Maryland Physicians for a National Health Program and Richard McVay of Penn Action were the panelists for the forum, which was sponsored by Eastern Panhandle Single-Payer Action Network and the Shepherd University Health Center.

Hannah Geffert, an adjunct professor at Shepherd, was the moderator.

Almost 100 people attended the symposium in the Robert C. Byrd Center for Legislative Studies on the Shepherd campus.

Flowers, who left her pediatrics practice to work full time on a single-payer health care system, gave a bit of the history of how health care is paid for in America.

She said that during World War II, companies were prohibited from giving raises to employees, so in order to attract and keep the best workers, businesses began offering benefits, such as paid health care insurance, to their employees.

“No other country ties health insurance to employers like we do,” she said.

The health care provider dynamic changed in the 1980s, Flowers said. Private, for-profit health care providers became dominant.

“Patients became customers, and health care became a commodity,” she said.

This system is very good at making money but not very good at providing health care, Flowers said.

To her, the solution is a single-payer, publicly funded, privately delivered, health care system, namely, the expansion of Medicare to cover everyone in the country from cradle to grave.

The shift would take place all at once, without a transition period in which private and public insurance companies would compete for customers.

However, she said there is a large, well-heeled special interest group that opposes such a plan – insurance companies.

“They love mandatory insurance, subsidies and a public-private partnership,” Flowers said. “They don’t like a single-payer program.”

She and McVay agree that the time is ripe to push for reforming the way Americans pay for health care.

“We have to get it done this year,” McVay said. “The alignment is right. The mood of the people is right. The next big issue is health care, and we can’t straighten out the economy without health care reform.”

He also agreed that there is a big battle ahead because of monied interests opposing any kind of reform that would take the private insurance companies out of the picture.

However, McVay would like to see a hybrid form of payer system, at least to start. There would be both private insurance companies and a public system competing for customers, although he said the single-payer system eventually would win out.

Responding to a question from the audience, McVay said his group wants to start at the state level.

“Politically, it makes sense to start with the states, build a system, a model, and then take it to the federal level,” he said.

Minimum wage and Social Security started with the states, then were adopted by the federal government, McVay said.

The key to changing the system is getting business on board, he said.

McVay and Flowers also agreed without hesitation that health care is a human right.

“The way (health care) is delivered in this country is immoral,” McVay said.

For more information about EPSPAN, call (304) 671-0433, (304) 876-3158, or e-mail epspan@gmail.com

N.H. house backs single-payer health plan

New Hampshire Business Review
Wednesday, March 25, 2009

The New Hampshire House went on record in favor of a single-payer national health-care system Tuesday, in a last minute, 192-150 roll call vote.

Rep. Jill Shaffer Hammond, D-Peterborough, spoke for the resolution, HCR2, which supports the federal National Health Insurance Act and calls for similar coverage offered in other industrialized nations. The federal act, currently languishing in Congress, goes far beyond what President Obama, and most Democratic candidates running to the left of him, proposed in the last campaign. The act would increase the Medicaid payroll tax to 4.5 percent from 1.2 percent, allowing the federal government to insure everyone not currently insured, said Shaffer Hammond Ć¢ā‚¬ā€œ an amount, she contended, that is far lower than the amount most people currently pay for health insurance.

Already, she said, the government pays for veterans, elderly and the poor, and all high-risk groups with expensive coverage.

Add on government workers, and “we are more than 60 percent there already,” she said.

“No more would the small-business owner faced with a 23 percent increase in insurance premiums have to negotiate a 16 percent increase and then talk to their employees about doubling their deductible,” she said. “No more would a family have to face medical bankruptcy. Let’s liberate our small business to compete locally, nationally and globally.”

Rep. John Hunt, R-Rindge who asked for the roll call vote, urged representatives to vote against the bill, adding “say no to payroll taxes.”

Battle over public option to private insurance plans

Health-Care Battle Set to Focus on Public Plan

By Laura Meckler
The Wall Street Journal
March 24, 2009
Congress is poised for a battle over whether an ambitious health-care overhaul should include a new government-run health plan to compete with private companies in the effort to cover the uninsured.
The matter is likely to come to a head first in the Senate Finance Committee, where Chairman Max Baucus (D., Mont.) has pledged to write a bipartisan bill. His partner, Sen. Charles Grassley of Iowa, the top Republican on the panel, is adamantly opposed to the provision for a public health-care plan. As such, aides in both parties say it’s unlikely a public plan will be included in the legislation now being negotiated.
The House of Representatives, on the other hand, is likely to include the provision in its version of the bill, expected in late spring or early summer, aides say. That suggests the issue would have to be worked out in negotiations between the chambers later this year.
But opponents say a public plan would be an unfair competitor because it could become big enough to drive down reimbursements to doctors and hospitals, much like Medicare does, putting more cost pressure on the private sector. Consumers would then flock to the public plan because its premiums would be cheaper, opponents fear, and ultimately no viable private plans would remain.
Insurance companies, many of which support other aspects of the health-system overhaul, strongly oppose a public plan, said Karen Ignagni, president of America’s Health Insurance Plans, the industry lobby group. “It’s a very short step to a Medicare-like program for all Americans in a single-payer system,” she said.
http://online.wsj.com/article/SB123785156695519283.html

And…

Hearing: Addressing Insurance Market Reform in National Health Reform

U.S Senate Committee on Health, Education, Labor, and Pensions
March 24, 2009
Senator Tom Harkin: I want to ask about a public plan… Can a public plan coexist with private insurance plans? That seems to be a question I’m getting all of the time. Can we have a health reform that has all these private plans, and then have a public plan?
Ronald A. Williams, MS, Chairman and Chief Executive Officer, Aetna Inc.: My opinion is no, it cannot…
Janet Trautwein, Executive Vice President and CEO, National Association of Health Underwriters: I would just add to that, and also I don’t think it is possible for a public and private sector to compete on a level playing field. I don’t see any way that that’s possible…
Karen Pollitz, M.P.P., Research Professor, Health Policy Institute at Georgetown University: Private health insurance and public plans coexist today… …I think it’s absolutely essential.
Karen Ignagni, M.B.A., President and CEO, America’s Health Insurance Plans: …what we have done is propose an aggressive system of government regulation that would supervise private sector competition…
Len Nichols, Ph.D, Director, Health Policy Program at the New America Foundation: …if we just decide to put everybody into Medicare, except for the private plans that would survive for maybe three years… we’re going to end up with a system that is basically going to be run from Washington and Baltimore… think about a public plan model more like what state employees do… …let it compete with the private insurance industry… …a PPO type arrangement… We would suggest even stronger firewalls between the people who run the new marketplace and the people who run the plan…
Katherine Baicker, PhD, Professor of Health Economics, Department of Health Policy and Management at the Harvard School of Public Health: …I worry that in practice one ends up doing more harm than good…
Sandy Praeger, Health Insurance Commissioner, State of Kansas: The public plan… and I’ve read Dr. Nichols’ report… and I think he makes some very good points. …if it’s competing on a level playing field with the private marketplace… If you have equal rules and are treating the public plan the same as the private plan, it can help drive market changes…
http://help.senate.gov/Hearings/2009_03_24/2009_03_24.html

Perhaps the surest sign of trouble for the proposal to offer a public Medicare-like plan to compete with private insurance plans is the commitment of Finance Chairman Max Baucus that reform will be bipartisan along with the adamant opposition of a public option by Ranking Member Charles Grassley. Having discarded other public insurance proposals such as single payer, even before the negotiations began, the competing Medicare-like option is standing alone as the obvious trade-away for achieving political consensus.
The insurance industry contends that a public plan would provide “unfair” competition to the private plans, just as the private Medicare Advantage plans had to be granted large overpayments to counter the “unfair” advantage of the traditional public Medicare program. It is surprising how many others perpetuate this framing that the private insurers should be granted extra tax dollars in order to level the playing field with a more efficient government health financing system. The real unfairness is gifting taxpayer funds to the private insurers.
So what is being proposed as a compromise public insurance option? Let’s have the government set up a private insurance-style PPO, and require it to copy the private sector business model of taking away choice through restricted provider lists, expanding administrative functions including the necessity of marketing its product, competing on benefits and cost-sharing provisions, and engaging in all of the other non-beneficial excesses of the marketplace. Just to be absolutely certain that the public option has all of the flaws of the private health plans, Len Nichols would put up even stronger firewalls between the government administrators and the government’s own public option disguised as a private plan. And this ridiculous effort to “level” the playing field is all for the benefit of… not the patients… but the insurers!
What is sad is that the enemies of reform have already won. They have managed to eliminate comprehensive reform from the national dialogue and have reduced the debate to whether or not we’ll add one more plan, a public plan, to our dysfunctional, fragmented, multi-payer system that costs so much and serves us so poorly. Anyone who believes that the mere additional option of purchasing a public insurance plan is going to transform our health care system is living in La La Land.

Battle over public option to private insurance plans

Health-Care Battle Set to Focus on Public Plan

By Laura Meckler
The Wall Street Journal
March 24, 2009

Congress is poised for a battle over whether an ambitious health-care overhaul should include a new government-run health plan to compete with private companies in the effort to cover the uninsured.

The matter is likely to come to a head first in the Senate Finance Committee, where Chairman Max Baucus (D., Mont.) has pledged to write a bipartisan bill. His partner, Sen. Charles Grassley of Iowa, the top Republican on the panel, is adamantly opposed to the provision for a public health-care plan. As such, aides in both parties say it’s unlikely a public plan will be included in the legislation now being negotiated.

The House of Representatives, on the other hand, is likely to include the provision in its version of the bill, expected in late spring or early summer, aides say. That suggests the issue would have to be worked out in negotiations between the chambers later this year.

But opponents say a public plan would be an unfair competitor because it could become big enough to drive down reimbursements to doctors and hospitals, much like Medicare does, putting more cost pressure on the private sector. Consumers would then flock to the public plan because its premiums would be cheaper, opponents fear, and ultimately no viable private plans would remain.

Insurance companies, many of which support other aspects of the health-system overhaul, strongly oppose a public plan, said Karen Ignagni, president of America’s Health Insurance Plans, the industry lobby group. “It’s a very short step to a Medicare-like program for all Americans in a single-payer system,” she said.

http://online.wsj.com/article/SB123785156695519283.html

And…

Hearing: Addressing Insurance Market Reform in National Health Reform

U.S Senate Committee on Health, Education, Labor, and Pensions
March 24, 2009

Senator Tom Harkin: I want to ask about a public plan… Can a public plan coexist with private insurance plans? That seems to be a question I’m getting all of the time. Can we have a health reform that has all these private plans, and then have a public plan?

Ronald A. Williams, MS, Chairman and Chief Executive Officer, Aetna Inc.: My opinion is no, it cannot…

Janet Trautwein, Executive Vice President and CEO, National Association of Health Underwriters: I would just add to that, and also I don’t think it is possible for a public and private sector to compete on a level playing field. I don’t see any way that that’s possible…

Karen Pollitz, M.P.P., Research Professor, Health Policy Institute at Georgetown University: Private health insurance and public plans coexist today… …I think it’s absolutely essential.

Karen Ignagni, M.B.A., President and CEO, America’s Health Insurance Plans: …what we have done is propose an aggressive system of government regulation that would supervise private sector competition…

Len Nichols, Ph.D, Director, Health Policy Program at the New America Foundation: …if we just decide to put everybody into Medicare, except for the private plans that would survive for maybe three years… we’re going to end up with a system that is basically going to be run from Washington and Baltimore… think about a public plan model more like what state employees do… …let it compete with the private insurance industry… …a PPO type arrangement… We would suggest even stronger firewalls between the people who run the new marketplace and the people who run the plan…

Katherine Baicker, PhD, Professor of Health Economics, Department of Health Policy and Management at the Harvard School of Public Health: …I worry that in practice one ends up doing more harm than good…

Sandy Praeger, Health Insurance Commissioner, State of Kansas: The public plan… and I’ve read Dr. Nichols’ report… and I think he makes some very good points. …if it’s competing on a level playing field with the private marketplace… If you have equal rules and are treating the public plan the same as the private plan, it can help drive market changes…

http://help.senate.gov/Hearings/2009_03_24/2009_03_24.html

Comment:

By Don McCanne, MD

Perhaps the surest sign of trouble for the proposal to offer a public Medicare-like plan to compete with private insurance plans is the commitment of Finance Chairman Max Baucus that reform will be bipartisan along with the adamant opposition of a public option by Ranking Member Charles Grassley. Having discarded other public insurance proposals such as single payer, even before the negotiations began, the competing Medicare-like option is standing alone as the obvious trade-away for achieving political consensus.

The insurance industry contends that a public plan would provide “unfair” competition to the private plans, just as the private Medicare Advantage plans had to be granted large overpayments to counter the “unfair” advantage of the traditional public Medicare program. It is surprising how many others perpetuate this framing that the private insurers should be granted extra tax dollars in order to level the playing field with a more efficient government health financing system. The real unfairness is gifting taxpayer funds to the private insurers.

So what is being proposed as a compromise public insurance option? Let’s have the government set up a private insurance-style PPO, and require it to copy the private sector business model of taking away choice through restricted provider lists, expanding administrative functions including the necessity of marketing its product, competing on benefits and cost-sharing provisions, and engaging in all of the other non-beneficial excesses of the marketplace. Just to be absolutely certain that the public option has all of the flaws of the private health plans, Len Nichols would put up even stronger firewalls between the government administrators and the government’s own public option disguised as a private plan. And this ridiculous effort to “level” the playing field is all for the benefit of… not the patients… but the insurers!

What is sad is that the enemies of reform have already won. They have managed to eliminate comprehensive reform from the national dialogue and have reduced the debate to whether or not we’ll add one more plan, a public plan, to our dysfunctional, fragmented, multi-payer system that costs so much and serves us so poorly. Anyone who believes that the mere additional option of purchasing a public insurance plan is going to transform our health care system is living in La La Land.

Residents learn about health care options

Madison forum discusses alternatives to for-profit system

By Katelyn Farago
Daily Record
March 22, 2009

MADISON — Borough residents Geoff and Laurie Thomas are currently facing a reality many unemployed and self-employed Americans share. They are paying for their own health insurance.

For the Thomases, who are insured under Cobra, the cost is $900 per month.

Unsatisfied with the accessibility and affordability of health care in the current for-profit system, the couple decided to organize a health care forum at the Madison Public Library Saturday and showed the PBS Frontline documentary “Sick Around The World.” The documentary examines the health care systems of five capitalist democracies in order to determine what the United States might be able to learn from them.

“This gives us a view of what’s possible,” Laurie Thomas said.

The couple also organized a forum at the library last year.

A believer in the principles of a participatory democracy, she said she thinks citizens have the responsibility to educate themselves on important issues such as health care.

She said she would personally prefer to have a national health care system in the United States, and supports the new congressional bill, House Resolution 676, which would ensure that every American is provided with comprehensive health insurance coverage by essentially expanding and improving Medicare.

After the documentary, the Thomases held an informal discussion. One resident spoke up to say that he has Parkinson’s disease, and has not been able to get health coverage. He asked the room what he could do.

Another resident described the American resistance to socialized medicine as a “joke,” explaining that the United States has other socialized institutions, namely education and law enforcement.

And yet another resident asked what could be done, and how citizens could help get HR 676 passed.

“It’s going to take a movement of activists,” Laurie Thomas said, and her husband, Geoff, emphasized education. Both are members of Healthcare-now! and Physicians for a National Health Care Program — organizations in favor of a single-payer health care system.

Madison resident Sarah Mercuri, who works as a human relations consultant, has been paying for her own health care for seven years. But after being laid off, she said she doesn’t think she can afford to pay for it any longer.

“Health care in this country just isn’t affordable,” she said. “If you lose your job, you basically lose your health coverage.”

Mercuri said she was motivated to attend the forum because she wanted to show her support for HR 676.

Dr. Carol Dimond, M.D., also a supporter of the bill, said she thinks it’s important to spread the word about the legislation.

“There are too many people suffering unnecessarily,” she said. “I feel there is a need for single-payer (health care),” Dimond said.

Protests at White House healthcare hearing in Iowa

By Kay Henderson
Reuters
March 23, 2009

DES MOINES, Iowa (Reuters) – The latest White House regional forum on healthcare drew protests and complaints on Monday along with a promise that government-run insurance was at least on the table for discussion.

“Why are we having this shameful event?” said Mona Shaw, a political activist, at the start of the session. “People are dying,” she said, because of what she termed a callous insurance industry.

Iowa Governor Chet Culver who chaired the event cued up a video message from President Barack Obama as security personnel escorted Shaw from the room.

It was the third of five regional meetings which Obama hopes would help Congress figure out how to overhaul the U.S. healthcare system, which is the most expensive in the world even though some 46 million Americans have no health insurance.

Obama plans to make sweeping changes to the system this year to try to cut the number of uninsured while improving the quality of care and controlling costs that are forecast to reach $2.5 trillion dollars this year.

About 20 protesters at the meeting waved signs and chanted “Everybody in, nobody out” — a demand for universal coverage.

Dr. Jess Fiedorowicz, a psychiatrist at the University of Iowa Hospitals who was with the protest group, told the meeting a majority of Americans support a “single payer” or government-run national health insurance program.

“Can we put it on the table for discussion?” Fiedorowicz asked Nancy-Ann De Parle, director of the White House Office on Health Reform.

“Can we study costing? Can we study feasibility of this truly universal, socially just and fiscally responsible alternate to our currently unjust and woefully inefficient system?” Fiedorowicz asked. Many in the crowd applauded.

Vashti Winterburg, 61, co-chair of Kansas Health Care for All, said she opposes any plan that keeps health insurance companies in business.

She said the Kansas nonprofit board she serves on is finding it more and more difficult to pay the premiums of workers who provide in-home care to the elderly.

Chris Peterson, 53, who farms near Clear Lake, Iowa, said he cannot buy private health insurance for his wife or himself two years after his insurance carrier dropped them. They now have $14,000 in medical debt.

(Editing by Michael Conlon and Chris Wilson)

http://www.reuters.com/article/healthNews/idUSTRE52M70020090323