PNHP

“Keeping the insurance you have” – Don’t believe it!

“Keeping the insurance you have” – Don’t believe it!

Statement of Common Purpose

Health Care for America Now!

“A choice of a private insurance plan, including keeping the insurance you have if you like it…”

http://healthcareforamericanow.org/site/content/about_us/

And…

Proposed GM/UAW VEBA: A House of Cards?

By Stephen Diamond
School of Law, Santa Clara University
October 2, 2007

This MOU (Memorandum of Understanding) makes clear that the entire VEBA (voluntary employees’ beneficiary association) structure fails to secure future health care obligations from the potential risk of GM (General Motors) bankruptcy. To put it succinctly, the VEBA structure can be said to balance like a house of cards completely subject to the ups and downs of GM’s financial future. If GM collapses into bankruptcy it is very likely that the VEBA will also collapse.

The basis of this conclusion is simple: according to the MOU GM retains unilateral power to make up to $7 billion of its potential contributions to the VEBA in cash over a twelve to twenty year period through annual payments. Since these payments are to be made in cash they depend entirely on the availability of that cash from GM. But if GM declares bankruptcy there is no means to guarantee now that the cash will be available or that GM will not use the bankruptcy process to shield itself from these future payment obligations. This compounds the problems associated with the Convertible Note whose value rises and falls with GM stock and whose annual interest payment and return of principal could be blocked in bankruptcy.

http://www.soldiersofsolidarity.com/files/relatednewsandreports07-2/GM-UAWVEBADealDescribedAsHouseofCards.html

Stephen F. Diamond, J.D., Ph.D., Associate Professor of Law:
http://www.scu.edu/law/faculty/profile/diamond-stephen.cfm

Comment:

By Don McCanne, MD

Pause for a minute. Think back to the insurance you had twenty years ago. Remember? Now… do you still have precisely that same coverage? Unless you are over 85 and have been in the traditional Medicare program for the past twenty years, it is highly likely that you do not.

Why not? After all, wasn’t the coverage then better and much less expensive than what you now have? Likely it provided you with a free choice of physicians and hospitals. It covered all reasonable health care services, maybe with small co-payments for routine services, and complete coverage for catastrophic expenses after a modest hospital deductible. Perhaps it was a non-profit Blue Cross or Blue Shield plan administered in the public interest, rather than today’s for-profit plans with a mission to maximize shareholder return by spending as little as possible on actual patient care. The fine print of the older insurance products designed to serve the patient was quite different from the fine print of today’s insurance products designed to compete in a profit-driven insurance market.

It is probable that your current coverage restricts you to a list of contracted physicians and hospitals, and assesses severe financial penalties if you obtain care outside of the plan. More plans today exclude from coverage some essential services such as obstetrical care and mental health services, and some even go so far as to exclude hospital coverage and specialist services. More of you are finding that the deductible and coinsurance in your plans are now large enough to cause financial hardship if you should develop significant health problems. Medical debt has become a major contributor to personal bankruptcy, and three-fourths of those with medical debt had health insurance when their problems started. All too commonly, health insurance now fails to perform its primary function: protecting us from financial hardship in the face of medical need.

So why do you no longer have the better coverage that you had twenty years ago? You may have changed jobs, likely more than once, and lost the coverage that your prior employer provided. Your employer may have changed plans because of ever-increasing insurance premiums. Frequently your insurer introduces plan innovations such as larger deductibles, a change from fixed-dollar copayments to higher coinsurance percentages, tiering of your cost sharing for services and products, reduction in the benefits covered, dollar caps on payouts, and other innovations all designed to keep premiums competitive in a market of rapidly rising health care costs. You may have lost coverage when your age disqualified you from participating in your parents’ plan. You may have found that health benefit programs have been declining as an incentive offered by new employers. Your children may have lost coverage under the Children’s Health Insurance Program when your income, though modest, disqualified your family from the program. Your union may not have been able to negotiate the continuation of the high-quality coverage that you previously held. Your employer may have reduced or eliminated the retirement coverage that you were promised but not guaranteed. Your employer may have filed for bankruptcy without setting aside the legacy costs of their pensions and retiree health benefit programs. You may have decided to start your own small business and found that you could not qualify for coverage because of your medical history, even if relatively benign, or maybe your small business margins are so narrow that you can’t afford the premiums. You may have been covered previously by a small business owner whose entire group plan was cancelled at renewal because one employee developed diabetes, or another became HIV infected. Your COBRA coverage may have lapsed and you found that the individual insurance market offered you no realistic options. You may have retired before Medicare eligibility, only to find that premiums were truly unaffordable or coverage was not even available because of preexisting medical problems.

Okay, so you say that your plan is an exception, and you want to keep it. You have or did have an employer that is so large and has such great resources that your plan will always be there, including throughout retirement. Well, let’s look at the largest and most successful private health program ever – that of General Motors. Twenty years ago, every General Motors employee knew that he or she had the best health plan available, and for life. Whoa. What was that about General Motors being saddled with legacy costs? This highly successful health program threatened to sink General Motors because of projected future commitments. They ducked that one by establishing a VEBA (voluntary employees’ beneficiary association) and dumped it on UAW (the auto workers union). UAW is now in a position of holding its breath, hoping that the VEBA does not collapse before we have adopted a national health program. Are you really sure that your secure lifetime coverage is stronger than that of General Motors? Don’t count on it.

The point is that hardly anyone under 85 has the same coverage that they had twenty years ago, and that has not been by choice. Factors over which you had very little or no control dictated that you could no longer keep the insurance you had. Today, the politicians promise you that you can keep the insurance you have, if that’s your choice, even though that has hardly ever been true in the past. Is there any reason to expect it to be true in the future?

The politicians propose token programs to control future health care cost increases, but none of these programs will have a significant impact. As long as we rely on a dysfunctional, fragmented system of public programs and private plans to finance health care, we will never control the true cost drivers that are making health care unaffordable for most of us. To keep insurance premiums affordable, the insurers will have no choice but to continue to introduce innovations in their products that will further diminish the capability of the plans to prevent financial hardship for those who need care. That means that you do not have the option of keeping the plan you have today, simply because the insurers will not be able to offer the same plan twenty years from now.

That applies to Medicare as well. It will not be the same in twenty years. But here there is hope. Medicare can be changed so that it works even better to allow us to have access to health care without the potential for financial ruin. If all of us were enrolled in a new and improved Medicare program, we would have the ability to address the true causes of escalating health care costs. We would dramatically reduce the profound administrative waste that is a direct result of trying to finance health care through a disconnected system of a multitude of private plans and public programs wherein none of the players has significant control over our global health care expenditures. A single Medicare-like program would be capable of realigning incentives to encourage the reinforcement of our primary care infrastructure in order to ensure that everyone has access to a system that provides higher quality care at a more reasonable cost. Incentives could also be altered to reduce ineffective and even detrimental high-tech excesses that drive up costs, while ensuring that beneficial high-tech services will always be there when we need them.

If we had a comprehensive, high quality, value-based Medicare system for everyone, then all of us would want to keep the system that we would have, not only for the next twenty years, but for the rest of our lives. In the meantime, don’t let the politicians tell you that you can keep the coverage you have. It likely won’t be there when you need it twenty years from now.

(This message will be posted on the PNHP Blog at https://www.pnhp.org/blog/ and your responses are invited.)

China's failed experiment with the market

From A National, Centrally Planned Health System To A System Based On The Market: Lessons From China

By Jin Ma, Mingshan Lu and Hude Quan
Health Affairs
July/August 2008
No other country has undergone health care reforms as dramatic as China’s. Starting in 1978, China reformed its health system from a governmental, centrally planned, and universal system to a heavily market-based one. Now, three decades later, the Chinese government openly acknowledges that the reforms failed and seeks new directions. This paper adds to the literature by examining China’s health care from a system perspective, describing its health services delivery, access, outcomes, and population health in the post-reform era. It also identifies the main issues in the current system and highlights the key lessons learned from China’s reform process.
http://content.healthaffairs.org/cgi/content/abstract/27/4/937

When Incentives And Professionalism Collide

By William C. Hsiao
As Jin Ma and colleagues observe, an unfettered market approach in China has reduced access to care, increased patients’ financial burden, and reduced emphasis on prevention and may have caused declines in quality and outcomes. A major driving force was that perverse incentives altered physicians’ behavior toward self-interest at the expense of patients, even where professional ethics dictated otherwise. Other nations, including India, are grappling with the profit motive and its consequences. Chinese leaders are attempting to deal with these problems by expanding public investment and reducing perverse incentives. However, profit motives remain a powerful, potentially offsetting feature of a reformed system.
http://content.healthaffairs.org/cgi/content/abstract/27/4/949

Fundamental human ethics and mores are the same the world around.
There are those of us who believe that the people of the United States possess some sort of a superior intellect that allows us to use the sterile tools of market economics to provide a better life for all of us, at least for those of us who are willing to put in a greater effort, without any compromise whatsoever in our ethical and moral principles.
Some of the intellectuals in China had decided that using market dynamics was just the solution that they needed to help modernize the Chinese health care system. Sterile, amoral business decisions allow the leeway to bring out the best in us… and the worst. China got the best for a few, and the worst for the many.
Our health care system represents both the best and the worst, but now is so expensive that we have reached a point that we must realign incentives to promote the best for everyone, and discourage the worst that is draining our resources while benefiting primarily those who are capitalizing on the market.
China’s great experiment with free market health care demonstrates, once again, that mankind’s mores and ethics are best supported by social solidarity, rather than by the market, when establishing policies designed to benefit us all. It is a lesson that most other nations have learned, but one with which we are still struggling.

China's failed experiment with the market

From A National, Centrally Planned Health System To A System Based On The Market: Lessons From China

By Jin Ma, Mingshan Lu and Hude Quan
Health Affairs
July/August 2008

No other country has undergone health care reforms as dramatic as China’s. Starting in 1978, China reformed its health system from a governmental, centrally planned, and universal system to a heavily market-based one. Now, three decades later, the Chinese government openly acknowledges that the reforms failed and seeks new directions. This paper adds to the literature by examining China’s health care from a system perspective, describing its health services delivery, access, outcomes, and population health in the post-reform era. It also identifies the main issues in the current system and highlights the key lessons learned from China’s reform process.

http://content.healthaffairs.org/cgi/content/abstract/27/4/937

When Incentives And Professionalism Collide

By William C. Hsiao

As Jin Ma and colleagues observe, an unfettered market approach in China has reduced access to care, increased patients’ financial burden, and reduced emphasis on prevention and may have caused declines in quality and outcomes. A major driving force was that perverse incentives altered physicians’ behavior toward self-interest at the expense of patients, even where professional ethics dictated otherwise. Other nations, including India, are grappling with the profit motive and its consequences. Chinese leaders are attempting to deal with these problems by expanding public investment and reducing perverse incentives. However, profit motives remain a powerful, potentially offsetting feature of a reformed system.

http://content.healthaffairs.org/cgi/content/abstract/27/4/949

Comment:

By Don McCanne, MD

Fundamental human ethics and mores are the same the world around.

There are those of us who believe that the people of the United States possess some sort of a superior intellect that allows us to use the sterile tools of market economics to provide a better life for all of us, at least for those of us who are willing to put in a greater effort, without any compromise whatsoever in our ethical and moral principles.

Some of the intellectuals in China had decided that using market dynamics was just the solution that they needed to help modernize the Chinese health care system. Sterile, amoral business decisions allow the leeway to bring out the best in us… and the worst. China got the best for a few, and the worst for the many.

Our health care system represents both the best and the worst, but now is so expensive that we have reached a point that we must realign incentives to promote the best for everyone, and discourage the worst that is draining our resources while benefiting primarily those who are capitalizing on the market.

China’s great experiment with free market health care demonstrates, once again, that mankind’s mores and ethics are best supported by social solidarity, rather than by the market, when establishing policies designed to benefit us all. It is a lesson that most other nations have learned, but one with which we are still struggling.

China’s failed experiment with the market

From A National, Centrally Planned Health System To A System Based On The Market: Lessons From China

By Jin Ma, Mingshan Lu and Hude Quan
Health Affairs
July/August 2008

No other country has undergone health care reforms as dramatic as China’s. Starting in 1978, China reformed its health system from a governmental, centrally planned, and universal system to a heavily market-based one. Now, three decades later, the Chinese government openly acknowledges that the reforms failed and seeks new directions. This paper adds to the literature by examining China’s health care from a system perspective, describing its health services delivery, access, outcomes, and population health in the post-reform era. It also identifies the main issues in the current system and highlights the key lessons learned from China’s reform process.

http://content.healthaffairs.org/cgi/content/abstract/27/4/937

When Incentives And Professionalism Collide

By William C. Hsiao

As Jin Ma and colleagues observe, an unfettered market approach in China has reduced access to care, increased patients’ financial burden, and reduced emphasis on prevention and may have caused declines in quality and outcomes. A major driving force was that perverse incentives altered physicians’ behavior toward self-interest at the expense of patients, even where professional ethics dictated otherwise. Other nations, including India, are grappling with the profit motive and its consequences. Chinese leaders are attempting to deal with these problems by expanding public investment and reducing perverse incentives. However, profit motives remain a powerful, potentially offsetting feature of a reformed system.

http://content.healthaffairs.org/cgi/content/abstract/27/4/949

Comment:

By Don McCanne, MD

Fundamental human ethics and mores are the same the world around.

There are those of us who believe that the people of the United States possess some sort of a superior intellect that allows us to use the sterile tools of market economics to provide a better life for all of us, at least for those of us who are willing to put in a greater effort, without any compromise whatsoever in our ethical and moral principles.

Some of the intellectuals in China had decided that using market dynamics was just the solution that they needed to help modernize the Chinese health care system. Sterile, amoral business decisions allow the leeway to bring out the best in us… and the worst. China got the best for a few, and the worst for the many.

Our health care system represents both the best and the worst, but now is so expensive that we have reached a point that we must realign incentives to promote the best for everyone, and discourage the worst that is draining our resources while benefiting primarily those who are capitalizing on the market.

China’s great experiment with free market health care demonstrates, once again, that mankind’s mores and ethics are best supported by social solidarity, rather than by the market, when establishing policies designed to benefit us all. It is a lesson that most other nations have learned, but one with which we are still struggling.

PNHP's New Blog

Pro-single-payer Doctors' Group Announces New Blog

Physicians for a National Health Program
Press Release
July 9, 2008

Physicians for a National Health Program (PNHP) today launched a new blog that looks at the politics of health care reform, the obstacles to care created by the for-profit, private health insurance industry, and the urgency of the U.S. adopting a Medicare-like, single-payer national health insurance program.

Dr. Quentin Young, the group’s national coordinator, said: “Our failing health care system weighs heavily on the minds of doctors and patients alike. In this election year, our members felt we needed to enhance the timeliness of informed commentary on the worsening crisis and on the only effective remedy – a single-payer plan, which would guarantee comprehensive, quality care for all.”

Since its founding in 1987, PNHP members have produced numerous groundbreaking, peer-reviewed articles on health policy, including studies that show 31 percent of every U.S. health care dollar goes to administrative overhead, higher than anywhere else in the world, and that half of all personal bankruptcies are caused by medical bills.

Initial contributors to the blog include Dr. John Geyman, author of the new book “Do Not Resuscitate: Why the Health Insurance Industry Is Dying, and How We Must Replace It,” writing on some of the substandard insurance products being marketed to healthier people in the individual insurance market, products that have very high deductibles or benefit caps as low as $1,000 a year.

Dr. Suzanne King writes about how Blue Cross and Blue Shield of California has decided to charge women more for health insurance than their male counterparts, reflecting the pervasive discrimination in the private health insurance industry against women because, among other things, “they are the ones who get pregnant, have babies, and use obstetrical services.”

Dr. SteveB, a health policy blogger at DailyKos.com, offers “Four Questions to Ask When Analyzing Any Health ‘Reform’ Proposal.” Dr. SteveB will be regularly tracking support for the U.S. National Health Insurance Act, H.R. 676, a single-payer bill sponsored by Rep. John Conyers of Michigan and 90 others.

Dr. David Himmelstein, a PNHP co-founder, and Dr. Don McCanne, PNHP’s senior policy fellow, offer their respective assessments of Health Care for America Now, a new coalition launched this week, which, in the words of Himmelstein, pushes “a superficially attractive health reform model that has a long record of failure.” He said that, despite good intentions, the HCAN proposal is “akin to prescribing a placebo for a serious illness when effective treatment is available,” that treatment being single payer.

Another blogger is Dr. Andy Coates of upstate New York, who will be writing on support for single payer in the labor movement and in The Empire State; and Dr. Mary O’Brien of New York City on physician support for single-payer national health insurance. A survey published in April showed 59 percent of U.S. physicians now support national health insurance, a jump of 10 percent from five years ago.

Dr. Young said, “Our aim is to provide a lively but well-grounded source of news and commentary on the hot topics of the day, trying to cut through some of the fog and myths that often accompany discussions of health care reform. We hope our readers will join in the dialogue.”

Physicians for a National Health Program (www.pnhp.org), a membership organization of over 15,000 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.

PNHP:

Physicians for a National Health Program

PNHP’s Blog:
https://pnhp.org/blog/

Comment:

By Don McCanne, MD

It’s your turn to contribute to the national dialogue on health care reform. Frequent postings will be made by some of the leaders in the movement for a single payer national health program. Your responses are not only invited, they are encouraged.

Quote of the Day messages also will be posted. For those who have had an urge to respond to some of my comments, you will now have that opportunity.

As Quentin Young states, “Our aim is to provide a lively but well-grounded source of news and commentary on the hot topics of the day, trying to cut through some of the fog and myths that often accompany discussions of health care reform. We hope our readers will join in the dialogue.”

Pro-single-payer Doctors' Group Announces New Blog

For immediate release:
July 9, 2008

Contact:
Quentin Young, M.D., (312) 782-6006, info@pnhp.org

www.pnhp.org/blog

Physicians for a National Health Program (PNHP) today launched a new blog that looks at the politics of health care reform, the obstacles to care created by the for-profit, private health insurance industry, and the urgency of the U.S. adopting a Medicare-like, single-payer national health insurance program.

Dr. Quentin Young, the group’s national coordinator, said: “Our failing health care system weighs heavily on the minds of doctors and patients alike. In this election year, our members felt we needed to enhance the timeliness of informed commentary on the worsening crisis and on the only effective remedy – a single-payer plan, which would guarantee comprehensive, quality care for all.”

Since its founding in 1987, PNHP members have produced numerous groundbreaking, peer-reviewed articles on health policy, including studies that show 31 percent of every U.S. health care dollar goes to administrative overhead, higher than anywhere else in the world, and that half of all personal bankruptcies are caused by medical bills.

Initial contributors to the blog include Dr. John Geyman, author of the new book “Do Not Resuscitate: Why the Health Insurance Industry Is Dying, and How We Must Replace It,” writing on some of the substandard insurance products being marketed to healthier people in the individual insurance market, products that have very high deductibles or benefit caps as low as $1,000 a year.

Dr. Suzanne King writes about how Blue Cross and Blue Shield of California has decided to charge women more for health insurance than their male counterparts, reflecting the pervasive discrimination in the private health insurance industry against women because, among other things, “they are the ones who get pregnant, have babies, and use obstetrical services.”

Dr. SteveB, a health policy blogger at DailyKos.com, offers “Four Questions to Ask When Analyzing Any Health ‘Reform’ Proposal.” Dr. SteveB will be regularly tracking support for the U.S. National Health Insurance Act, H.R. 676, a single-payer bill sponsored by Rep. John Conyers of Michigan and 90 others.

Dr. David Himmelstein, a PNHP co-founder, and Dr. Don McCanne, PNHP’s senior policy fellow, offer their respective assessments of Health Care for America Now, a new coalition launched this week, which, in the words of Himmelstein, pushes “a superficially attractive health reform model that has a long record of failure.” He said that, despite good intentions, the HCAN proposal is “akin to prescribing a placebo for a serious illness when effective treatment is available,” that treatment being single payer.

Another blogger is Dr. Andy Coates of upstate New York, who will be writing on support for single payer in the labor movement and in The Empire State; and Dr. Mary O’Brien of New York City on physician support for single-payer national health insurance. A survey published in April showed 59 percent of U.S. physicians now support national health insurance, a jump of 10 percent from five years ago.

Dr. Young said, “Our aim is to provide a lively but well-grounded source of news and commentary on the hot topics of the day, trying to cut through some of the fog and myths that often accompany discussions of health care reform. We hope our readers will join in the dialogue.”

###

Physicians for a National Health Program (www.pnhp.org), a membership organization of over 15,000 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.

PNHP’s New Blog

Pro-single-payer Doctors’ Group Announces New Blog

Physicians for a National Health Program
Press Release
July 9, 2008

Physicians for a National Health Program (PNHP) today launched a new blog that looks at the politics of health care reform, the obstacles to care created by the for-profit, private health insurance industry, and the urgency of the U.S. adopting a Medicare-like, single-payer national health insurance program.

Dr. Quentin Young, the group’s national coordinator, said: “Our failing health care system weighs heavily on the minds of doctors and patients alike. In this election year, our members felt we needed to enhance the timeliness of informed commentary on the worsening crisis and on the only effective remedy – a single-payer plan, which would guarantee comprehensive, quality care for all.”

Since its founding in 1987, PNHP members have produced numerous groundbreaking, peer-reviewed articles on health policy, including studies that show 31 percent of every U.S. health care dollar goes to administrative overhead, higher than anywhere else in the world, and that half of all personal bankruptcies are caused by medical bills.

Initial contributors to the blog include Dr. John Geyman, author of the new book “Do Not Resuscitate: Why the Health Insurance Industry Is Dying, and How We Must Replace It,” writing on some of the substandard insurance products being marketed to healthier people in the individual insurance market, products that have very high deductibles or benefit caps as low as $1,000 a year.

Dr. Suzanne King writes about how Blue Cross and Blue Shield of California has decided to charge women more for health insurance than their male counterparts, reflecting the pervasive discrimination in the private health insurance industry against women because, among other things, “they are the ones who get pregnant, have babies, and use obstetrical services.”

Dr. SteveB, a health policy blogger at DailyKos.com, offers “Four Questions to Ask When Analyzing Any Health ‘Reform’ Proposal.” Dr. SteveB will be regularly tracking support for the U.S. National Health Insurance Act, H.R. 676, a single-payer bill sponsored by Rep. John Conyers of Michigan and 90 others.

Dr. David Himmelstein, a PNHP co-founder, and Dr. Don McCanne, PNHP’s senior policy fellow, offer their respective assessments of Health Care for America Now, a new coalition launched this week, which, in the words of Himmelstein, pushes “a superficially attractive health reform model that has a long record of failure.” He said that, despite good intentions, the HCAN proposal is “akin to prescribing a placebo for a serious illness when effective treatment is available,” that treatment being single payer.

Another blogger is Dr. Andy Coates of upstate New York, who will be writing on support for single payer in the labor movement and in The Empire State; and Dr. Mary O’Brien of New York City on physician support for single-payer national health insurance. A survey published in April showed 59 percent of U.S. physicians now support national health insurance, a jump of 10 percent from five years ago.

Dr. Young said, “Our aim is to provide a lively but well-grounded source of news and commentary on the hot topics of the day, trying to cut through some of the fog and myths that often accompany discussions of health care reform. We hope our readers will join in the dialogue.”

Physicians for a National Health Program (www.pnhp.org), a membership organization of over 15,000 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.

PNHP:

Physicians for a National Health Program

PNHP’s Blog:
https://www.pnhp.org/blog/

Comment:

By Don McCanne, MD

It’s your turn to contribute to the national dialogue on health care reform. Frequent postings will be made by some of the leaders in the movement for a single payer national health program. Your responses are not only invited, they are encouraged.

Quote of the Day messages also will be posted. For those who have had an urge to respond to some of my comments, you will now have that opportunity.

As Quentin Young states, “Our aim is to provide a lively but well-grounded source of news and commentary on the hot topics of the day, trying to cut through some of the fog and myths that often accompany discussions of health care reform. We hope our readers will join in the dialogue.”

What is "Health Care for America Now" doing?

HEALTH CARE FOR AMERICA NOW!

Campaign launch – July 8, 2008
For coalition members see:
http://healthcareforamericanow.org/site/content/who_we_are/
Campaign ad:
Mother with son, consulting Magic Eight Ball: Will they pay for his inhaler?
Magic Eight Ball: Not likely
Gentleman, in workshop of his garage: Is my surgery covered?
Magic Eight Ball: Don’t think so
Pregnant mother-to-be: Can I chose my child’s doctor?
Magic Eight Ball: Better not tell you
Concerned woman, too young to die: Will they cover the chemo?
Magic Eight Ball: Doubtful
Off-screen voice: Will health insurance companies ever put your health before their profits?
Magic Eight Ball: Not a chance
Off-screen voice: We can’t trust insurance companies to fix the health care mess.
http://www.youtube.com/watch?v=tirU5qpmFK4
Statement of common purpose:
Our government’s responsibility is to guarantee quality affordable health care for everyone in America and it must play a central role in regulating, financing, and providing health coverage by establishing:
A choice of a private insurance plan, including keeping the insurance you have if you like it, or a public insurance plan without a private insurer middleman that guarantees affordable coverage.
(… and nine other requirements for a regulated private insurance industry.)
http://healthcareforamericanow.org/site/content/statement_of_common_purpose

The members of the Health Care for America Now! (HCAN) coalition are very dedicated, altruistic individuals and organizations who share with us the goal of affordable, comprehensive, high quality care for everyone. They agree with us that the private insurance industry has failed miserably in fulfilling its responsibility to bring to all of us the affordable health care that we need.
The private insurance industry, as it functions today, clearly must be replaced with a system that works. So what is the solution proposed by the HCAN coalition? Let’s replace the private insurance industry with… the private insurance industry. Only let’s regulate it by requiring the insurers to provide us with the comprehensive coverage that we need “through the largest possible pools” – thus ensuring that their products will have premiums that only the very wealthiest of us can afford.
The HCAN coalition also would enact a public program in competition with the private plans to be sure that the private plans would sell us the comprehensive products that we need – a not-so-difficult challenge considering that the public program would be outrageously expensive due to adverse selection. So then we would have a choice of highly-regulated, unaffordable private plans, or an even less affordable public program option.
Why did the coalition insist on including private plans when the industry’s track record is so miserable? It was a political decision based not on which policies would actually work, but rather based on rhetorical framing that would resonate with a public that remains relatively uninformed on the make-or-break nuances of health policy. Focus groups and polls showed that “choice of private plans” resonated well, so they decided to abandon policy and go with messaging.
The members of Physicians for a National Health Program would take a more “doctorly” approach toward reform. While the HCAN coalition is recommending placebo therapy, we would point out that effective treatment is available: a single payer national health program.

What is "Health Care for America Now" doing?

HEALTH CARE FOR AMERICA NOW!

Campaign launch – July 8, 2008
For coalition members see:
http://healthcareforamericanow.org/site/content/who_we_are/

Campaign ad:

Mother with son, consulting Magic Eight Ball: Will they pay for his inhaler?

Magic Eight Ball: Not likely

Gentleman, in workshop of his garage: Is my surgery covered?

Magic Eight Ball: Don’t think so

Pregnant mother-to-be: Can I chose my child’s doctor?

Magic Eight Ball: Better not tell you

Concerned woman, too young to die: Will they cover the chemo?

Magic Eight Ball: Doubtful

Off-screen voice: Will health insurance companies ever put your health before their profits?

Magic Eight Ball: Not a chance

Off-screen voice: We can’t trust insurance companies to fix the health care mess.

http://www.youtube.com/watch?v=tirU5qpmFK4

Statement of common purpose:

Our government’s responsibility is to guarantee quality affordable health care for everyone in America and it must play a central role in regulating, financing, and providing health coverage by establishing:

A choice of a private insurance plan, including keeping the insurance you have if you like it, or a public insurance plan without a private insurer middleman that guarantees affordable coverage.

(… and nine other requirements for a regulated private insurance industry.)

http://healthcareforamericanow.org/site/content/statement_of_common_purpose

Comment:

By Don McCanne, MD

The members of the Health Care for America Now! (HCAN) coalition are very dedicated, altruistic individuals and organizations who share with us the goal of affordable, comprehensive, high quality care for everyone. They agree with us that the private insurance industry has failed miserably in fulfilling its responsibility to bring to all of us the affordable health care that we need.

The private insurance industry, as it functions today, clearly must be replaced with a system that works. So what is the solution proposed by the HCAN coalition? Let’s replace the private insurance industry with… the private insurance industry. Only let’s regulate it by requiring the insurers to provide us with the comprehensive coverage that we need “through the largest possible pools” – thus ensuring that their products will have premiums that only the very wealthiest of us can afford.

The HCAN coalition also would enact a public program in competition with the private plans to be sure that the private plans would sell us the comprehensive products that we need – a not-so-difficult challenge considering that the public program would be outrageously expensive due to adverse selection. So then we would have a choice of highly-regulated, unaffordable private plans, or an even less affordable public program option.

Why did the coalition insist on including private plans when the industry’s track record is so miserable? It was a political decision based not on which policies would actually work, but rather based on rhetorical framing that would resonate with a public that remains relatively uninformed on the make-or-break nuances of health policy. Focus groups and polls showed that “choice of private plans” resonated well, so they decided to abandon policy and go with messaging.

The members of Physicians for a National Health Program would take a more “doctorly” approach toward reform. While the HCAN coalition is recommending placebo therapy, we would point out that effective treatment is available: a single payer national health program.

Three Approaches to Health Care Reform

By Len Rodberg, PhD

Public Single Payer Approach: Expanded and Improved Medicare for All (HR676)

John Conyers: “Ensure that every American; regardless of income, employment status, or race, has access to the highest quality and affordable health care services possible.”

* Automatic enrollment in unified public plan
* Free choice of doctor and hospital
* Doctors and hospitals remain independent, negotiate fees, budgets with public agency
* Public agency processes and pays bills
* Financed through progressive taxes
* Cost control through budgeting, capital planning, emphasis on primarycare

Private Republican Party Approach: Individual Responsibility (“You’re On Your Own”)

John McCain: “The key to health care reform is to restore control to the patients themselves.”

* Shrink employer-based insurance by eliminating the employers’ tax deduction
* Use tax credits to partially subsidize individuals, encourage purchase of insurance
* Make “consumers” more cost-conscious through taxes, co-pays, and deductibles
* Eliminate “costly” state “mandates” (consumer protections)
* Lower costs through market competition

Public-private mix Democratic Party Approach: Private Insurance, Public Option & Mandates

Barack Obama: “Quality, affordable, and portable coverage for all”

* The problem: Too many uninsured
* The solution: Require everyone to have insurance
* Public Medicare-like option
* Guaranteed issue, community rating
* Sliding-scale subsidies for low-income individuals and families
* Employers must contribute but may choose not to offer insurance
* Continued reliance on private insurance, no regulation of premiums or reimbursement practices
* “Keep what you have”
* Cost control through computerization, disease management, insurance competition

What’s Wrong with Approaches that Include Private Insurance?

* Will not improve insurance coverage for most people.
* Will not make affordable insurance available.
* Will not address the problem of underinsurance.
* Will not contain the continuing growth in the cost of health care and premiums.
* Require complex income-based subsidies.
* Will not pass, since they don’t benefit enough people to build popular support.

"Show Me the Money": Labor and the Bottom Line of National Health Insurance

By Marie Gottschalk
Dissent Magazine
Spring 2008

http://dissentmagazine.org/article/?article=1166

A WELL-KNOWN political scientist once declared that the definition of the alternatives is the supreme instrument of power. The simple question–single-payer or not–conceals major differences over whether to frame the health care issue primarily as an economic question or a moral one. Economic considerations are critical to propelling the cause of universal health care. But advocates of universal health care should not cast the economic competitiveness of U.S. business as the central economic issue at stake in the debate over health care reform.

If we are to finally achieve a fair, affordable, and truly universal health care system, other economic considerations need to frame the debate. These include: How efficient is the U.S. health system? How is the health care cost burden distributed between business, government, and the public? What are the trends in health care cost shifting? What is (and what should be) the role of insurance companies in the U.S. health system and the wider political economy? To their credit, single-
payer supporters have been some of the loudest and most articulate voices raising these important questions.

In bringing up these issues, advocates of universal health care need to be wary about emphasizing the economic rationale for health care reform at the cost of the moral rationale. The two cannot be disentangled. All of these economic issues in some way touch on how to redivide the economic pie–and that raises basic questions about economic and social justice.

Organized labor has enormous potential to be the pivotal player in raising these economic and moral questions and anchoring a reform coalition that fundamentally reshapes the health care debate. For well over a century now, labor has been instrumental in the development of the U.S. health system. It established some of the first prepaid group practices and health maintenance organizations, was the leading voice for national health insurance up until the mid-1970s, and was decisive in the establishment of Medicare and in the expansion of other major social programs, like Social Security and the Great Society. The employment-based system of health benefits is largely the product of a collective-bargaining regime established during and immediately after the Second World War. That system is under siege today. Without unions to act as a brake, today’s downward spiral in health benefits for union and nonunion workers would be even faster.

Divided and hemorrhaging members, organized labor still has formidable resources to influence the course of health care reform. The membership rolls and resources of the major unions dwarf those of most public interest groups. Labor’s lobbying capacity has expanded dramatically as the American Federation of Labor-Congress of Industrial Organizations (AFL-CIO), other labor groups, and individual unions have invested more heavily in lobbyists, enlarged their research departments, and developed grassroots lobbying networks. Labor’s financial resources have not contracted significantly despite its dwindling membership base.

Today the Democratic Party is more dependent than ever on labor’s money, votes, and electoral apparatus. Although money and members are important, they are not decisive in determining the political influence of organized labor. As Douglas A. Fraser, the late former president of the United Auto Workers, once said, the strength of the union movement also depends “on the agenda, the sense of commitment and the manner in which the labor movement allocates resources.”

As we stand at the brink of another major attempt to overhaul the U.S. health care system, organized labor is divided about how to define the alternatives. At one pole is Andrew Stern, president of the Service Employees International Union (SEIU), the nation’s largest union, and arguably the best known labor leader today. He stridently contends that health care reform must be pitched primarily as an economic competitiveness issue, not a moral one. Stern also has indicated that the single-payer approach, for all its virtues, is a political nonstarter. At the other pole is the growing number of national unions, locals, labor councils, and rank-and-file members pledged to the single-payer solution. Somewhere in between is the AFL-CIO, the nation’s largest labor federation, which in March 2007 endorsed the idea of “Medicare for All” but carefully avoided mentioning the “s” word, that is, single-payer.

So far, Stern has garnered a disproportionate amount of media and popular attention. His business-friendly stance on health care reform, which stresses how the U.S. health care system is fundamentally hurting the country’s economic competitiveness, helps explain why. But his economic competitiveness argument is not convincing and could undermine efforts to forge a successful coalition or movement on behalf of affordable, high-quality care for all.

Economic Competitiveness

In breaking away from the AFL-CIO in 2005 to form the Change to Win federation, which represents about six million workers, Stern implored organized labor to radically reposition itself on organizing new members and other issues. Yet his position on health care reform is remarkably similar to the pro-business stance that John Sweeney, currently president of the nine-million-member AFL-CIO, maneuvered the federation into as chairman of its health care committee in the lead-up to the battle over the Clinton plan in the early 1990s. Like Sweeney years ago, Stern has focused on courting the business sector. In his view, no fundamental change in health care will “arrive until American business leaders make the call for change.”

Stern has aggressively identified the interests of the SEIU with the interests of the business sector. In July 2006, he sent a letter to every Fortune 500 CEO asking them to make health care their national priority. In January 2007, Stern’s union launched a new health care coalition with two organizations that have checkered pasts on universal health care–the Business Roundtable, the elite business organization of top CEOs that helped torpedo the Clinton plan, and the AARP, the country’s largest organization for senior citizens, which gave critical support to the controversial Medicare prescription drug bill in 2003. In December 2006, Stern joined Safeway’s chief executive, Steve Burd, and Senator Ron Wyden (D-OR) in support of the Healthy Americans Act. The bill is modeled on the individual-mandate solution lionized in the Massachusetts reform effort. But it also includes a radical proposal to end employer-sponsored health insurance altogether.

Stern’s most controversial public dalliance is with H. Lee Scott, Jr., chief executive officer of Wal-Mart. In February 2007, Stern joined Scott and other business executives to announce the creation of “Better Health Care Together,” a business-labor coalition. Despite Wal-Mart’s dismal record on health benefits and other labor issues, Stern appears confident that the bottom line provides compelling reasons for Wal-Mart and other large employers to be constructive allies in health reform. “Obviously, we have a huge problem for American business because it is pretty hard to compete in a global economy when the price of your health care is put on the cost of goods, while in other countries, it is shared among society,” he contends.

In tapping big business as a key ally in the health care debate beginning in the 1980s, much of organized labor took a stance remarkably similar to Stern’s position today. Labor leaders largely accepted the Fortune 500’s definition of what was ailing the American economy and hence the American worker. Many of them jumped on the competitiveness bandwagon. In their public statements, labor and business leaders regularly sang off the same song sheet. Their refrain was a simple one–higher medical costs were making American products less competitive in the international marketplace, which was severely hurting the U.S. economy and the American worker.

Health care economists have raised numerous objections to the claim that escalating health care costs imperil the economic competitiveness of the United States and the overall health of the U.S. economy. Their analyses, however, have made little headway against what Princeton professor Uwe Reinhardt calls the “shared folklore” that higher health care costs are pricing U.S. products out of the market.

It is true that employer spending on health care, measured as a percentage of after-tax profits, did jump in the late 1990s. But the rise in health care costs as a percentage of profits was due partly to a drop overall in corporate profits as the dot-com and high technology sectors went bust in the late 1990s. Spending on health care measured as a percentage of after-tax corporate profits declined steadily from 1986 to 2004, except during the 1998–2001 period. More significantly, employer spending on wages and salaries and on total compensation as a percentage of after-tax profits has dropped precipitously since 1986, except during the 1998–2001 period. [1] While health care costs continue to escalate, employers have had great success at squeezing wages and other forms of compensation and shifting more health care costs onto their employees. Wages and salaries make up the smallest portion of the country’s gross domestic product since the government began collecting such data in 1947. In 2006, on the eve of the subprime crisis and the recession, corporate profits were at their highest level in four decades.

To underscore the exceptional severity of the health care cost crunch, Stern and some business leaders stress (as they did in the late 1980s and early 1990s) what U.S. employers pay directly for health care compared to their foreign competitors. Once again, the auto industry is the designated poster child as auto executives and labor leaders bemoan how crippling medical expenses add $1,500 to the cost of each car manufactured by General Motors, while some of its competitors pay as little as $200 per vehicle.

The focus on comparing what U.S. companies pay directly for health care relative to what their foreign competitors pay directly ignores the higher indirect costs that many European and Japanese firms and individuals shoulder due to higher corporate and personal income taxes to support more extensive public welfare states. This amount generally exceeds what even the most generous U.S. firms spend on health care for their employees. “The cost of employment-related health benefits as a percentage of payroll is nearly 50 percent greater in Germany than in the United States, but little is heard about this,” according to health care economist Mark Pauly. The fact is that many European and Japanese firms are highly competitive even though their workers enjoy more generous health, vacation, maternity, and other benefits.

In the early 1990s, much of labor’s political energy went into forging an elite-level deal between labor, business, and the government over health care. The failed Clinton plan, which caused such an uproar with much of the business sector, called for larger employers to contribute a modest 7.9 percent of their payroll to help pay for employees’ health coverage. According to Drew Altman, president of the Henry J. Kaiser Family Foundation, “You couldn’t have done more to pay off corporate America than they did with the Clinton plan, but in the end, companies turned on it because it was viewed as a big government plan.” When business walked away from the table, there was no sustained grassroots pressure to bring it back. The ingredients for that mobilization had been squandered by promises that business would do right by workers on health care even as it was engaged in a massive assault on workers in other areas, such as the right to unionize and passage of the North American Free Trade Agreement (NAFTA) in late 1993. Labor leaders repeatedly portrayed employers as ready to do the right thing on health care–until they weren’t.

The persistent faith that business will somehow unlock the door to universal, affordable health care flies in the face of the experience of other countries. While analysts may disagree about precisely why universal and near-universal health care took root in Western Europe and Canada, they concur that business was at best a passive player and at worst an obstructionist. Studies of the politics of health policy in other countries reveal that the medical providers, the business sector, and other conservative political forces often fiercely opposed the establishment of universal health care.

The Bottom Line

As we gear up for another major debate over universal health care, what economic factors should be stressed? First, the focus needs to stay squarely on the question of who bears the greatest burden of rising health care costs. There is a health care crisis in the United States, but it is a health care crisis with wrenching economic consequences for individuals and households, not employers. Emphasizing what U.S. employers pay out directly for health insurance obscures the question of who really shoulders the U.S. health care bill. Government expenditures account for about 36 percent of the tab. Household spending comes in next at 33 percent, and employers are in third place at 27 percent. The burden on households is even greater than these figures suggest because of hidden costs in taxes, lower wages, and higher prices for goods and services.

The economic competitiveness framework obscures the fact that employers and insurers have been remarkably successful at shifting health care costs onto employees, their families, and other individuals through higher co-pays, higher deductibles, restrictions on coverage, and other measures. Since the demise of the Clinton health plan fifteen years ago, the benefits of unionized workers have come under attack from many directions. The erosion of benefits in unionized jobs has hastened the erosion of benefits for workers in nonunion jobs. Some employers are eliminating benefits altogether; others are whittling away at them. Companies are creatively using bankruptcy proceedings to wiggle out of contract obligations to unionized workers. They also have been suing their retirees in an effort to renege on earlier promises made to retired workers. New national accounting standards for private and public employers threaten to hollow out retiree benefits further. In the public sector, the new standards pit taxpayers against state and municipal employees. The U.S. government has been remarkably complicit in this assault on employee benefits. For example, the U.S. Labor Department has not taken up the cause of retired workers denied promised health benefits, arguing that they “aren’t our constituents anymore.”

Another important economic question has to do with economic efficiency. The United States has the most expensive, inefficient health care system in the world with great variations in quality. The country spends over 15 percent of its GDP on health care, yet has forty-seven million people who are uninsured and millions more who are underinsured. By comparison, other industrialized countries have been able to achieve universal care while spending on average about 9 percent of their GDP on health care. The United States spends so much more, yet has fewer hospital beds, doctors, and nurses per capita than many other industrialized countries. No wonder that only 40 percent of Americans describe themselves as satisfied with the U.S. medical system, making the United States nearly last in public satisfaction (and dead last among public health experts polled).

One reason the U.S. health care system is so expensive is because it is so highly regulated by the private insurance industry. The main difference between here and other countries is that the commercial insurers–not the government–are the prime regulators. They determine, with little public input, who is fit to be insured and who is not; which medical bills to pay and which to deny; and which treatments are “experimental” and which are not. These regulations are expensive and have created what Henry Aaron characterizes as “an administrative monstrosity.” In 2006, Wellpoint, the country’s largest for-profit insurer, spent nearly $9 billion in marketing and administrative costs, many of which involved “regulating” the insurance market. Even with these high marketing and administrative costs, the health insurers are incredibly profitable. In 2006, the six largest health insurance companies had combined profits of more than $10 billion. Ironically, the costs of administering the U.S. health system roughly equal what employers pay out directly for health care–or about one-quarter of total spending on health care in the United States. And these calculations for administrative costs do not include all the time wasted as patients chase down referrals, wade through piles of incomprehensible medical bills, and navigate phone trees that take them nowhere. Streamlining U.S. administrative costs to levels comparable to those of Canada would reduce the U.S. health tab by an estimated 17 percent.

Another important economic question is where to assign blame for health care inflation. The recent stampede to enact health care legislation based on an individual mandate that penalizes people without insurance is shifting the wider understanding of who is to blame for rising medical costs. Somehow the uninsured have become the prime culprits. Fingers are pointed at the sickly uninsured who rely on expensive emergency room care and rack up unpaid hospital and doctors’ bills that have to be shifted onto someone else. They also are directed at the young and healthy who forgo insurance because they cannot imagine falling ill and needing expensive medical care. As one analyst remarked, attempting to solve the problem of the uninsured by mandating they buy insurance is akin to attempting to solve world hunger by ordering the hungry to buy food. Blaming individuals for medical inflation shifts attention away from the more significant culprits, such as the expansive for-profit health care system with its high administrative and marketing costs; the perverse incentives to perform high-cost medical procedures and not invest in primary care, preventive care, and public health; and the enormous economic clout of the pharmaceutical companies and other health care industries, which buys them enormous political clout.

The bottom line is that to achieve universal health care, the country needs to have real cost containment and to reallocate its health care resources. If we are truly committed to creating a high-quality, affordable universal health care system, someone will have to give something up, and some will have to give up more than others. The call for health care reform in the name of economic competitiveness holds out the chimera that a bloodless win-win solution is possible for all the stakeholders in the health care system–insurers, medical providers, and the general population.

A Dose of Political Realism

The economic rationales for national health insurance are considerable. But we need to resist the temptation to reduce this mainly to a question of dollars and cents. As Uwe Reinhardt recently said, the health care debate really boils down to one question: “Should the child of a gas station attendant have the same chance of staying healthy or getting cured, if sick, as the child of a corporate executive?” Reinhardt notes that it would cost about $100 billion in additional government spending to provide health care coverage for every man, woman, and child in the United States–or about what the country spends every nine months to fund the war in Iraq.

Successful reform movements in the United States–the abolitionist movement, the New Deal, the civil rights movement–have always had strong moral overtones. President Franklin D. Roosevelt did not invoke the dollars-and-cents language of an accountant to spur the country to support the landmark social insurance programs that became known as the second New Deal.

The New Deal example is relevant in another respect. In the 1930s, the popular Townsend movement of older Americans took the country by storm. This movement induced FDR and business to support Social Security and other social welfare protections so as to neutralize growing public sentiment for more radical pension proposals. Facing not only ruinous economic competition at the time but also a burgeoning and threatening social movement, employers decided to accept some legislated solution.

It is reasonable to raise the question whether the pursuit of a single-payer strategy is realistic given how politically and economically entrenched the drug and insurance industries are and how entrenched the for-profit medical system is. But Stern of the SEIU is wrong to claim that single-payer is a dead end because Americans deeply mistrust the government, are basically satisfied with their health care system, and don’t like anyone else’s system. Recent public opinion data show strong public support for a government guarantee of health care. Moreover, a revealing new study of voter discontent by the Democracy Corps found the most commonly chosen phrase to characterize what’s wrong with the country was, “Big business gets whatever they want in Washington.” Instead of attempting to ride what New York Times columnist Paul Krugman has characterized as the “strong populist tide running in America right now,” Stern is flying against it. As the famous German sociologist Max Weber once said, “Successful politics is always the art of the possible. It is no less true, however, that the possible is often achieved only by reaching out towards the impossible which lies beyond it.”

Marie Gottschalk is an associate professor of political science at the University of Pennsylvania and author, among other works, of The Shadow Welfare State: Labor, Business and the Politics of Health Care in the United States (Cornell University Press, 2000) and The Prison and the Gallows: The Politics of Mass Incarceration in America(Cambridge, 2006). A longer version of this article will appear in Ten Excellent Reasons for National Health Insurance, ed. Mary E. O’Brien, M.D. (New Press, forthcoming 2008).

Statement of Dr. Quentin Young on "Health Care for America Now"

For Immediate Release:
July 8, 2008

Contact:
Quentin Young, M.D., (312) 782-6006, info@pnhp.org

In a statement coinciding with today’s announcement of a new coalition called Health Care for America Now, Dr. Quentin Young, national coordinator of Physicians for a National Health Program, made the following remarks:

“Physicians for a National Health Program welcomes the call for quality, affordable health care for all by the new Health Care for America Now coalition.

“We note that a number of the organizations in Health Care for America Now are supporters of single-payer national health insurance, and we sincerely hope they will convince the entire coalition to adopt single payer as its platform and hasten the enactment of HR 676.”

“Based on more than two decades of research, including the study of domestic programs like Medicare and the failed “universal” reform efforts of several states, as well as the health care systems of other nations, we remain convinced that the only way to achieve the goal of truly universal, equitable and affordable health care in the United States is to remove the for-profit private insurance industry from the health care picture and to establish a single-payer national health insurance system, an improved and expanded version of Medicare for all.”

“The U.S. private insurance system is not the solution, but the source of the present problem.”

“We share the coalition’s abhorrence of health care policies that have been associated with the Bush administration and the presidential campaign platform of Sen. John McCain. These policies, if fully implemented, would substantially worsen an already untenable situation in which 47 million Americans are uninsured and a comparable number are underinsured, thanks to the profiteering and administrative waste of the for-profit private insurance industry.”

“At a time when the U.S. Conference of Mayors unanimously endorsed HR 676 and a recent poll indicated that 59 percent of U.S. physicians now support government-sponsored national health insurance, this is hardly the time to fall back to failed private insurance programs.”

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Physicians for a National Health Program (www.pnhp.org), a membership organization of over 15,000 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.