By Rose Ann DeMoro
The Huffington Post
Posted December 18, 2007 | 09:36 PM (EST)

Christmas came one week early for California insurers Monday.

In a present gift wrapped by the California Assembly with Gov. Arnold Schwarzenegger playing Santa, Assembly members passed a bill mislabeled as healthcare reform that will guarantee not health care but millions of new customers for the insurance industry, with California taxpayers paying the bill.

Need more evidence. Look at the list of supporters. They include industry giants, Kaiser Permanente, Health Net, PacifiCare, Blue Shield, Cigna, and Molina Health Care — all among the biggest and most profitable health plans in the state.

It’s not hard to see why they are on board.

Under the new bill, insurers would gain millions of new customers who are either forced to buy insurance under threat of having their wages garnished or facing a lien on their property — or signed up into private insurance plans through a public pool funded with taxpayer or employer funded subsidies.

The bill passed Monday — the product of a backroom deal between Schwarzenegger and Assembly Speaker Fabian Nunez — even eliminated a provision from an earlier draft that would have provided exemptions to the forced insurance for Californians whose costs would exceed 6.5 percent of their income. Now those people will still have the mandate to buy insurance, though they will be eligible for full or partial public subsidies.

It’s a disgraceful day when we have our elected leaders shaking down patients and consumers to swell the profits of an industry that became incredibly rich off the pain and suffering of patients who are routinely denied care when they need it most.

Nothing in this plan changes those deplorable practices. Insurers will continue to be able to block care even when recommended by a physician when they brand it as “experimental” or “not medically necessary.” They will continue to be able to reject diagnostic procedures and access to specialists.

And, they will continue to be permitted to charge whatever they want. There are absolutely no restrictions on skyrocketing premiums, deductibles, or co-pays. The inevitable result will be more Californians facing bankruptcy for medical debt when they are forced to buy junk insurance they can’t afford or self-rationing care even while they continue to pay the premiums.

Proponents of the bill praise the model of a similar Massachusetts law on which the California bill is based. Well, here’s what’s happening in Massachusetts today. State officials has discovered that since they failed to place any limits on insurance industry price gouging, the state will not be able to continue to afford the subsidies. So they are going to have to reduce payments to doctors and hospitals or sharply increase out-of-pocket costs for patients. That’s progress?

This is not health care reform. It’s a hijacking of the yearning of the public for genuine overhaul of our health care system. It’s Schwarzenegger as a reverse Robin Hood, picking the pockets of patients and the public coffers for the biggest insurers in the land. And it will not stand.

California’s State Senate may yet put the brakes on this plan — not even scheduled to go into effect for four more years.

If California lawmakers want to actually accomplish something today on health care, they should look elsewhere. Thousands of California children face the imminent cutoff of coverage due to the President’s veto of the children’s health program. Concurrently, with California facing a $14 billion and growing budget deficit, Schwarzenegger is talking about big across the board cuts, including significant reductions in existing health programs.

Let’s address these immediate crises — and then move to enact genuine, healthcare reform such as a single payer, improved Medicare for all approach embodied in HR 676 in Congress and SB 840 in California — rather than handing out any more presents to a wealthy industry that hardly needs the help.

By Nelson Bradshaw
Catskill Mountain Foundation

Excerpts from http://www.catskillmtn.org/publications/articles/2007-12-giving-back.html

The Oneonta Free Clinic will make a valiant effort meet the medical needs of these people. But small, private clinics are not the real answer to the nation’s mounting health care crisis, according to Doctor Friedell. “A free clinic is just a band-aid,” says the physician. “It’s a way of getting care to people in a hurry. My personal belief is that we need a single-payer health insurance system in this country. A simple name for the program might be Medicare for Everybody. Medicare is the Federally funded system that pays for everybody who is over 65-years-old or who is disabled. It is a single-payer system. All the bills go to the Federal government. It works very well. The customers are quite satisfied. Nevertheless, there has been a tremendous amount of resistance to establishing a similar program for the whole country.”

Friedell notes that the existence of a one-payer, national system would mean that just by virtue of being a citizen of this country, you would be insured from the time of your birth to the time of your death. Friedell expands, “You would never have to worry about that, no matter how many times you changed your job or college or your status in the military.”

Most opponents of a proposed national system say that the country can’t afford it. Dr. Friedell argues that, first, a patient wouldn’t be able to get just any treatment or an infinite amount of care under a national plan. “There would be a cut-off point,” Friedell asserts. “Medicare, Medicaid and the Veteran’s Administration are all examples of government-run, single-payer systems. They have cut-offs.”

Second, a single-payer system would save a lot on administrative costs, the doctor points out. “The advantage of using a single-payer program is that it eliminates bureaucracy and expense,” he says. “If you come to my office now for treatment, for example, you have to show your insurance card. My staff has to get on the phone or a Web site and verify that you still have coverage. There is a plethora of insurance companies in our area alone, and they all have different rules and different measures of membership and services covered.It is really very frustrating.”

Friedell concedes that one point frequently raised by national health care plan critics is valid–some procedures would have to be rationed. “If we go to a single-payer system, certainly if you want an elective procedure like having a cataract removed or a hip replaced, you’re going to have wait a few months,” says the doctor. “These things are not emergencies. However, if you come into a hospital with a true emergency, if will get taken care of that day or the next day.

Doctor Friedell also points out that health care is rationed under the current system. “If you live in New York City, you can get in to see a gastroenterologist quickly,” he states. “But, if you live up here and you want to see one, you’ve got a long wait ahead of you. If you have the money or insurance and you live in an urban area or can travel, you can get whatever medical care you want. But, you can’t if you lack insurance or if you reside upstate or in a poor part of town. We’re doing de facto rationing right now. We’re limiting medical care on an economic basis.”

Another fear raised by the critics of a proposed national care system is idea that the government would make a mess of it. “They talk about the idea that you can’t trust government to run health care,” Doctor Friedell notes. “But, the government’s been doing it very effectively for over 40 years. Medicare and Medicaid have been in existence since the mid ’60s. Medicare spends a very small percentage of its funding on administration. That allows more money to be spent on doctors, nurses and medicine.”

After the next presidential election, there could be a public debate on a national scale about the single-payer idea. But a small, determined group in Oneonta is ready to do what it can right now.

By Susan F. Wood
The Boston Globe
December 17, 2007

The State Children’s Health Insurance Program, which provides working families with low-cost health insurance coverage, is now in limbo – on short term extensions by Congress and just vetoed again by the president. This confronts states with difficult choices on how to continue providing health coverage for kids when the funding from Washington just isn’t enough.

This latest affront to public health also comes at the same time that the price of birth control pills on colleges campuses has skyrocketed from $5-10 a month to $40 a month or more as an unintended consequence of a recent change in federal law. There is an easy and free technical fix that Congress or the Department of Health and Human Services could make, but this administration does not support allowing companies to sell birth control pills at a discount to colleges, universities, and other safety net programs.

These are just two of the more visible defeats that healthcare has suffered during this administration. At a deeper level, the low priority healthcare gets from President Bush is reflected in his failure to staff important health-related positions with qualified individuals willing to provide science-based advice.

Currently, the Department of Health and Human Services, the lead department that includes all of our national health agencies, lacks a permanent assistant secretary for health, assistant secretary for children and families and a surgeon general. All of these key senior positions are held by temporary appointees, some highly qualified, others not, but none with the ability to truly move us forward by providing sound advice and having the ear of decision-makers.

The Food and Drug Administration lacked a permanent commissioner for over half of the current administration, and currently the Centers for Medicare and Medicaid – which runs the State Children’s Health Insurance Program – also has no permanent leader.

Over two years ago, I resigned my post as assistant commissioner of women’s health at the FDA because of the agency leadership’s disregard for scientific decision-making regarding emergency contraception.

Unfortunately, since then, I have only seen mounting evidence of this administration putting politics before science. Key leadership positions in our health agencies are left vacant for unacceptable time periods or filled with individuals who advance an ideological agenda and show a disregard for scientific integrity. This pattern is troubling because it threatens the objectivity that guarantees the health and safety of American families.

Just a year after my resignation, Dr. Richard H. Carmona resigned as surgeon general. He later revealed that the administration asked him to censor his reporting on embryonic stem cell research, contraception, and the unrealistic proposition of abstinence-only sex education. This position has been vacant for over a year and in October Dr. Steven K. Galson – who was one of those at FDA who initially blocked the provision of emergency contraception over-the-counter – was given the temporary appointment of acting surgeon general.

More recently, President Bush appointed Dr. Susan Orr, an opponent of family planning, as acting deputy assistant secretary for population affairs where she is charged with advising on issues regarding population affairs and overseeing the only federal grant program dedicated solely to providing individuals with comprehensive family planning and preventive health services.

By appointing a leader who clearly does not support contraception, the administration is once again neglecting the health needs of millions of Americans, particularly those who are low income and rely on public programs to get access to preventive healthcare, including contraception and pap tests.

To ensure the health of our families we need strong, consistent leaders who value the integrity of science, make decisions on the best available information, and support prevention. Without that leadership, we will not succeed in promoting the health of all Americans. We shouldn’t have to wait for a change in presidential leadership.

Susan F. Wood is research professor at the George Washington University School of Public Health and Health Services. She served as assistant commissioner for women’s health at the Food and Drug Administration from 2000 to 2005 and is advising Hillary Clinton on health issues.

A new American College of Physicians paper says the government should guarantee a basic level of health care as part of larger reforms

By Doug Trapp
American Medical News
Dec. 24/31, 2007

Washington — The American College of Physicians has endorsed the concept of a single-payer health care system for the first time.

In a new position paper, the organization, which represents 124,000 physicians in internal medicine and related subspecialties, identified a system in which the federal government is the sole third-party payer as one of two reform vehicles to achieve universal coverage. The other is a public-private system that includes a legal guarantee that everyone has access to coverage and that offers health care subsidies to low-income residents.

The ACP likely was influenced by the general deterioration of the U.S. health system, with its 47 million uninsured and decreasing affordability of health care, said David Dale, MD, the organization’s president.

The 31-page paper, published Dec. 4 on the Annals of Internal Medicine Web site and in the Jan. 1, 2008, print issue, compares the U.S. health care system to systems in 12 other industrialized countries and offers eight major health reform recommendations based on that review. One proposal calls for adoption of a single-payer or pluralistic system, while the others tackle everything from electronic health records to physician training.

The paper is part of the college’s ongoing effort to effect changes to the U.S. health care system that would support patient-centered medical homes, in which a primary care physician coordinates care. The ACP endorsed guidelines for establishing medical homes in March.

“I think there’s a consensus that our system is not working very well, and when we compare it with others, that brings it into the spotlight,” Dr. Dale said. The paper highlights how the U.S. system, compared with others, underemphasizes primary care, in part, by not covering everyone.

Dr. Dale said the heart of the reform proposal is making sure that everyone has access to primary and preventive care.

ACP leadership reviewed the paper for about six months. “What we have is a consensus document,” he said. Dr. Dale said he received only a few e-mails — all positive — about the paper in the first few days after it was published online. He had anticipated receiving some negative comments from members questioning why the ACP didn’t ask for their opinion, but Dr. Dale said he senses that support for single-payer is growing among younger physicians.

That consensus does not extend to the American Medical Association or the American Academy of Family Physicians. The AMA opposes a single-payer health system, and the AAFP has not taken a position on the issue.

But a co-founder of Physicians for a National Health Program welcomed the ACP position. “It says that the mainstream is ready for [single payer],” said David Himmelstein, MD. “It doesn’t go as far as we’d like to see, but it’s a big step forward.”

Dr. Dale said the U.S. already has more than 40 years’ experience with single-payer health care — in the Medicare program. “So single-payer hasn’t failed in America. It’s actually succeeded.”

But AMA President Ron Davis, MD, takes a different lesson from Medicare. Both Medicare and Medicaid sometimes pay physicians less than it costs doctors to provide care. Inadequate payment leads physicians to limit the number of elderly, disabled and poor patients they see.

“While other nations’ experiences with single-payer health care provide important information, we need look no further than our own experiment with government-run health care to see the flaws with this approach,” Dr. Davis said.

AAFP President Jim King, MD, said many of his members wouldn’t support the organization endorsing a single-payer system. AAFP membership is divided on the issue much in the way America is split between urban and rural, and Democratic- and Republican-leaning areas, he said.

Instead, the AMA and AAFP have proposals that would expand health care access and call for patient protections, choice and responsibility.

The 26-page AMA plan, promoted in its Voice for the Uninsured campaign, recommends increasing individual access to health insurance by offering refundable tax credits or vouchers, with larger subsidies for low-income people, who could get their credits in advance. The Association also calls for increasing individual choice by standardizing health insurance regulations to help broaden insurance markets.

“Our pluralistic approach to covering the uninsured focuses on tax credits to individuals and families, individual ownership and choice of health insurance, and market reforms,” Dr. Davis said.

The seven-page AAFP plan, “Health Care Coverage for All,” recommends creating patient-centered medical homes and offering incentives for patients to seek care through those entities.

It also would safeguard patients against excessive medical costs by capping out-of-pocket spending at a fixed amount per household, possibly $5,000, and offering a free, basic set of mostly primary and preventive health care services.

The AAFP proposal doesn’t delve into how the U.S. should pay for health care. Dr King said it’s more important for the organization to focus on the kind of health care delivery system the country should have.

The financial structure can be worked out later, he said. “The problem at this particular stage is when you start mentioning a specific plan and how it’s going to be paid for, it closes so many doors,” he added.

Could be influential later

The ACP position paper won’t cause the 2008 presidential candidates to change their health plans, which already have been issued, but it could influence health reform after the election, said Robert Blendon, ScD, professor of health policy and political analysis at Harvard School of Public Health.

A large physician organization like the ACP hasn’t endorsed single-payer before. Once the election is over, the paper could gain political traction.

“[The paper is] important for sort of setting an agenda for the future,” Dr. Blendon said.

That assumes, however, that Congress tackles health system reform. “The country is concerned about things now other than redoing the health care system,” he said.