Healthy Opinions About Health Care June 21, 2009
Posted by rogerhollander in A: Roger's Original Essays, About Health, Canada, Health.Tags: canada health, canada health care, health care, health care reform, health costs, health insurance, health opinions, healthcare reform, hmos, national helath, new york time poll, opinion polls, private health insurance, roger hollander, single payer, tommy douglas, universal health
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Roger Hollander, www.rogerhollander.com, June 21, 2009
We Canadians know a good thing when we see, and live it and enjoy it and depend on it. I’m not talking about maple syrup, although that might come in a distant second. It’s our national health plan. In the forty one years I have lived in Canada I have never once heard any politician from any political party suggest its abolition (not that the Tories do not do their best to defund and attempt to erode it). It would be political suicide. A few years ago a CBC poll asked Canadians who in their estimation was the greatest Canadian of all times. The hands down winner was Tommy Douglas, the man who, as Premier of the prairie Province of Saskatchewan, introduced universal health care to Canada (he also happened to be Donald Sutherland’s father-in-law).
What Canada has is NOT government health care. It is rather universal health insurance with a single insurer, the government (organized province by province). Contrary to myth, and unlike HMOs and other private health insurance in the States, Canadians have an absolute right to choose their own physicians. Furthermore, in all my years living in Canada not once have I walked into a doctor’s office, clinic, laboratory or hospital and had to open my wallet (other than to produce my plastic health card). When my father was visiting from the States and needed to see my primary care physician, the office staff had to fumble around trying to figure out how to take a cash payment from him. It had never happened before.
The Canadian health care provider, be it a physician, laboratory, etc., simply fills out a form and sends it to the government for payment according to a scale that is negotiated between the government a provider organizations such as the Canadian Medical Association. There are no blood-sucking private health insurers to send costs through the ceiling and squeeze out bigger profits with co-payments and by denying treatment. The Canadian plan is funded by employer and employee contributions.
Despite massive disinformation campaigns about the Canadian health care system that are funded and promoted by the health insurance industry, the pharmaceutical industry and the Republican Party, a majority of Americans favor what is referred to as a single-payer system over the existing Rube Goldberg system in the States that passes for health care, a system that costs more, yields poorer results, and leaves tens of millions without coverage.
A CBS News/New York Times poll that was published in today’s New York Times (http://www.nytimes.com/2009/06/21/health/policy/21poll.html?_r=1&hpw) showed that 72% of respondents supported government health insurance with only 20% opposed (the poll did not refer to a “single-payer” plan, but rather a public plan that would compete with private plans; other polls have shown a majority in favor of single-payer).
Surprisingly, the poll showed 50% of Republicans in favor with 30% opposed. 87% of registered Democrats approved and 73% of Independents.
50% of all respondents thought government would do a better job than private insurance companies in providing medical coverage against 34% who thought it would do a worse job. 59% thought government would do a better job of holding down health costs while 26% thought they would do worse.
But here is what for me is the most interesting and telling statistic that arises out of the poll. Respondents were asked if they were willing to pay higher taxes so that all Americans have health insurance that they can’t loose no matter what. 57% said yes and 27 % said no. That’s better than a two to one ratio. And here’s the kicker: of those who earn less than $50.000 annually, 64% are willing to pay more so fellow Americans are not denied health care and 27% are not. For those earning more than $50,000, 52% are willing and 44% are not.
Look at those numbers carefully. While only 27% of poorer Americans are not willing to help their fellow citizens, a whopping 44% of those with greater means don’t give a damn.
This is what I call compassionate conservatism.
Health Care is a Right, Not a Privilege June 9, 2009
Posted by rogerhollander in Health.Tags: bernie sanders, cigna, doctor shortages, drug companies, health, health care, health care costs, health care reform, health care system, health costs, health insurance, health insurance industry, healthcare, healthcare reform, medicare medicare for all, private health insurance, roger hollander, single payer, united health
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Senator Bernie Sanders
www.opednews.com, June 8, 2009
Let’s be clear. Our health care system is disintegrating. Today, 46 million people have no health insurance and even more are underinsured with high deductibles and co-payments. At a time when 60 million people, including many with insurance, do not have access to a medical home, more than 18,000 Americans die every year from preventable illnesses because they do not get to the doctor when they should. This is six times the number who died at the tragedy of 9/11 – but this occurs every year.
In the midst of this horrendous lack of coverage, the U.S. spends far more per capita on health care than any other nation – and health care costs continue to soar. At $2.4 trillion dollars, and 18 percent of our GDP, the skyrocketing cost of health care in this country is unsustainable both from a personal and macro-economic perspective.
At the individual level, the average American spends about $7,900 per year on health care. Despite that huge outlay, a recent study found that medical problems contributed to 62 percent of all bankruptcies in 2007. From a business perspective, General Motors spends more on health care per automobile than on steel while small business owners are forced to divert hard-earned profits into health coverage for their employees – rather than new business investments. And, because of rising costs, many businesses are cutting back drastically on their level of health care coverage or are doing away with it entirely.
Further, despite the fact that we spend almost twice as much per person on health care as any other country, our health care outcomes lag behind many other nations. We get poor value for what we spend. According to the World Health Organization the United States ranks 37th in terms of health system performance and we are far behind many other countries in terms of such important indices as infant mortality, life expectancy and preventable deaths.
As the health care debate heats up in Washington, we as a nation have to answer two very fundamental questions. First, should all Americans be entitled to health care as a right and not a privilege – which is the way every other major country treats health care and the way we respond to such other basic needs as education, police and fire protection? Second, if we are to provide quality health care to all, how do we accomplish that in the most cost-effective way possible?
I think the answer to the first question is pretty clear, and one of the reasons that Barack Obama was elected president. Most Americans do believe that all of us should have health care coverage, and that nobody should be left out of the system. The real debate is how we accomplish that goal in an affordable and sustainable way. In that regard, I think the evidence is overwhelming that we must end the private insurance company domination of health care in our country and move toward a publicly-funded, single-payer Medicare for All approach.
Our current private health insurance system is the most costly, wasteful, complicated and bureaucratic in the world. Its function is not to provide quality health care for all, but to make huge profits for those who own the companies. With thousands of different health benefit programs designed to maximize profits, private health insurance companies spend an incredible (30 percent) of each health care dollar on administration and billing, exorbitant CEO compensation packages, advertising, lobbying and campaign contributions. Public programs like Medicare, Medicaid and the VA are administered for far less.
In recent years, while we have experienced an acute shortage of primary health care doctors as well as nurses and dentists, we are paying for a huge increase in health care bureaucrats and bill collectors. Over the last three decades, the number of administrative personnel has grown by 25 times the numbers of physicians. Not surprisingly, while health care costs are soaring, so are the profits of private health insurance companies. From 2003 to 2007, the combined profits of the nation’s major health insurance companies increased by 170 percent. And, while more and more Americans are losing their jobs and health insurance, the top executives in the industry are receiving lavish compensation packages. It’s not just William McGuire, the former head of United Health, who several years ago accumulated stock options worth an estimated $1.6 billion or Cigna CEO Edward Hanway who made more than $120 million in the last five years. The reality is that CEO compensation for the top seven health insurance companies now averages $14.2 million.
Moving toward a national health insurance program which provides cost-effective universal, comprehensive and quality health care for all will not be easy. The powerful special interests – the insurance companies, drug companies and medical equipment suppliers – will wage an all-out fight to make sure that we maintain the current system which enables them to make billions of dollars. In recent years they have spent hundreds of millions on lobbying, campaign contributions and advertising and, with unlimited resources, they will continue spending as much as they need.
But, at the end of the day, as difficult as it may be, the fight for a national health care program will prevail. Like the civil rights movement, the struggle for women’s rights and other grass-roots efforts, justice in this country is often delayed – but it will not be denied. We shall overcome!
To keep up to date on the health care debate in the Senate, sign up for the Bernie Buzz newsletter here.
http://www.sanders.senate.gov/buzz
Gutting the Health Care Plan: The Scorpion and the Congress June 9, 2009
Posted by rogerhollander in Health.Tags: big pharma, canada helath, canadian health care, canadian healthcare, clintons, health, health care, health care costs, health care reform, health costs, health insurance, health insurance industry, healthcare, healthcare costs, healthcare reform, Medicaid, medicare, paul rogat loeb, pharmaceutical industry, private health insurance, rick scott, Robert Reich, roger hollander, singel-payer, single payer, tommy douglas
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Will serious health reform meet the fate of the scorpion and the turtle? In that fable, the scorpion pleads with the turtle to carry him across a river. The turtle resists, fearing the scorpion’s sting, but the scorpion reassures him that he’d do nothing so foolish, since both would drown if he did. Finally the turtle agrees. Halfway across, the scorpion betrays his promise with a lethal sting. As the turtle begins to drown, he asks why he took both their lives. “It’s just who I am,” the scorpion replies.
I fear we’re about to get stung again. When people look back at the failure of the Clinton-era health care initiative, they point, accurately, to an opaque process that produced a baroque Rube Goldberg mess that satisfied no one. That happened even before the insurance industry went on the attack with their Harry and Louise ads. But another missing element parallels our current challenge-appeasement of the insurance companies as the plan’s centerpiece, and the inevitability that these same interests will betray us again.
The Clintons assumed the insurance companies were too powerful to confront, so the plan had to go along with them. But once they assumed any bill had to get the companies’ approval, no plan could work, because it had to build in ways for the companies to maintain their profit margins and the immensely wasteful overhead they spend on advertising, processing claims, and turning down as many sick people as they can. Their approach also creates corollary wastes, like the third of the expenses of the average medical office that go toward dealing with insurance company paperwork.
Our health care crisis is so dire that the simple single-payer approach, as in Canada, should be at least seriously debated. Compared with us, most Canadians are satisfied with their system, in contrast with a recent US poll where 49 percent said our health system needed fundamental changes and 38 percent said it should be completely rebuilt. Canadians get a full choice of doctors (unlike in the US, where households have to switch doctors when employers change their insurance or insurance companies change their preferred provider lists). Tommy Douglas, the Canadian New Democratic Party leader who pushed through national health care in the mid-60s (replacing a system like ours), was recently voted Greatest Canadian in a recent contest, beating hockey star Wayne Gretzky and Prime Minister Pierre Trudeau.
Even if single payer isn’t politically achievable yet, there’s no reason to take it off the table from the beginning. Doing so means most Americans never get to hear the contrast in cost savings, in allocation ease, in impact on ordinary citizens and their health outcomes. They never get to hear the story that might allow them to overcome current fears about losing the health care they have, being unable to see their preferred doctor, or being condemned to the Purgatory of endless waiting. Maybe we’ve been so conditioned that we can’t quite get the support for a full-fledged switch. A recent Kaiser Foundation poll still gives single-payer a narrow 49 to 47 percent majority, vs 67 percent for including a fully competitive public option, and maybe that isn’t enough. But at least we need to tell the story, so the probably inevitable compromise works down from full public coverage, as opposed to considering options that gut even the option of serious public coverage entirely.
Instead, because we’ve accepted the premise that the private insurance companies have to be included, we’re now starting to consider including a public option only if it includes poison pills that will doom it to fail, like requiring it be triggered by a set of exceedingly unlikely circumstances deferred to the indefinite future. Or requiring it to play by rules so onerous that it can’t achieve its straightforward cost savings. Or turning it over to the states, so Big Pharma and Big Insurance interests can simply, as Robert Reich warns, “buy off legislators and officials as they’ve been doing for years.”
But why assume that the insurance companies are our friends? Why appease them at all? It’s not as if they’ve played a helpful role in our current system. Rather, they’ve gamed it in every possible way, leaving our country with the highest health care costs in the world and worst health outcomes of any advanced industrial country. While they’ve made promises to cut costs, their promises are only that (like the scorpion’s), and they’re already lobbying with everything they have to gut any seriously competitive public option. Add in examples like former HCA/Columbia CEO Rick Scott. after his company paid a $1.7 billion fine (the largest in US history) for defrauding Medicare, Medicaid, and the program that serves our armed forces, he is now organizing attacks on any public program (hiring the PR firm that coordinated the “Swift Boat” attacks on John Kerry). We need to challenge the insurance companies, not appease them. There’s no evidence that suggests they’re constructive players, or are likely to do anything except defend their own parochial interest.
The insurance companies and other major financial interests are talking a good line of late. They have no choice if they don’t want to be cut out of the game. But ultimately, they are who they are, and their behavior reflects this. It makes no sense to embrace a partner who you know will ultimately betray you.
Maybe the public private mix is the best compromise we can get at the moment. But we must raise our voices now to demand a full debate on the other alternatives, like single payer, and then if necessary settle for something that gives a public option a chance, under equitable rules, to see how it plays out in efficiency, service, and cost. Trusting the insurance companies and stacking the deck to guarantee that private options will prevail merely assures we continue our dysfunctional system until its human and financial costs drown us all.
Paul Rogat Loeb is the author of The Impossible Will Take a Little While: A Citizen’s Guide to Hope in a Time of Fear, named the #3 political book of 2004 by the History Channel and the American Book Association. His previous books include Soul of a Citizen: Living With Conviction in a Cynical Time. See www.paulloeb.org To receive his articles directly email sympa@lists.onenw.org with the subject line: subscribe paulloeb-articles.
Health Care Activists Lament Single-Payer Snub May 30, 2009
Posted by rogerhollander in Health.Tags: ama, baucus 13, california nurses, green party, health, health care, health care reform, health insurance, health insurance industry, health system, healthcare, insurance industry, max baucus, medicare, national health plan, National Health Program, obama administration, pelosi, pharmaceutical industry, private health insurance, progressive democrats, reform, roger hollander, russell mokhiber, senage finance, single payer, single payer action, single payer now, universal health care, universal healthcare, victoria colliver
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Frustrated by the exclusion of government-financed medical care from the debate to revamp the nation’s troubled health system, advocates of a “single-payer” plan are increasingly turning to demonstrations and civil disobedience as a way to get their message across.
![[Jim Cowan takes part in a protest in front of the Federal Building in San Francisco. (David Paul Morris / The Chronicle) ]](http://www.commondreams.org/files/article_images/healthcare-2_0.jpg "healthcare-2.jpg")
Jim Cowan takes part in a protest in front of the Federal Building in San Francisco. (David Paul Morris / The Chronicle)During Senate Finance Committee hearings May 5 and 12 on health reform, 13 doctors, nurses, lawyers and activists stood up to complain that no single-payer proponent had been invited to take part and were arrested for disrupting the proceedings.On Friday in San Francisco, about 200 single-payer proponents held a rally in front of the Federal Building and headed in small groups to Rep. Nancy Pelosi’s office to urge the speaker of the House, who was in China, to back single-payer legislation and give its supporters a seat at the table of the health reform debate. The public appeals were part of a series of demonstrations being held in more than 50 U.S. cities over the next few days to encourage lawmakers to enact a single-payer plan.
Some advocates of a nationalized health plan are calling for activists to become even more militant.
“It’s the only way – direct confrontation with the people who are blocking what the majority of the American people want,” said Russell Mokhiber, the founder of the newly formed Single Payer Action.
“It’s about getting in people’s faces and being serious about the fact that 60 Americans are dying every day because of lack of health insurance,” said Mokhiber, who was arrested at the May 5 hearing and arraigned earlier this week in Washington.
Single payer unlikely
Reforming health care has become a focus of the Obama administration, with the president urging Congress to get legislation to his desk by the end of the year that would cover most of the nation’s 47 million uninsured. Whether that will happen remains to be seen, but whatever Congress passes is not likely to come in the form of a single-payer plan.
In a single-payer system, as envisioned by most advocates, the federal government would pay for basic medical care delivered by public and private health professionals. The money would come from taxes, and medical bills would go directly to a government insurance plan, similar to Medicare.
President Obama and lawmakers have proposed a form of “single-payer lite” – a government-administered plan people could buy into as an alternative to purchasing an individual policy offered by insurers. But single-payer supporters say this option doesn’t go far enough. They want private insurers completely out of the business of covering basic care, which they say could save nearly 30 percent in administrative costs.
That’s clearly not something the health insurance industry supports. Many of the nation’s largest insurers prefer a form of “universal” health care that would cover all Americans, while keeping them in business. They tend to avoid discussing the single-payer option largely because it hasn’t been included in the national debate.
Some statistics show the single-payer concept has grown in popularity as problems in the nation’s health care system have worsened. A CBS News/New York Times poll conducted in January found 59 percent of the 1,112 people surveyed said they supported government-provided national health insurance.
Physician support
Several groups, including the California Nurses Association and Physicians for a National Health Program, call for a single-payer option. While not supported by the American Medical Association, a nationalized health system got the backing of 59 percent of physicians in a poll published last year in the Annals of Internal Medicine.
The California Legislature has twice passed a state-level single-payer bill – in 2006 and 2008 – making it the first state to do so, but both times the effort was vetoed by Gov. Arnold Schwarzenegger. The legislation, authored by former state Sen. Sheila Kuehl, D-Santa Monica, has been reintroduced as by Sen. Mark Leno, D-San Francisco. Leno’s version is expected to meet the same fate as its predecessors.
Still, single payer has been largely dismissed from serious discussion on the national level as politically infeasible.
“It’s off the table in Washington because of the politics,” said Laurence Baker, associate professor of health research and policy at Stanford University.
Health insurers and drugmakers have contributed millions of dollars to members of Congress. One of the top recipients of that money, said Consumer Watchdog, an advocacy group based in Santa Monica, was Sen. Max Baucus, D-Montana, chairman of the Senate Finance Committee, who was running the hearings when the arrests took place this month. He accepted $413,000 in drug and health insurance campaign contributions during that time.
Many single-payer supporters interpret the resistance to the single-payer idea to be simply the result of a formidable lobbying effort by the health insurance and pharmaceutical industries, but Stanford’s Baker said the hurdles are more nuanced.
Distrust for government
Americans are clearly frustrated by the health care system. While some polls indicate that a majority of Americans favor single payer, some polls show a distrust of government’s ability to take over health care, he said. In a Kaiser Family Foundation poll released in April, just 35 percent of those surveyed expressed support for a government-run health system like Medicare.
As the debate continues, single-payer supporters have clearly ramped up their activity and tactics. The 50 demonstrations have been organized by a variety of groups including Healthcare-NOW!, Progressive Democrats of America and the Green Party.
But not all single-payer groups promote civil disobedience as a way to draw attention to the cause. Don Bechler, chairman and founder of Single Payer Now, a statewide advocacy group in San Francisco that helped organize the demonstrations, said he is more interested in drawing in more supporters than seeing people get arrested.
California nurse DeAnn McEwen didn’t set out to become one of the “Baucus 13,” the 13 arrested at the Senate Finance Committee hearings. She happened to be in Washington for a nurses’ union organizing committee meeting when she learned about the hearings.
McEwen, of Long Beach, a nurse for 35 years, said she felt compelled to speak out about the lack of a single-payer voice at the table.
“At that point, I felt I couldn’t be silent anymore because it was like I was seeing a gag, a hand covering the mouth of a victim,” McEwen said. “There’s therapy for the broken health care system, and any other reform that includes the insurance companies is not going to get us where we need to go in terms of providing equitable and fair coverage.”
Health care proposals
A number of health policy proposals are under consideration as lawmakers work to overhaul the nation’s health care system, but a proposal to have the government pay exclusively for basic health care has largely been left out of the discussions. Here are some of the ideas on the table:
Public plan: Create a government-financed purchasing pool or “exchange” – one that people could buy as an alternative to individual health policies offered by private insurers.
Individual mandate: Require individuals to get health insurance through an employer, the government or on their own. In exchange, insurers would have to stop discriminating against people with medical problems.
New taxes: Tax job-based health insurance benefits, a controversial option that proponents say could help pay for the overhaul estimated to cost some $1.2 trillion to $1.5 trillion over 10 years. Other taxes would come from hikes on alcohol, tobacco and soda.
Reduce health costs: Improve efficiency in the delivery system by upgrading technologies, increasing the availability of generic medications, realigning provider payments to reward quality of care rather than just quantity, and funding efforts to figure out which medical treatments work best.
© 2009 Hearst Communications Inc.
Disruption of Congress or Corruption of Congress? May 27, 2009
Posted by rogerhollander in Health.Tags: baucus 13, campaing contributions, consume watchdog, corruption of congress, disruption of congress, health, health care, health care reform, health insurance corporations, health insurance deaths, healthcare, healthcare reform, max baucus, pharmeceutical corporations, private health insurance, roger hollander, russell mokhiber, senate finance, single payer, single payer action
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Single Payer Trial for the Baucus 13
Single Payer Action
Seven of the Baucus 13 were arraigned in Washington, D.C. Superior Court this morning.
The Baucus 13 are doctors, nurses, lawyers and other single payer advocates who stood up before Senator Max Baucus and the Senate Finance Committee during hearings on May 5 and May 12 and demanded that a single payer advocate be allowed to testify.
Senator Baucus called 41 witnesses over three days of hearings on health care reform – not one of which was a single payer advocate.
The Baucus 13 were handcuffed, arrested, and now face charges of “disruption of Congress.”
Seven of the thirteen – Dr. Margaret Flowers, Dr. Pat Salomon, Dr. Carol Paris, Russell Mokhiber, Kevin Zeese, Mark Dudzik, and Adam Schneider – pled not guilty this morning.
The remaining six – Katie Robbins, Dr. Judy Dasovich, Dr. Steve Fenichel, Sue Cannon, DeAnn McEwan, and Jerry Call – will be arraigned later this week and next month.
A status hearing for the Baucus 13 was set for June 22 before Judge Harold L. Cushenberry.
The Baucus 13 are being represented by criminal defense attorneys Ann Wilcox and James Klimaski.
If they go to trial, the Baucus 13 will probably face a trial date sometime in the early fall.
Prosecutors this morning asked that the Baucus 13 be ordered to stay away from the Dirksen Senate Office Building – the scene of the single payer actions on May 5 and May 12.
But after objections from Klimaski, the presiding DC judge ordered the defendants to stay away from Dirksen “except for formal business – meaning other than protests.”
“Senator Baucus is charging us with ‘disruption of Congress,’” said Russell Mokhiber of Single Payer Action. “We are charging Senator Baucus with corruption of Congress. We believe we have a stronger case.”
According to a recent analysis by the public interest group Consumer Watchdog, Senator Baucus, the leading architect of health reform in the Congress, has received more campaign contributions from the health insurance and pharmaceutical corporations than any other current Democratic member of the House or Senate.
According to the report, Senator Baucus received $183,750 from health insurance companies and $229,020 from drug companies in the last two election cycles.
During recent Senate Finance Committee hearings on health care reform, Baucus has refused to allow even one person to testify on behalf of a single payer health care system.
According to recent polls, single payer is supported by a majority of Americans, doctors and health economists.
Baucus has been repeatedly asked over the past months to allow a single payer advocate to testify.
He has steadfastly refused.
“Sixty Americans die every day from lack of health insurance,” Mokhiber said. “Only single payer will save hundreds of billions of dollars in overhead, waste, profits and fraud needed to insure every person in this country. President Obama, Senator Baucus and the corporate Democrats are engaged in the futility of piecemeal tinkering while Americans die. We need to put an end to the private health insurance industry so that the American people can get the health care they deserve.”
What Single Payer Action Wants:
- Single payer.
- Simple.
- Direct.
- Everybody in.
- Nobody out.
Obama, the healthcare Riddler May 16, 2009
Posted by rogerhollander in Barack Obama, Health.Tags: david sirota, health, health care, health care reform, health industry, health insurance, healthcare, healthcare companies, healthcare reform, insurance industry, max baucus, medicare, national health plan, obama promises, president obama, private health care, private health insurance, profiteering, public health plan, roger hollander, single payer
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David Sirota
www.salon.com, May 16, 2009
Why is the president suddenly so afraid of a single-payer solution to America’s healthcare crisis?
May 16, 2009 | The most stunning and least reported news about President Barack Obama’s press conference with health industry executives this week wasn’t those executives’ willingness to negotiate with a Democrat. It was that Democrat’s eagerness to involve those executives in a discussion about healthcare reform even as they revealed their previous plans to pilfer $2 trillion from Americans.
That was the little-noticed message from the made-for-TV spectacle that administration officials called a healthcare “game changer”: In saying they can voluntarily slash $200 billion a year off the country’s medical bills over the next decade and still preserve their profits, healthcare companies implicitly acknowledged they were plotting to fleece consumers and have been fleecing them for years. With that acknowledgment came the tacit admission that the industry’s business is based not on respectable returns, but on grotesque profiteering and waste — the kind that can give up $2 trillion and still guarantee huge margins.
Chief among the profiteers at the White House event were insurance companies, which have raised premiums by 119 percent since 1999, and one obvious question is why — why would Obama engage those particular thieves?
It’s a difficult query to answer, because Obama is a healthcare mystery, struggling to muster consistent positions on the issue.
Listening to a 2003 Obama speech, it’s hard to believe he has become such an enigma. Back then, he declared himself “a proponent of a single-payer universal healthcare program” — that is, one eliminating private insurers and their overhead costs by having government finance healthcare. Obama’s position was as controversial then as it is today — which is to say, controversial among political elites, but not among the general public. ABC’s 2003 poll showed almost two-thirds of Americans desiring a single-payer system “run by the government and financed by taxpayers,” just as CBS’s 2009 poll shows roughly the same percentage today.
In that speech six years ago, Obama said the only reason single-payer proponents should tolerate delay is “because first we have to take back the White House, we have to take back the Senate, and we have to take back the House.”
That might explain why, when Illinois contemplated a 2004 healthcare proposal raising insurance lobbyists’ “fears that it would result in a single-payer system,” those lobbyists “found a sympathetic ear in Obama, who amended (read: gutted) the bill more to their liking,” according to the Boston Globe. Maybe Obama didn’t think single-payer healthcare was achievable without a Democratic Washington. And when in a 2006 interview he told me he was “not convinced that [single-payer healthcare] is the best way to achieve universal healthcare,” perhaps he was following the same rationale, considering his insistence that he must “take into account what is possible.”
Of course, even as a senator aiming for the “possible” in a Republican Congress, Obama promised to never “shy away from a debate about single payer.” And after the 2008 election fulfilled his precondition of Democratic dominance, it was only logical to expect him to initiate that debate.
That’s why the White House’s current posture is so puzzling. As the Associated Press reports, Obama aides are trying to squelch any single-payer discussion, deploying their healthcare point-person, Sen. Max Baucus, D-Mont., to announce that “everything is on the table with the single exception of single-payer.”
So it’s back to why — why Obama’s insurance-industry-coddling inconsistency? Is it a pol’s payback for campaign cash? Is it an overly cautious lawmaker’s paralysis? Is it a conciliator’s desire to appease powerful interests? Or is it something else?
For a president who spends so much time on camera answering questions, those have become the biggest unanswered questions of all.
© 2009 Creators Syndicate Inc.
Baucus’ Raucous Caucus May 14, 2009
Posted by rogerhollander in Health.Tags: ama, amy goodman, Democracy Now, denis moynihan, free speech movement, health, health care, health care reform, health insurance lobby, health net.ahip, healthcare, healthcare reform, hosptial association, insurance industry, kaiser, mario savio, max baucus, merc, national health insurance, pharma, pharmaceutical industry, phrma, private health insurance, roger hollander, russ feingold, single payer
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Barack Obama appeared this week with health-industry bigwigs, proclaiming light at the end of the health-care tunnel. Among those gathered were executives from HMO giants Kaiser Foundation Health Plan and Health Net Inc., and the health-insurance lobbying group America’s Health Insurance Plans; from the American Hospital Association and the American Medical Association; from medical-device companies; and from the pharmaceutical industry, including the president and CEO of Merck and former Rep. Billy Tauzin, now president and CEO of PhRMA, the massive industry lobbying group. They have pledged to voluntarily shave some $2 trillion off of U.S. health-care costs over 10 years. But these groups, which are heavily invested in the U.S. health-care status quo, have little incentive to actually make good on their promises.
This is beginning to look like a replay of the failed 1993 health-care reform efforts led by then-first lady Hillary Rodham Clinton. Back then, the business interests took a hard line and waged a PR campaign, headlined by a fictitious middle-class couple, Harry and Louise, who feared a government-run health-care bureaucracy.
Still absent from the debate are advocates for single-payer, often referred to as the “Canadian-style” health care. Single-payer health care is not “socialized medicine.” According to Physicians for a National Health Program, single-payer means “the government pays for care that is delivered in the private (mostly not-for-profit) sector.”
A February CBS News poll found that 59 percent in the U.S. say the government should provide national health insurance.
Single-payer advocates have been protesting in Senate Finance Committee hearings, chaired by Democratic Montana Sen. Max Baucus. Last week, at a committee hearing with 15 industry speakers, not one represented the single-payer perspective. A group of single-payer advocates, including doctors and lawyers, filled the hearing room and, one by one, interrupted the proceedings.
Protester Adam Schneider yelled: “We need to have single-payer at the table. I have friends who have died, who don’t have health care, whose health care did not withstand their personal health emergencies. … Single-payer now!”
Baucus gaveled for order, guffawing, “We need more police.” The single-payer movement has taken his words as a rallying cry. At a hearing Tuesday, five more were arrested. They call themselves the “Baucus 13.”
One of the Baucus 13, Kevin Zeese, recently summarized Baucus’ career campaign contributions:
“From the insurance industry: $1,170,313;
health professionals: $1,016,276;
pharmaceuticals/health-products industry: $734,605;
hospitals/nursing homes: $541,891;
health services/HMOs: $439,700.”
That’s almost $4 million from the very industries that have the most to gain or lose from health-care reform.
Another of the Baucus 13, Russell Mokhiber, co-founder of SinglePayerAction.org, has been charged with “disruption of Congress.”
He was quick to respond: “I charge Baucus with disrupting Congress. It once was a democratic institution; now it’s corrupt, because of people like him. He takes money from the industry and does their bidding. He won’t even diffuse the situation by seating a single-payer advocate at the table.”
As I traveled through Montana recently, from Missoula to Helena to Bozeman, health-care activists kept referring to Baucus as the “money man.” Montana state Sen. Christine Kaufmann sponsored an amendment to the Montana Constitution, granting everyone in Montana “the right to quality health care regardless of ability to pay,” or health care as a human right. It died in committee.
Wisconsin Sen. Russ Feingold, a single-payer advocate, said his position will not likely prevail in Washington: “I don’t think there’s any possibility that that will come out of this Congress.” That’s if things remain business as usual.
Mario Savio led the Free Speech Movement on the UC Berkeley campus. In 1964, he said: “There comes a time when the operation of the machine becomes so odious, makes you so sick at heart, that you can’t take part, you can’t even passively take part, and you’ve got to put your bodies upon the gears and upon the wheels, upon all the apparatus, and you’ve got to make it stop. And you’ve got to indicate to the people who run it, the people who own it, that unless you’re free, the machine will be prevented from working at all.”
“Unless you’re free,” the Baucus 13 might add, “to speak.” The current official debate has locked single-payer options out of the discussion, but also escalated the movement-from Healthcare-NOW! to Single Payer Action-to shut down the orderly functioning of the debate, until single-payer gets a seat at the table.
Denis Moynihan contributed research to this column.
Is the House Health Care Bill Better than Nothing? November 9, 2009
Posted by rogerhollander in Health.Tags: conyers, health, health care, health care reform, health costs, health insurance, healthcare, healthcare reform, insurance industry, kucinich, marcia angell, Medicaid, medicare, private health insurance, public option, roger hollander, single payer
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Well, the House health reform bill — known to Republicans as the Government Takeover — finally passed after one of Congress’s longer, less enlightening debates. Two stalwarts of the single-payer movement split their votes; John Conyers voted for it; Dennis Kucinich against. Kucinich was right.
Conservative rhetoric notwithstanding, the House bill is not a “government takeover.” I wish it were. Instead, it enshrines and subsidizes the “takeover” by the investor-owned insurance industry that occurred after the failure of the Clinton reform effort in 1994. To be sure, the bill has a few good provisions (expansion of Medicaid, for example), but they are marginal. It also provides for some regulation of the industry (no denial of coverage because of pre-existing conditions, for example), but since it doesn’t regulate premiums, the industry can respond to any regulation that threatens its profits by simply raising its rates. The bill also does very little to curb the perverse incentives that lead doctors to over-treat the well-insured. And quite apart from its content, the bill is so complicated and convoluted that it would take a staggering apparatus to administer it and try to enforce its regulations.
What does the insurance industry get out of it? Tens of millions of new customers, courtesy of the mandate and taxpayer subsidies. And not just any kind of customer, but the youngest, healthiest customers — those least likely to use their insurance. The bill permits insurers to charge twice as much for older people as for younger ones. So older under-65′s will be more likely to go without insurance, even if they have to pay fines. That’s OK with the industry, since these would be among their sickest customers. (Shouldn’t age be considered a pre-existing condition?)
Insurers also won’t have to cover those younger people most likely to get sick, because they will tend to use the public option (which is not an “option” at all, but a program projected to cover only 6 million uninsured Americans). So instead of the public option providing competition for the insurance industry, as originally envisioned, it’s been turned into a dumping ground for a small number of people whom private insurers would rather not have to cover anyway.
If a similar bill emerges from the Senate and the reconciliation process, and is ultimately passed, what will happen?
First, health costs will continue to skyrocket, even faster than they are now, as taxpayer dollars are pumped into the private sector. The response of payers — government and employers — will be to shrink benefits and increase deductibles and co-payments. Yes, more people will have insurance, but it will cover less and less, and be more expensive to use.
But, you say, the Congressional Budget Office has said the House bill will be a little better than budget-neutral over ten years. That may be, although the assumptions are arguable. Note, though, that the CBO is not concerned with total health costs, only with costs to the government. And it is particularly concerned with Medicare, the biggest contributor to federal deficits. The House bill would take money out of Medicare, and divert it to the private sector and, to some extent, to Medicaid. The remaining costs of the legislation would be paid for by taxes on the wealthy. But although the bill might pay for itself, it does nothing to solve the problem of runaway inflation in the system as a whole. It’s a shell game in which money is moved from one part of our fragmented system to another.
Here is my program for real reform:
Recommendation #1: Drop the Medicare eligibility age from 65 to 55. This should be an expansion of traditional Medicare, not a new program. Gradually, over several years, drop the age decade by decade, until everyone is covered by Medicare. Costs: Obviously, this would increase Medicare costs, but it would help decrease costs to the health system as a whole, because Medicare is so much more efficient (overhead of about 3% vs. 20% for private insurance). And it’s a better program, because it ensures that everyone has access to a uniform package of benefits.
Recommendation #2: Increase Medicare fees for primary care doctors and reduce them for procedure-oriented specialists. Specialists such as cardiologists and gastroenterologists are now excessively rewarded for doing tests and procedures, many of which, in the opinion of experts, are not medically indicated. Not surprisingly, we have too many specialists, and they perform too many tests and procedures. Costs: This would greatly reduce costs to Medicare, and the reform would almost certainly be adopted throughout the wider health system.
Recommendation #3: Medicare should monitor doctors’ practice patterns for evidence of excess, and gradually reduce fees of doctors who habitually order significantly more tests and procedures than the average for the specialty. Costs: Again, this would greatly reduce costs, and probably be widely adopted.
Recommendation #4: Provide generous subsidies to medical students entering primary care, with higher subsidies for those who practice in underserved areas of the country for at least two years. Costs: This initial, rather modest investment in ending our shortage of primary care doctors would have long-term benefits, in terms of both costs and quality of care.
Recommendation #5: Repeal the provision of the Medicare drug benefit that prohibits Medicare from negotiating with drug companies for lower prices. (The House bill calls for this.) That prohibition has been a bonanza for the pharmaceutical industry. For negotiations to be meaningful, there must be a list (formulary) of drugs deemed cost-effective. This is how the Veterans Affairs System obtains some of the lowest drug prices of any insurer in the country. Costs: If Medicare paid the same prices as the Veterans Affairs System, its expenditures on brand-name drugs would be a small fraction of what they are now.
Is the House bill better than nothing? I don’t think so. It simply throws more money into a dysfunctional and unsustainable system, with only a few improvements at the edges, and it augments the central role of the investor-owned insurance industry. The danger is that as costs continue to rise and coverage becomes less comprehensive, people will conclude that we’ve tried health reform and it didn’t work. But the real problem will be that we didn’t really try it. I would rather see us do nothing now, and have a better chance of trying again later and then doing it right.
Marcia Angell, M. D., is Senior Lecturer in the Department of Social Medicine at Harvard Medical School. She stepped down as Editor-in-Chief of the New England Journal of Medicine on June 30, 2000.