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The Real Health Care Debate April 9, 2012

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Published on Monday, April 9, 2012 by Truthdig

  by  Chris Hedges

The debate surrounding the Patient Protection and Affordable Care Act illustrates the impoverishment of our political life. Here is a law that had its origin in the right-wing Heritage Foundation, was first put into practice in 2006 in Massachusetts by then-Gov. Mitt Romney and was solidified into federal law after corporate lobbyists wrote legislation with more than 2,000 pages. It is a law that forces American citizens to buy a deeply defective product from private insurance companies. It is a law that is the equivalent of the bank bailout bill—some $447 billion in subsidies for insurance interests alone—for the pharmaceutical and insurance industries. It is a law that is unconstitutional. And it is a law by which President Barack Obama, and his corporate backers, extinguished the possibilities of both the public option and Medicare for all Americans. There is no substantial difference between Obamacare and Romneycare. There is no substantial difference between Obama and Romney. They are abject servants of the corporate state. And if you vote for one you vote for the other.

 

But you would never know this by listening to the Democratic Party and the advocacy groups that purport to support universal health care but seem more intent on re-electing Obama. It is the very sad legacy of the liberal class that it proves in election cycle after election cycle that it espouses moral and political positions it will not pay a price to defend. And since we have no fight in us, since we will not punish politicians like Obama who betray our core beliefs, the corporate juggernaut rolls forward with its inexorable pace to cement into place our global neofeudalism.

Protesting outside the Supreme Court recently as it heard arguments on the constitutionality of the Affordable Care Act were both conservatives from Americans for Prosperity who denounced the president as a socialist and demonstrators from Democratic front groups such as the SEIU and the Families USA health care consumer group who chanted “Protect the law!” Lost between these two factions were a few stalwarts who hold quite different views, including public health care advocates Dr. Margaret Flowers, Dr. Carol Paris and attorneys Oliver Hall, Kevin Zeese and Russell Mokhiber. They displayed a banner that read: “Single Payer Now! Strike Down the Obama Mandate!” They, at least, have not relinquished the demand for single payer health care for all Americans. And I throw my lot in with these renegades, dismissed, no doubt, as cranks or dreamers or impractical by those who flee into the embrace of empty political theater and junk politics. These single payer advocates, joined by 50 doctors, filed a brief to the court that challenges, in the name of universal health care, the individual mandate.

“We have the solution, we have the resources and we have the money to provide lifelong, comprehensive, high-quality health care to every person,” Dr. Flowers said when we spoke a few days ago in Washington, D.C. Many Americans have not accepted the single payer approach “because people get confused by the politics,” she said. “People accept the Democratic argument that this [Obamacare] is all we can have or this is something we can build on.”

“If you are trying to meet the goal of universal health coverage and the only way to meet that goal is to force people to purchase private insurance, then you might consider that it is constitutional,” Flowers said. “Our argument is that the individual mandate does not meet the goal of universality. When you attempt to use the individual mandate and expansion of Medicaid for coverage, only about half of the uninsured gain coverage. This is what we have seen in Massachusetts. We do, however, have systems in the United States that could meet the goal of universality. That would be either a Veterans Administration type system, which is a socialized system run by the government, or a Medicare type system, a single payer, publicly financed health care system. If the U.S. Congress had considered an evidence-based approach to health reform instead of writing a bill that funnels more wealth to insurance companies that deny and restrict care, it would have been a no-brainer to adopt a single payer health system much like our own Medicare. We are already spending enough on health care in this country to provide high-quality, universal, comprehensive, lifelong health care. All the data point to a single payer system as the only way to accomplish this and control health care costs.”

Obamacare will, according to figures compiled by Physicians for a National Health Plan (PNHP), leave at least 23 million people without insurance, a figure that translates into an estimated 23,000 unnecessary deaths a year among people who cannot afford care. Costs will continue to climb. There are no caps on premiums, including for people with “pre-existing conditions.” The elderly can be charged three times the rates provided to the young. Companies with predominantly female workforces can be charged higher gender-based rates. Most of us will soon be paying about 10 percent of our annual incomes to buy commercial health insurance, although this coverage will pay for only about 70 percent of our medical expenses. And those of us who become seriously ill, lose our incomes and cannot pay the skyrocketing premiums are likely to be denied coverage. The dizzying array of loopholes in the law—written in by insurance and pharmaceutical lobbyists—means, in essence, that the healthy will receive insurance while the sick and chronically ill will be priced out of the market.

Medical bills already lead to 62 percent of personal bankruptcies, and nearly 80 percent of those declaring personal bankruptcy because of medical costs had insurance. The U.S. spends twice as much per capita on health care as other industrialized nations, $8,160. Private insurance bureaucracy and paperwork consume 31 percent of every health care dollar. Streamlining payment through a single, nonprofit payer would save more than $400 billion per year, enough, the PNHP estimates, to provide comprehensive, high-quality coverage for all Americans.

But as long as corporations determine policy, as long as they can use their money to determine who gets elected and what legislation gets passed, we remain hostages. It matters little in our corporate state that nearly two-thirds of the public wants single payer and that it is backed by 59 percent of doctors. Public debates on the Obama health care reform, controlled by corporate dollars, ruthlessly silence those who support single payer. The Senate Finance Committee, chaired by Max Baucus, a politician who gets more than 80 percent of his campaign contributions from outside his home state of Montana, locked out of the Affordable Care Act hearing a number of public health care advocates including Dr. Flowers and Dr. Paris; the two physicians and six other activists were arrested and taken away. Baucus had invited 41 people to testify. None backed single payer. Those who testified included contributors who had given a total of more than $3 million to committee members for their political campaigns.

“It is not necessary to force Americans to buy private health insurance to achieve universal coverage,” said Russell Mokhiber of Single Payer Action. “There is a proven alternative that Congress didn’t seriously consider, and that alternative is a single payer national health insurance system. Congress could have taken seriously evidence presented by these single payer medical doctors that a single payer system is the only way to both control costs and cover everyone.”

© 2012 Truthdig.com

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Chris Hedges

Chris Hedges writes a regular column for Truthdig.com. Hedges graduated from Harvard Divinity School and was for nearly two decades a foreign correspondent for The New York Times. He is the author of many books, including: War Is A Force That Gives Us Meaning, What Every Person Should Know About War, and American Fascists: The Christian Right and the War on America.  His most recent book is Empire of Illusion: The End of Literacy and the Triumph of Spectacle.

REVEALED: The Democrats’ devious plan to compromise with the Republicans April 3, 2012

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In Monday’s New York Times, Ross Douthat explains the devious reasoning behind the Democrats’ adoption of the individual mandate: “It protected the Democratic bill on two fronts at once: buying off some of the most influential interest groups even as it hid the true cost of universal coverage.”

Clever! But I can’t help feeling like Ross is forgetting something. There was some other reason Democrats adopted this policy. I’m almost sure of it. If you give me a second, I’m sure it’ll come to me.

Ah, right! Because Chuck Grassley, the ranking Republican on the Senate Finance Committee, was saying things like “I believe that there is a bipartisan consensus to have individual mandates,” and “individual mandates are more apt to be accepted by a majority of the people in Congress than an employer mandate.”

And it wasn’t just Grassley. A New York Times columnist by the name of Ross Douthat praised Utah Sen. Bob Bennett for “his willingness to co-sponsor a centrist (in a good way!) health care reform bill with the Oregon Democrat Ron Wyden.” That health-care reform bill was the Healthy Americans Act which included, yes, an individual mandate. But while Douthat did later say that the Healthy Americans Act wasn’t his “preferred health care reform,” at no point did he accuse Bennett of “buying off some of the most influential interest groups” even as he “hid the true cost of universal coverage.”

The Healthy Americans Act, meanwhile, had been cosponsored by a bevy of heavy-hitting Senate Republicans, including Lamar Alexander, Mike Crapo, Bob Corker, Judd Gregg, Norm Coleman and Trent Lott. And it’s not like they were off the reservation in some significant way: In 2007, both Sen. Jim DeMint and the National Review endorsed Mitt Romney, who had passed an individual mandate into law in Massachusetts. In their endorsements, both icons of conservatism specifically mentioned his health-care plan as a reason for their endorsement. DeMint, for instance, praised Romney’s health-care plan as “something that I think we should do for the whole country.”

Avik Roy points out that many liberals — including candidate Barack Obama — were historically skeptical of the individual mandate. And that’s true! There was a robust debate inside the party as to whether Democrats should move from proposing a government-centric health-care model to one Republicans had developed in order to preserve the centrality of “personal responsibility” and private health insurers. Many liberals opposed such a shift. But they lost to the factions in the party that wanted health-care reform to be a bipartisan endeavor.

Roy tries to use this to draw some equivalence between the two parties. Both Democrats and Republicans changed their mind on the individual mandate, he argues. But there’s a key difference: The Democrats changed their mind in order to secure a bipartisan compromise on health-care reform. Republicans changed their mind in order to prevent one.

And so what did Democrats get for their troubles? Well, the individual mandate is the least popular element of the health-care law. The entire Republican Party decided the individual mandate was an unconstitutional assault on freedom. And today, even relatively moderate Republicans like Douthat present the mandate as some kind of underhanded trick.

That’s politics, I guess. But ask yourself: If Obamacare is overturned, and Obama is defeated, who will win the Democratic Party’s next fight over health care? Probably not the folks counseling compromise. Too many Democrats have seen how that goes. How much easier to propose a bill that expands Medicaid eligibility to 300 percent of the poverty line, covers every child through the Children’s Health Insurance Program, and makes Medicare availability to every American over age 50. Add in some high-risk pools, pay for the bill by slapping a surtax on rich Americans — indisputably constitutional, as even Randy Barnett will tell you — and you’ve covered most of the country’s uninsured. Oh, and you can pass the whole thing through the budget reconciliation process.

I don’t think that’s a particularly good future for the health-care system. And I doubt that bill will pass anytime soon. But, if Obamacare goes down, something like it will eventually be passed. And what will Republicans have to say about it? That no, this time, they really would have worked with the Democrats to reform America’s health-care system? Who will believe them?

All U.S. Constituencies Oppose Obama’s “Individual Mandate” for Health Care April 3, 2012

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Black Agenda Radio commentary by Glen Ford

President Obama’s mandate to buy private insurance was born in the rightwing Heritage Foundation, and has not found a home among any actual constituency of the public – white, non-white, Republican, Democrat, college-educated or not. A new poll confirms that “Obama has based his plan on a scheme that nobody likes – even his most loyal supporters.”

 

All U.S. Groups Oppose Obama’s “Individual Mandate” for Health Care

A Black Agenda Radio commentary by Glen Ford

“The new poll shows that no significant constituency supports Obama’s individual mandate.”

When one takes a cursory look at where various groups in the nation stand on President Obama’s health care legislation – now under review by the U.S. Supreme Court – it appears the country is split along party and race lines. A new poll conducted by Princeton Research Associates shows 75 percent of Democrats support the Obama position, and 86 percent of Republicans oppose it, with so-called independents evenly split. The racial divide is similar. Sixty-eight percent of non-whites “strongly favor” or “somewhat favor” the overall health care law, with only 18 percent opposed. Whites are far more divided, with 33 percent favoring Obama’s law, and 47 percent opposed.

These numbers are, however, heavily influenced by what people think is in the law, and what side they think they should be on, based on their larger loyalties. It is doubtful that majorities on either side of the issue actually understand most of the law’s many provisions, some of which do not go into effect for several years. Therefore, many of the respondents are using the poll to register their broader preference for or against the incumbent president and his party. It is no surprise that majorities of whites and super-majorities of Republicans oppose ObamaCare, as Republicans call it, and more than two thirds of non-whites and three-quarters of Democrats support Health Care Reform, as Obama calls it.

However, most people do understand the central element of the law, the “individual mandate” that forces nearly everyone to buy health insurance from private companies, or face a fine. The new poll shows that no significant constituency supports Obama’s individual mandate, with only 28 percent of the overall public favorable to the scheme. Even non-whites, two-thirds of whom claim to support Obama on health care in general, balk at mandatory purchase of insurance from private companies. Fifty-three percent of non-whites give thumbs down to the individual health insurance mandate, as do 71 percent of whites. More Democrats are opposed to Obama’s individual mandate than favor it: 48 to 44 percent. And Republicans are off the scale in opposition, at 15 to 1.

“Fifty-three percent of non-whites give thumbs down to the individual health insurance mandate.”

So, if the core of the Obama health care plan is the individual mandate, as both the administration and the Republicans contend in their arguments before the Supreme Court, then Obama has based his plan on a scheme that nobody likes – even his most loyal supporters.

There’s another interesting aspect to the new poll. It shows that only a hard core of one in four people want to tamper with Medicare as the Republicans do, with around two-thirds of all racial groups opting to keep the program the way it is, with the government paying doctors and hospitals directly for the service they provide to seniors.” Taken together, the poll indicates strong support for the core elements of the U.S. healthcare safety net, and rejection of private schemes, including Obama’s mandatory purchase of insurance from private companies. It appears that most Americans would rather have the option of dependable, direct health care paid for by the government – which was the case at the beginning of 2009, before Obama unveiled his health care scheme, when 60 percent and more of the American people favored single-payer health care. But Obama maneuvered them into a something they hadn’t asked for, and which, three years later, nobody wants. For Black Agenda Radio, I’m Glen Ford. On the web, go to BlackAgendaReport.com.

 

Sleazy California Democratd on Health Reform February 6, 2012

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Roger’s note: this is an excerpt from an email I received from activist.thepen@gmail.com.  It describes the machinations of the California Democratic Party in appearing to support a single payer health insurance plan while at the same time behind the scenes doing everything it can to ensure that it DOESN’T come to pass.  In the seven years I spend on the Toronto municipal council, I saw this kind of hypocrisy in action time and time again.  What they did in California is a classical example of this tactic, and the pen activists captured it perfectly and are to be congratulated for the exposé.  And one more example of why electoral politics (as opposed to taking to the streets) is for the most part futile.

As you know, if you have been a participant of this distribution list for a while, we have been valiantly advocating for a single payer health care system for many years. Such a bill (SB 840) was passed by both chambers of the CA state legislature in 2006, but the bill was vetoed by Governor Maid Molester (Schwarzenegger).
At the time we TRIED to get the Democratic nominee Phil Angelides (who had previously claimed to support single payer) to do an action to demand that Arnold sign the bill. It would have been a great campaign issue for him, but he was too chicken hearted or corrupt himself (your choice) to do it, and he lost by 30 points or something like that.

The same bill passed in 2008 and was vetoed again.

Now fast forward the clock to last week, when single payer
(renumbered SB 810) was again in front of the CA Senate, but now with a Democratic governor, Jerry Brown, who would be expected to sign the bill. All of a sudden four Democratic senators refused to even vote at all. That’s right, folks, they ABSTAINED, which is being in the room for the vote and refusing to cast a vote one way or another. At least three of these abstainers had voted “Yes” for single payer the last time.
So we cranked out a targeted action aimed only at these turncoat abstainers and have good information they got LOTS of phone calls for them to reconsider. But reconsideration never happened. So what’s really going on here? Here’s what the sponsor of the bill, Mark Leno, said on the Thom Hartmann show when gently challenged on why previous supporters were now abstaining.
“Arnold Schwartzeneggar was always going to veto the bill, so if one
had an interest in not ruffling the feathers of the insurance industry, the possibility is to vote for it with the wink of the eye that it’s not going anywhere anyway.”
In Greek mythology, Tantalus as his eternal punishment was cursed to stand in a pool of water underneath a fruit tree with low hanging branches always just out of reach, with the water always receding before he could take a drink. THAT is the very image of what the
Democratic party has become for the interests of the people who consider themselves constituents. It’s all a scam, folks, just one great, big, giant, honking scam.
This is essentially the same thing that happened in 2010 with that phony baloney health care bill, with a bottom line of nothing but pig grease for the medical insurance corporations. After lulling people
along for almost a year with the promise of a “public option”, itself a feeble impersonation of single payer, they refused to even allow a vote on it. In the end, having been forced to pass the bill using a reconciliation gimmick requiring only 51 votes, and 51 Democratic senators on record as supporting the so-called public option, they simply REFUSED to bring it up for a vote, even though they had the votes to do.
And the worst thing about it is that even the so-called good guys are in on it. Mark Leno, the sponsor of SB 810, KNOWS it will never pass, that the vote will always be manipulated so it falls just short in some way. The only reason for him to bring the bill up at all is to CON his own constituents into thinking he’s on their side, otherwise he would be vociferously calling out these abstainer traitors, not accidentally spilling the beans as he did. It’s nothing but a cynical PR stunt, and they are ALL in on it. No matter how many Democrats we vote for, till the end of all eternity, they will always find some way to fail to pass single payer health care.

What sick socialist bastard would want to provide free healthcare to the poor! January 30, 2012

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Roger’s note: I am no fan of the Obama health care legislation, which gave away the store to the health insurance industry and by no means provides free healthcare to the poor; but this image is a perfect antidote to the mean spirited and  hypocritical “Christian” Republicans, to Ron Paul and the other Ayn Rand worshipers.

One Montana County’s Medicare-for-All Coverage June 28, 2011

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Published on Tuesday, June 28, 2011 by OtherWords

As the Ryan Republicans try to destroy Medicare, here’s a prescription to clean up the whole mess.

  by  Kay Tillow

Back when he presided over the Senate’s health care reform debate, Max Baucus, chairman of the all-powerful Senate Finance Committee, had said everything was on the table — except for single-payer universal health care. When doctors, nurses, and others rose in his hearing to insist that single payer be included in the debate, the Montana Democrat had them arrested. As more stood up, Baucus could be heard on his open microphone saying, “We need more police.”

Yet when Baucus needed a solution to a catastrophic health disaster in Libby, Montana and surrounding Lincoln County, he turned to the nation’s single-payer healthcare system, Medicare, to solve the problem.

You see, a vermiculite mine had spread deadly airborne asbestos that killed hundreds and sickened thousands in Libby and northwest Montana. W.R. Grace & Co., which owned the mine, denied its connection to the outbreaks of mesothelioma and asbestosis and dodged responsibility for this disaster. The federal government got stuck with most of the tab for the cleanup costs, and the EPA has issued a first-of-its-kind order declaring Lincoln County a public health disaster.

When all lawsuits and legal avenues failed, Baucus turned to Medicare.

The single-payer plan that Baucus kept off the table in 2009 is now very much on the table in Libby. It turns out that Baucus quietly inserted a section into the Affordable Care Act that covers the suffering people of Libby, Montana. Medicare covers the whole community, not just the former miners.

Residents of Libby don’t have to be 65 years old or more. They don’t have to wait until 2014 for the state exchanges. There’s no 10-year roll out for them — it’s immediate. They don’t have to purchase a plan — this isn’t a buy-in to Medicare. It’s free. They don’t have to be disabled for two years before they apply. They don’t have to go without care for three years until Medicaid expands. They don’t have to meet income tests. They don’t have to apply for a subsidy or pay a fine for failure to buy insurance. They don’t have to hope that the market will make a plan affordable or hide their pre-existing conditions. They don’t have to find a job that provides coverage.

Baucus simply inserted a clause into the health care reform law to make special arrangements for them in Medicare.

No one should begrudge the people of Lincoln County, where toxic mine waste was used as soil additives, home insulation, and even spread on the running tracks at local schools. Miners brought carcinogens home on their clothes.

“The people of Libby have been poisoned and have been dying for more than a decade,” Baucus explained in a New York Times interview. “New residents continue to get sick all the time. Public health tragedies like this could happen in any town in America. We need this type of mechanism to help people when they need it most.”

But health tragedies are happening in every American town. Over 51 million have no insurance. and over 45,000 uninsured people die needlessly each year. Employers are cutting coverage and dropping plans. States in economic crisis are slashing both Medicaid and their employees’ plans.

Nothing in Obama’s health care law will mitigate the skyrocketing costs. More than half of us, including tens of millions of insured Americans, now go without necessary care. As Baucus said of Medicare, “We need this mechanism to help people when they need it most.” We all need it now.

So as the Ryan Republicans try to destroy Medicare and far too many Democrats use the deficit excuse to suggest other ways to tear the social safety net apart, Libby offers a prescription to clean up the whole mess. Only single-payer universal health care — improved Medicare for all — can save and protect Medicare, rein in skyrocketing health care costs, and give us universal coverage.

Medicare was implemented within less than a year of its 1965 passage. When Congress passes a national single-payer bill, we can all be enrolled in the twinkling of an eye.

A longer version of this commentary first appeared on Firedoglake.

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Kay Tillow

Kay Tillow is the coordinator of the All Unions Committee for Single Payer Health Care, which builds union support for H.R. 676. She lives in Louisville, Kentucky. www.unionsforsinglepayer.org

Canada May Have the Cure For US’s Medicare Ailment June 21, 2011

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Roger’s note: A few FACTS about the Canadian Health Care System to counter the lies put forward by the shameless Tea Party and other right-wing Republican Evangelical types.  (1) users have absolute right to choose their physicians; (2) to make the system more efficient, one needs to be referred to a specialist by her family physician; (3) some provinces have community clinics where one can join — at no cost, of course — and receive care from salaried health care professionals (doctors on salary, can you imagine such a radical notion?!?); the founder of the Canadian Health Care System, Tommy Douglas, was voted the greatest Canadian of all times in a poll conducted by the Canadian Broadcasting Company; (4) the rumours about long waits for service have a grain of truth to them, but this is not because of a flaw in the system; rather it is due to right-wing provincial governments reducing funding; but in emergency situations care is not delayed.  I am a Canadian, and I have lived under both the US and Canadian health care systems, and there is absolutely no question which is more efficient and humane.  The Canadian system of early intervention at no cost to the patient or her family saved the life of my two-year old daughter when she had spinal meningitis.  When my father visited us in Canada from the States and took ill, I brought him to the office of my family physician, who treated him.  The office, however, was stumped as to what to do about payment.  They never had to collect money before and didn’t know what to do with it.  In Canada, you go to the doctor or laboratory and present you health card.  No money changes hands.  No co-payments.  Imagine!

Tuesday 21 June 2011

by: Paul Krugman, Krugman & Co.         | Op-Ed

Crystal Bentley is examined by Dr. Tom Novak at a clinic in Oshawa, Canada. (Photo: Donald Weber for The New York Times)

 

I keep hearing people say that Medicare in its current form is not sustainable in the United States, as if that were an established fact. It’s anything but.

What is Medicare? It’s single-payer coverage for the elderly.

Other countries have single-payer systems that are much cheaper than ours — and also much cheaper than private insurance in America. So there’s nothing about the form that makes Medicare unsustainable, unless you think that health care itself is unsustainable.

What is true is that American Medicare is expensive compared to, say, Canadian Medicare (yes, that’s what they call their system) or the French health care system (which is complicated, but largely single-payer in its essentials); that’s because American-style Medicare is very open-ended, reluctant to say no to paying for medically dubious procedures, and also fails to make use of its pricing power over drugs and other items. So Medicare will have to start saying no; it will have to provide incentives to move away from fee-for-service, and so on and so forth. But such changes would not mean a fundamental change in the way Medicare works.

Of course, what the people who say things like “Medicare is unsustainable” usually mean is that it must be privatized, converted into a voucher system, or whatever. The thing is, none of those changes would make the system more efficient — on the contrary.

So this business about Medicare in its present form being unsustainable sounds wise but is actually a stupid slogan. The solution to the future of Medicare is Medicare — smarter, less open-ended, but recognizably the same program.

Medicare Sustainability

Just a further data note. Canada’s Medicare is actually a lot like Medicare in the United States, but less open-ended and more serious about cost control. Here’s a chart showing Canadian spending on health versus American spending, both as percentages of gross domestic product.

Health Care Spending, USA and Canada

Hmm. Canadian Medicare looks pretty sustainable, especially as compared to the American system, which has much more private insurance.

Now, Canadian health care isn’t perfect — but it’s not bad, and Canadians are happier with their system than we are with ours in the United States. So anyone who tells you that Medicare as we know it — a single-payer system that covers everyone over a certain age — is unsustainable is ignoring the clear evidence that other countries somehow manage to make similar systems quite sustainable.

 

Paul Krugman joined The New York Times in 1999 as a columnist on the Op-Ed page and continues as a professor of economics and international affairs at Princeton University. He was awarded the Nobel in economic science in 2008.

Mr Krugman is the author or editor of 20 books and more than 200 papers in professional journals and edited volumes, including “The Return of Depression Economics” (2008) and “The Conscience of a Liberal” (2007). Copyright 2011 The New York Times.

Single-Payer in Vermont, A State of Healthy Firsts May 26, 2011

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Published on Thursday, May 26, 2011 by TruthDig.com

  by  Amy Goodman

Vermont is a land of proud firsts. This small, New England state was the first to join the 13 Colonies. Its constitution was the first to ban slavery. It was the first to establish the right to free education for all — public education.

Today, Vermont will boast another first: the first state in the nation to offer single-payer health care, which eliminates the costly insurance companies that many believe are the root cause of our spiraling health care costs. In a single-payer system, both private and public health care providers are allowed to operate, as they always have. But instead of the patient or the patient’s private health insurance company paying the bill, the state does.

It’s basically Medicare for all — just lower the age of eligibility to the day you’re born. The state, buying these health care services for the entire population, can negotiate favorable rates, and can eliminate the massive overhead that the for-profit insurers impose.

Vermont hired Harvard economist William Hsiao to come up with three alternatives to the current system. The single-payer system, Hsiao wrote, “will produce savings of 24.3 percent of total health expenditure between 2015 and 2024.”

An analysis by Don McCanne, M.D., of Physicians for a National Health Program, pointed out that “these plans would cover everyone without any increase in spending since the single-payer efficiencies would be enough to pay for those currently uninsured or under-insured. So this is the really good news — single payer works.”

Vermont Gov. Peter Shumlin explained to me his intention to sign the bill into law: “Here’s our challenge. Our premiums go up 10, 15, 20 percent a year. This is true in the rest of the country as well. They are killing small business. They’re killing middle-class Americans, who have been kicked in the teeth over the last several years. What our plan will do is create a single pool, get the insurance company profits, the pharmaceutical company profits, the other folks that are mining the system to make a lot of money on the backs of our illnesses, and ensure that we’re using those dollars to make Vermonters healthy.”

Speaking of healthy firsts, Vermont may become the first state to shutter a nuclear power plant. The Vermont Legislature is the first to empower itself with the right to determine its nuclear future, to put environmental policy in the hands of the people.

Another Vermont first was the legalization of same-sex civil unions. Then the state trumped itself and became the first legislature in the nation to legalize gay marriage. After being passed by the Vermont House and Senate, former Gov. Jim Douglas vetoed the bill. The next day, April 7, 2009, the House and the Senate overrode the governor’s veto, making the Vermont Freedom to Marry Act the law of the land.

Vermont has become an incubator for innovative public policy.

Canada’s single-payer health care system started as an experiment in one province, Saskatchewan. It was pushed through in the early 1960s by Saskatchewan’s premier, Tommy Douglas, considered by many to be the greatest Canadian. It was so successful, it was rapidly adopted by all of Canada. (Douglas is the grandfather of actor Kiefer Sutherland.)

Perhaps Vermont’s health care law will start a similar, national transformation. The anthropologist Margaret Mead famously said: “Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has.” Just replace “group” with “state,” and you’ve got Vermont.

Denis Moynihan contributed research to this column.

© 2011 Amy Goodman

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Amy Goodman

Amy Goodman is the host of “Democracy Now!,” a daily international TV/radio news hour airing on 900 stations in North America. She was awarded the 2008 Right Livelihood Award, dubbed the “Alternative Nobel” prize, and received the award in the Swedish Parliament in December.

Vt. Senate gives final nod to universal health care bill in 21-9 vote April 30, 2011

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Roger’s note:  I confess that I don’t understand the ins and outs of Obama’s Byzantine insurance industry dominated health care legislation, or how a Vermont single payer universal coverage plan can occur in that context.  As a Canadian, however, I cannot but think of Tommy Douglas.  Tommy Douglas was a clergyman and an unrepentant socialist who happened to be the Premier of the Canadian Province of Saskatchewan in the 1950s.  Against massive resistance and fears of economic collapse, he introduced universal health care into the province, which became the catalyst for its adoption by the entire country.  The domino theory at work.  Do Canadians value their system of single payer universal health insurance?   Would they support going back to private health care?  In 2004 the CBC polled Canadians on who what the greatest Canadian of all time.  Tommy Douglas won hands down.  We can only hope that what the governor and senate have now accomplished in Vermont will be more than symbolic, that it will introduce genuine universal coverage where no one is left unprotected and health care costs come under control through the limitation of windfall profits by private insurers.  Americans will then see what they are missing and demand single payer universal health care on a national basis.  I love what Dr. Richter said: You go for what you want, not for what you think you might get – that’s what the bill does.  Would that that great advocate of change you can believe in, Barack Obama, had had the courage to do just that instead of compromising the principled position of universal care from the very beginning of the congressional process.

by Anne Galloway | April 27, 2011

In a historic vote on Tuesday, the Vermont Legislature created the enabling legislation for a first-in-the-nation universal health care system. The state Senate approved the visionary plan for a single-payer system in a 21-9 vote after four hours of debate. The split was largely along party lines.

Gov. Peter Shumlin, a Democrat, campaigned on a promise to create a single-payer system in Vermont that would contain health care costs and give all of the state’s residents universal access to medical care. On Tuesday, Shumlin made good on the first step toward fulfilling that promise, and just five hours after the Senate vote, he marked the legislative victory in an appearance on MSNBC’s “The Rachel Maddow Show.”

Shumlin said in a statement to the Vermont press: “Today the Legislature took a huge step toward making Vermont the first state in the first in the nation to control skyrocketing health care costs and remove the burden of providing health care coverage from small business owners. This bill is good for Vermonters and Vermont businesses.

Many Vermont businesses, however, believe otherwise. Though small employers have said they will benefit, some larger employers actively lobbied against the bill. Opponents of H.202 argued that the legislation would leave businesses in the lurch during the transition period between 2013 and 2014 when the state is required under federal law to participate in insurance exchanges. The opposition was led by insurance brokers (the Fleischer Jacobs Group, Business Resource Specialists), business associations (Vermont Chamber of Commerce, Vermont Grocers’ Association and Vermont Retailers Association), large employers (Dealer.com, Biotek, Rhino Foods and IBM). The Senate debate on Monday and Tuesday centered on changes to the legislation that would have made it more palatable to these groups.

Sen. Vince Illuzzi, R/D-Essex Orleans, who proposed two amendments that would have made the bill more business friendly, said companies are afraid “we will end up with a plan most won’t be able to afford.”

The legislation sets the state’s health care system on a new trajectory. Instead of continuing to use an insurance model for covering the cost of care, the bill moves the state toward an integrated payment system that would be controlled by a quasi judicial board and administered by a third party entity. The system would be funded through a broad-based tax.

The universal health care system would be implemented in 2014, if it clears 10 very high hurdles, including the receipt of a federal waiver. Otherwise it wouldn’t kick in until 2017.

Longtime single-payer advocate Dr. Deb Richter was ecstatic about the Senate passage of the bill.

“I’m absolutely thrilled,” Richter said. “It’s one of the best days of my life. I’ve given 400 speeches over the last 10 years and it feels like the work was worth it. We have a ways to go, but this is a step in the right direction.”

A universal health care system is the only way to cover everyone and contain costs, Richter said.

The passage of H.202 marks the first time any state in the country has attempted to provide universal care and a cost containment system that addresses administrative costs, hospital budgeting and uniform payments to doctors, Richter said.

Whether the federal government will give Vermont a waiver to adopt a universal health care system in 2014 is an open question. Richter said the state has a 50-50 chance of getting the exemption from the Affordable Care Act. Even so, she believes Vermont’s attempt to create a single-payer system is worthwhile.

“You go for what you want, not for what you think you might get – that’s what the bill does,” Richter said.

The Senate debate focused on the state’s implementation of the insurance exchanges that are required under federal law. The Affordable Care Act has mandated that states provide an actuarial value for insurance products (the insurance equivalent of a per unit price mechanism that allows consumers to compare the cost of on the shelf grocery items). The federal government has set up very general guidelines for the actuarial levels for insurance products insurers must provide under the exchange. The idea is to create an easy system for comparison between health insurance benefit plans that offer a dizzying array of deductibles, co-insurance, co-pays and premiums. The products, under the federal requirements, range from bronze (60 percent actuarial value) to silver (70 percent), gold (80 percent) and platinum (90 percent). It also puts minimum requirements on the “qualifying plans.” Many of these mandates are already in Vermont law. Insurers, for example, are not allowed to “cherry pick” consumers who are healthy and create pools without a cross-section of the sick and healthy populations.

Read this summary of the ACA requirements from Kaiser Foundation.

The Affordable Care Act requires individuals without insurance to buy into the exchange or face a $695 fine. Families of four with incomes of less than $88,700 qualify for tax credits. Businesses with more than 50 employees that do not buy insurance face a penalty of $2,000 per worker.

The fight between employers and proponents of H.202 was about the potential for mandatory inclusion of businesses that have between 50 and 100 workers in the exchange. Sens. Hinda Miller, D-Chittenden, and Illuzzi argued that requiring companies of that size to participate in the exchange could jeopardize their economic viability. Employers in that range tend not to self-insure and so are not protected under the Employee Retirement Income Security Act.

The federal law allows states some flexibility. States can decide what benefit plan levels can be offered, for example. They can also determine the size of the businesses that must be included in the exchange. The Shumlin administration pushed for intent language in the bill that could have led to the inclusion of businesses with 50 to 100 employees into the exchange. Proponents of H.202 have said it’s important to include these 28,000 workers in the state’s insurance exchange in order to build toward a single-payer system.

An amendment proposed by Sen. Diane Snelling, R-Chittenden, and approved by the Senate struck the intent language. The Green Mountain Care board, which will oversee the health care reform effort including the exchanges, is charged with producing a report that would outline the impact of excluding the 50-100 employee group on the exchange, which the Shumlin administration wants to use as a stepping stone toward the single-payer system.

Illuzzi proposed two amendments that would have forced the state to include a broader array of insurance carriers in the exchange, would have specifically allowed health savings accounts and high deductible plans under the exchange and would have allowed “nonqualified” plans outside the exchange. H.202 allows for two carriers.

“Let’s not kid ourselves it will be more than one carrier,” Illuzzi said on the Senate floor. “It will likely be Blue Cross Blue Shield. It will be two carriers in name only. Both will be required to offer same (plans). It will be a change without a difference.”

Anya Rader Wallack, Shumlin’s special assistant on health care, said she was impressed by the Legislature.

“A lot of people worked very hard educating themselves in a short period of time,” Wallack said. “This isn’t simple stuff. I was impressed with the amount of effort both bodies have put into this.”

The Shumlin administration was heavily involved in drafting the bill, H.202. By the time the legislation reached final passage it had changed somewhat from its original incarnation, which was based in part on recommendations from Professor William Hsiao, the renowned Harvard economist who created a single payer system for Taiwan.

Sen. Claire Ayer talks with Anya Rader Wallack and Robin Lunge before Monday's session. VTD/Josh LarkinSen. Claire Ayer talks with Anya Rader Wallack and Robin Lunge before Monday’s session. VTD/Josh Larkin

Over the next year, the Shumlin administration will hire a director of health care reform and the chair of a quasi-judicial board. The board would be in place by January 2012 and would begin the arduous task of sorting through the maze of federal laws, waivers, benefits, provider reimbursements, system financing and cost containment options.

H.202 will be read in the House Health Care Committee on Wednesday morning. Rep. Mark Larson, D-Burlington, said he expects the bill will go to conference committee in several days. He expects to have no major beefs with the Senate version.

“The core composition of the bill remains identical to what passed in the House,” Larson said. “There are differences between the two bills but they are things we can work out.”

Larson said those details include a change in the dynamic of the board. “We want to make sure it’s an independent board.”

He also referred to the so-called “Mullin” amendment, which set conditions for implementation of Green Mountain Care, the single-payer style system that would be created under H.202. Larson said he thinks the new criteria for the implementation standards need to be more clearly defined.

“It has to be clear what hurdle has to be overcome,” Larson said.

Vermont House Passes Single-Payer Health Care Bill March 27, 2011

Posted by rogerhollander in Canada, Health.
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(Roger’s note: Vermont’s state legislature taking this bold step brings to mind Canada’s revered Tommy Douglas, when his leadership led to the passing of a single payer plan in the Province of Saskatchewan in 1962.  This turned out to be the domino that that began the overwhelming popular drive for Canadian national health care, and which led to the passing of Canada’s single payer universal coverage national health plan.  But that was then and this is now.  Today in the United States the giant blood-sucking private health insurance and pharmaceutical industries virtually own a gutless president and the majority of legislators in both pathetic political parties.  This was evidenced in the debate that led to the passing of the Obama health legislation last year, a debate in which a public plan or single payer plan was off the table from the beginning; and where the Democratic members of the House who were considered the most progressive and principled caved in the end and supported legislation that enshrines the power of the health insurance industry.  Nevertheless, the Vermont action can very well be a first step towards setting an example for a health care plan that is single payer, universal and economic; which in turn can generate public opinion to put on the pressure in other jurisdictions.  That is, if the gigantic insurance and pharmaceutical industries don’t find a way to snuff the breath out of the Vermont initiative before it has a chance to come to life.)

Published on Friday, March 25, 2011 by the Brattleboro Reformer (Vt.)

by Chris Garofolo

MONTPELIER — The Vermont House of Representatives passed a bill calling for a single-payer system Thursday afternoon, putting the state on a path to become the first in the nation to adopt universal access to health care.

Lawmakers voted 92 to 49 after nearly two days of debate, including discussion on the floor until the early morning hours on Thursday.

Advocates hail the measure as the solution to control costs by reducing administrative overhead. However, critics said it leaves too much financial uncertainty and could hurt the economic growth in Vermont.

The legislation proposes to develop a unified health system where all Vermonters are eligible for benefits under a universal coverage program called Green Mountain Care. Democratic leaders are optimistic the single-payer plan will contain the skyrocketing costs of health care and put the state on a more sustainable fiscal path.

“I think that we all know, and there was universal agreement on the House floor, that the current system will bankrupt us. Costs of health care in Vermont are going up $1 million a day. They are $2 billion more than they were 10 years ago. We have a problem, we need to solve it,” said House Speaker Shap Smith, D-Morrisville. “This is just the first step in the process. This will be a long road ahead, and we have much work left to do. But we have taken a bold step forward today.”

The measure also designs a four-year timeframe to establish a publicly funded system, beginning with the creation of the Green Mountain Care Board on July 1 with a budget of $1.2 million. The five-member board will design a more sensible payment plan for health care providers, control the overall cost to align it closer to Vermonters’ ability to pay and recommend a benefit package for every resident.

However, the bill does not require the governor to propose a payment plan for the single-payer system until 2013, which sparked outcry from House Republicans. Paying for the reform is the most controversial portion of the bill and it will not be addressed until Gov. Peter Shumlin campaigns for his second term next year.

Shumlin, the first-term Democrat who made health care reform a cornerstone of his gubernatorial campaign last year, said the House has moved Vermont in a historic direction toward fixing a broken system.

“This is a really important step for Vermont. If we want to create jobs, if we want to be the state that makes the difference in controlling health care costs so that we can grow jobs and economic opportunities … this is an extraordinary moment,” he said.

Thursday’s otherwise civil debate turned into a political war of words after Rep. Thomas Burditt, R-West Rutland, said promoting universal coverage is the “keystone in the arch of socialism,” drawing criticism from Democrats and independents supporting the measure.

“I take offense at the remarks … that we’re socialists, that we’re communists,” said Rep. Paul Poirier, I-Barre. “I ask all members to respect other people’s points of view.”

Cooler heads prevailed as lawmakers wrapped up the roll call vote shortly after 3 p.m. The legislation heads to the Senate, where it is expected to pass with some possible changes.

Republican critics called on Senate members to “correct the errors” on the bill, particularly the cost burdens on state government.

Opponents said it is not feasible to implement a single-payer system as a stand-alone, suggesting instead an amendment to protect self-insured employers in the state. GOP lawmakers pressured their Democratic counterparts to listen to the hundreds of small businessowners voicing concerns over self-insurance.

“Risk and uncertainty are two barriers to economic growth and this promise would help alleviate these concerns,” said Rep. Oliver Olsen, R-Jamaica. “Self-insured businesses represent nearly 20 percent of all employers in Vermont, which is a large portion of our economy, and they are worried about how this bill will affect their ability to do business in Vermont.”

The amendment, proposed by Stowe Republican Heidi Scheuerman, was soundly defeated.

Rep. Michael Hebert, R-Vernon, spoke from the floor about his issues with the uncertain cost of such a health care network.

“I have a tremendous number of questions. And I’m not in opposition to health care finance reform, I’m just in opposition of us going down a road where we don’t know what it costs,” he said. “There are just so many unanswered questions and I’m really concerned with this five-member board. They’re going to have the authority to rule on every aspect of our health care in the state of Vermont.”

Meanwhile, Democrats hailed the swift-moving bill as a vote for hope and not fear. Supporters hugged outside the House chamber following the passage, a sense of pride on their faces as they praised the landmark health care measure.

“Today, Vermont’s House of Representatives showed America our small state has both the courage and conviction to lead the way nationwide on the creation of a unified single-payer health care system,” said Rep. Valerie Stuart, D-Brattleboro. “I thank the members of the [House Health Care] committee that created this piece of legislation with all my heart.”

The benefits under Green Mountain Care would not take effect until after Vermont receives a federal waiver under the Patient Protection and Affordable Care Act of 2010. By 2014, the bill established a health care exchange as required by federal law.

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