Time to Play the Single Payer Card

Rob Stone MD  March 30,2009

“First they ignore you, then they ridicule you, then they fight you, then you win.”  - Ghandi

A health care reform bill out of Congress by the end of the summer?  An end to our national nightmare within five months?  The health insurance industry is banking on an Obama-Kennedy-Baucus bailout – “universal” health care, with taxpayer subsidies for those who can’t afford the unaffordable premiums.

Right now the insurance gang is controlling the debate, with big headlines about how they will give up a few of their most egregious behaviors and accept a modicum more government oversight as long as we mandate that everyone become their customer.  And, most importantly, don’t let the Socialists have their way and allow a Medicare-like “public option.”  They cry that it would be unfair competition to ask the for-profit insurance companies to go up against a government run plan. 

If they think the government can do so much better than they can, why don’t we listen to them?  Let’s go ahead and put everyone in a government plan!

The strategy from the industry and their Republican allies is obvious – appear to offer a series of compromises, but draw the line to prevent any government plan.  Wrap it all up in a big package and proclaim that we’ve got a uniquely American solution to our problem: a huge system of taxpayer subsidies to the insurance industry, with no mechanism to control costs, because there are too many big money interests who don’t want to see real cost control.  They are happy to expand access to insurance because it makes good business sense to create more customers.

The strategy of Obama, the Democrats, many labor leaders, and “progressive” groups like Healthcare For America Now is equally clear.  Let’s offer a compromise plan with many complex features, all of which need to be clarified and debated, and hope that we can get the whole thing through Congress intact, including the public option.  This is a strategy for failure.  The public option will be the part that gets compromised out.

Many prominent progressives like Paul Krugman and Jacob Hacker have argued that the public option is the key to the whole reform process.  The public option will constrain the rapacious insurance companies.  The public option will be popular and efficient.  The public option will be, at its best, a slippery slope to a single payer plan.  Never mind that critics have pointed out that if the public plan is enacted, the insurance companies will find ways to game the system again.  Never mind that the Right has recognized the slippery slope argument, and that is why they are so adamantly against it.

This calls for an obvious change in the Democrats’ strategy.  Up to now they have tried hard to keep the voices for single payer out of the debate. They have reassured the Republicans that single payer isn’t even “on the table.”  If they want to have a chance to get the public option through Congress, it‘s time for a new strategy.  Time to play the single payer card. 

Purely from a strategic perspective, the President should put single payer back on the table and start explaining to the people all the advantages of Medicare for All.  Then, when the going gets tough in the trenches of Congress, they can compromise and  settle for the public option, and a muscular enough public option that it could serve as a model (a slippery slope) for an eventual single payer system. 

Of course, maybe once the single payer cat is out of the bag, the weight of logic and public support will just push the insurance gang right out of the way.

 

National Call-in Day February 12

 

The National Single Payer Alliance

National Call-in Day for HR 676
February 12, 2009     Lincoln’s Birthday

Dear Friend,
  
The Leadership Conference for Guaranteed Healthcare is encouraging everyone to participate in the next National Call-in Day for HR 676. Mark your calendars.
  
February 12, 2009: Call Congress - Congressional switchboard: 202-224-3121 - ask for your representative’s office, and the President - 202-456-1414

  
If your member is a current co-sponsor,  thank your rep. and ask him or her to stand firm for HR 676 and actively seek additional co-sponsors.
  
If your member was a co-sponsor in the last Congress, ask him or her to sign on immediately as a co-sponsor in this Congress.
  
If your member has yet to co-sponsor HR 676, ask him or her to please become a co-sponsor, select one or two talking points here.

 
In a letter to Col. William F. Elkins written November 21, 1864, Lincoln wrote: “I see in the near future a crisis approaching that unnerves me and causes me to tremble for the safety of my country. . . . corporations have been enthroned and an era of corruption in high places will follow, and the money power of the country will endeavor to prolong its reign by working upon the prejudices of the people until all wealth is aggregated in a few hands and the Republic is destroyed.”
  
In celebration of Abraham Lincoln’s birthday, remind your member of Congress to honor his words and heed his warning as we look to reform his precious nation’s healthcare system. 

  
Sincerely,
  

Quentin D. Young, MD
National Coordinator
Phyisicans for a National Health Program

Donna Smith
Community Organizer
California Nurses Association
National Nurses Organizing Committee
PDA National Healthcare NOT Warfare Co-Chair

Tim Carpenter
Executive Director
Progressive Democrats of America

Katie Robbins
Assistant National Coordinator
Healthcare-NOW!

P.S. Don’t forget to call (202-456-1414) or fax (202-456-2461) the White House to make sure our current President recalls how very troubled another young lawyer from Illinois was as he viewed the future of the nation under the control of the monied and corporate interests just like those swirling in the for-profit health insurance industry.

 

Is Daschle part of the problem or part of the solution?

Published on Saturday, January 31, 2009 by Politico
Health Care Groups Paid Daschle $220k

by Kenneth P. Vogel

Tom Daschle, tapped to be President Obama’s health czar, was paid more than $200,000 by the health-care industry in the past two years, according to documents obtained by Politico.

[US President Barack Obama's pick for secretary of health and human services, Tom Daschle, seen January 8, paid over 100,000 dollars in back taxes in January after failing to report services from a wealthy friend, US media reported Friday. (AFP/Getty Images/File/Mark Wilson)]US President Barack Obama’s pick for secretary of health and human services, Tom Daschle, seen January 8, paid over 100,000 dollars in back taxes in January after failing to report services from a wealthy friend, US media reported Friday. (AFP/Getty Images/File/Mark Wilson)
The former Senate majority leader, who gave speeches to firms and groups with a vested-interest in the administration’s upcoming health reform, collected the checks as part of a $5 million windfall after he lost reelection to his South Dakota seat.

This weekend, Daschle’s nomination to be secretary of Health and Human Services became embroiled in controversy over the last-minute revelation that he had only recently paid long-overdue taxes.

Daschle made nearly $5.3 million in the last two years, records released Friday show, including $220,000 he received for giving speeches, many of them to outfits that stand to gain or lose millions of dollars from the work he would do once confirmed as secretary of Health and Human Services.

For instance, the Health Industry Distributors Association plunked down $14,000 to land the former Senate Democratic leader in March 2008. The association, which represents medical products distributors, boasts on its website that Daschle met with it after he was nominated to discuss “the impact an Obama administration will have on the industry.”

This week, the group began openly lobbying him, sending him a letter urging him to rescind a rule requiring competitive bidding of Medicare contracts.

Another organization, America’s Health Insurance Plans, paid $20,000 for a Daschle speaking appearance in February 2007. It represents health insurance companies, which under Obama’s plan would be barred from denying coverage on the basis of health or age.

There was a $12,000 talk to GE Healthcare in August, a $20,000 lecture in January to Premier, Inc., a health care consulting firm, and a pair of $18,000 speeches this year to different hospital systems, among other paid appearances before health care groups.

The speaking fees were detailed in a financial disclosure statement released Friday, which showed that Daschle pulled down a total of more than $500,000 from the speaking circuit in the last two years, and $5.3 million in overall income.

That includes more than $2 million in consulting fees from InterMedia Advisors, a private equity firm.

Daschle, who represented South Dakota in the Senate for three terms, initially failed to pay taxes on the free use of a car and driver that had been provided to him by InterMedia’s founder, high-rolling Democratic donor Leo Hindery Jr., according to the New York Times. It reported that Daschle this month paid more than $100,000 in back taxes and filed amended tax returns.

Daschle reported $182,520.26 of “company provided transportation” on the disclosure form, which also indicates he owns a stake in the company worth between $200,000 and $500,000, as well as a “5 % limited partner profit sharing interest.”

But he reported that only about half of his interest is vested, and he indicates that “upon confirmation, I will divest all my vested shares and unvested shares and relinquish any benefit to which I may otherwise be entitled.”

Daschle reported that he has been a consultant and chair of the company’s advisory board since January 2005, the same month he left the Senate after being upset in his reelection bid by Republican John Thune.

He also became an adviser to the law and lobbying firm Alston & Bird, which paid him $2.1 million in wages last year and also provided him a 401k and profit sharing plan worth between $100,000 and $250,000, according to the report.

In his three years at the firm, it’s earned more than $16 million lobbying on behalf of some of the health care industry’s most powerful interests before the department he’s in line to lead. Though Daschle himself did not register to lobby for the firm, he has advised the firm’s clients on health care issues, according to the firm’s website.

His disclosure indicates he provided “policy advice” to such clients as United Health, AT&T and the politically connected consulting shop Glover Park Group.

After leaving the Senate, Daschle also landed a host of lucrative board spots, including with the energy giant BP Corporation, which paid him $250,000 in fees, developer CB Richard Ellis, which paid $121,000, and ethanol processor Mascoma Corporation, which paid him $75,000, according to the disclosure.

It shows that Daschle has hundreds of thousands of dollars in stocks and options from CB Richard Ellis and Mascoma, though he indicated he forfeited his unvested stock options and wrote that “if confirmed, I will divest my vested stock options with CB Richard Ellis.”

He reported owning homes worth as much as $250,000 each in Aberdeen, S.D., and Altus, Okla., with his wife, a high-powered lobbyist for Baker, Donelson, Bearman, Caldwell & Berkowitz.

Daschle wasn’t required to disclose her income, but did report that her retirement plans through the firm were worth more than $260,000.

Chris Frates contributed to this report.

For the New York Times 1/31 on Daschle see http://www.nytimes.com/2009/02/01/us/politics/01daschle.html?_r=1&hp

Atul Gawande in The New Yorker 1/26/09

Some of you have seen this week’s New Yorker and the piece on healthcare reform http://www.newyorker.com/reporting/2009/01/26/090126fa_fact_gawande by Dr Atul Gawande. He is a good writer, but it is unfortunate that his hi profile piece is an apology for the for profit insurance industry and a call for incremental reform. Here is my reply to him:

Dear Dr Gawande,

“Getting There From Here” is a wonderfully written piece full of good analyses of how broken our healthcare “system” is and how we got into this mess.
Your central hypothesis is that we can use the idea of “path dependence” to understand how other countries achieved universal or national health insurance, and thus chart a route forward here in the US. Of course, path dependence is much better at explaining why things happened than it is at predicting what will be, or, as you put it, “With path-dependent processes, the outcome is unpredictable at the start.”
Your first example, the formation of the National Health System (NHS) in England after WW II, points out the temptation to choose facts to fit the hypothesis. You note that Churchill’s government never intended to coin a national health service, but you skipped over the British electorate turning out the Tories and installing a Labour government in 1945. The birth of the NHS required both political will on the part of the new government and a powerful economic incentive to use the implementation of the system as part of the economic recovery of the post war economy. When you frame the birth of the NHS this way, suddenly the path dependence implications for the US today take on a different hue.

You state that no other major country has adopted the British system, but that is only true if you don’t consider Spain a “major country.” The Spanish did borrow from England when they formed their system in 1986. The next “major” country to change to a universal system after Spain was Taiwan in 1995. Like Spain, they looked at systems all over the world, and they decided to model their new system on the US. Not our system of for-profit private insurance that you seem to be so fond of, but on our universal (single payer) system for seniors, Medicare. Learning from the experience of other countries is perhaps another way to consider path dependency.

Path dependence is one way to explain how history unfolds and systems change. Political courage and leadership are sometimes a better explanation. When Canadians were asked to choose “The Greatest Canadian” a few years ago, the overwhelming winner was Tommy Douglas, the father of Canada’s national health system. Starting in his home province of Saskatchewan, Douglas lead the charge that resulted in the Canadian system which was instituted in the mid-Sixties, right around the same time we launched Medicare and Medicaid in the US.

Finally, you use the example of Medicare Part D and its much maligned drug coverage as an example of the dangers of over-reaching reform that ignores the lessons of path dependence at its peril. Another interpretation of this fiasco is that Part D was an example of a different path, a Republican Congress running amok, a piece of legislation written by lobbyists, passed in the dead of the night, with debate suppressed, and the longstanding rules of House and Senate bent if not broken. There are many lessons to be learned from that debacle, but not that the idea of Medicare helping seniors purchase their medicines is somehow too ambitious a project for our government to tackle.

In fact, Medicare Part D should have been written to have traditional Medicare administer the plan, instead of creating a plan run by the for-profit insurance industry, with a built in subsidy to the pharmaceutical industry. If one reads from sources like the Heritage Foundation, it becomes clear that the goal of the far-right conservatives is to destroy Medicare by privatizing it. They don’t want Medicare to continue as such an appealing path toward healthcare reform.

Is it reasonable to conflate Medicare for all (single payer) with the total free-market crazies, to cast both as being extreme, radical positions that should be dismissed out of hand as impractical?

I think our 40+ year experience with Medicare has been pretty good. We already take care of the sickest, most expensive part of our population, everyone over age 65. The government (taxpayers) already pays for 60-65% of all healthcare spending. Medicare is the financial mechanism for healthcare for the elderly, but the care is delivered privately. After I see a Medicare patient in the ER, I send a bill, just the same as I do if they have private insurance or no insurance.

Let’s embrace path dependence from a different angle: the safest, simplest, most commonsense way to reform our broken healthcare system is to expand Medicare to cover everyone, and continue to deliver healthcare privately as we do now. The logical next step, Medicare Part E – E for Everyone!

‘_Medicare Advantage_ a misnomer | The Journal Gazette

Taxpayers foot bill for private insurance to inadequately cover seniors’ health care

Jonathan D. Walker

America has a split personality when it comes to health care. There is recognition that the government has to provide care for the people, but there is a conflicting sense that private industry has to be involved because it can somehow be more efficient. Medicare Advantage is the upshot of this thinking – but the result has been a lot of taxpayer dollars wasted on windfall payouts to private insurance companies.

With Medicare Advantage, the government is basically paying private insurance companies more money to do what Medicare could be doing more cheaply and more efficiently in the first place – if we as citizens asked it to. A lot of this extra money is not used to help the people Medicare is supposed to be helping.

via ‘_Medicare Advantage_ a misnomer | The Journal Gazette.

Hoosiers for a Commonsense Health Plan

Hoosiers for a Commonsense Health Plan.

The employer-based health care system is failing and is adversely affecting the public health, as well as the financial wellbeing of private industry and the nation’s position as a global economic superpower. Health care policy and public health experts are increasingly calling for major health care reform and an end to the incremental changes in the for-profit, market-driven sector of our health care economy.

Largely because of health care costs, businesses large and small are experiencing such severe financial difficulties that they are both discontinuing or minimizing benefits and outsourcing or changing the nature of their labor forces toward either minimum wage or part-time employment. Simultaneously, wages have stagnated and personal private health insurance is unaffordable for most. Indeed, half of our nation’s uninsured are employed full time, and the number of uninsured now exceeds forty-five million. More than eight hundred thousand Hoosiers lack coverage.

The nation now spends close to fifteen percent of its GDP on health care and spends twice as much per capita as any other nation. Despite our high rate of spending, measures of public health indicate that our health is worse than health in other industrialized countries. Administrative costs in health care simply to handle private insurance divert hundreds of billions of dollars annually from the direct provision of health care. The private health insurance industry routinely experiences inflation of three to four times the general rate, enjoys huge profit margins, discriminates against the sick and minorities, and adds no value to the health care sector. Economists agree that these trends are unsustainable. We concur and maintain that, in the absence of major federal reform, Indiana must seriously examine alternatives.

The top health stories of 2008 – CNN.com

Health care reform

In a period of economic uncertainty, record rates of unemployment and the turbulent economy have left many American families without health insurance, propelling the issue of health care reform into the historic presidential race.

During the campaign, Sen. John McCain and now President-elect Barack Obama acknowledged the flaws of the U.S. health care system but varied in ideas to fix it.

Obama has said expanding access to health insurance is one of his top priorities. He chose former Sen. Tom Daschle, who believes in universal health care, to lead the Department of Health and Human Services.

via The top health stories of 2008 – CNN.com.

Hchp’s Weblog › Tools — WordPress

Hchp’s Weblog › Tools — WordPress.

Is single payer healthcare reform too radical a step for America to take?

Tell MoveOn it is the right step.

“If you bend your back, people will ride your back.“- Taylor Rogers, retired Memphis Sanitation Department worker

There is a vigorous debate among those who agree that the US must move toward universal health insurance coverage, but disagree on how to get there. Health Care for America Now (HCAN) has pushed forward with a plan remarkably similar to that proposed by Barak Obama. It is based on the premise that the most politically feasible path forward requires giving Americans the choice between keeping their current insurance, or buying into a government sponsored plan based somehow on the Federal Employees Health Benefits Program, like members of Congress have.

Obama used to be a single payer advocate, and more than once has said that in the ideal world, single payer health insurance would be the best system possible, but given current political reality his plan is the best way to go. There are articulate voices arguing that the Obama-HCAN plan would be a strong step toward single payer. And there are others who argue that Obama and HCAN are simply afraid of the power of the insurance industry and their well-funded lobbyists.

If single payer is the ideal plan, then why compromise before we’ve even sat down at the negotiating table? I’m reminded of a piece NPR did on the 40^th anniversary of Martin Luther King’s assassination. They interviewed two of the sanitation workers on whose behalf Dr King had gone to Memphis. Mr. Taylor Rogers was one of those men, and he recalled how bad the working conditions were, and how inspired they were by the words of Dr. King. He explained how thirteen hundred sanitation workers decided they werent going to take it any more. You know, if you bend your back, people will ride your back. But if you stand up straight, people can’t ride your back. So that’s what we did. We just stood up straight.

I went to medical school 35 years ago to learn how to take care of sick people, and that’s what I still do. I serve the sick and the suffering. I love my work, but I hate how I’m paid. The cost shifting, the complicated crazy undecipherable bills, the lives ruined by my unpaid bills turned over to collections, and on and on. The insurance industry, on the other hand, is here to serve its shareholders, not its customers. It takes money in the form of premiums from the healthy, and in order to make a profit, it must put all its ingenuity and guile into not paying for the care of the sick. That’s how they are profitable, take in money as premiums, but find ways to not pay it back out for health care. I am completely at odds with that. I want to take care of the sick, and they want to avoid taking care of them.

The sins of the insurance industry are well documented, and I don’t need to recount them here. Our entire system has become distorted, inefficient, and administratively bloated, and the reason is as simple as this: Americans want the sick to get taken care of, and the private insurance industry doesn’t want to take care of them. The insurance companies are the problem. They are not going to be a helpful part of the solution, but the HCAN plan protects them. And yet they are collapsing as our bloated system collapses. The for-profit insurance industry is like a dinosaur stumbling toward a tar pit. Let them go.

On the other hand, we have over forty years experience with a universal single payer system. It’s called Medicare, and although not perfect, it works very well. It already takes care of our sickest and most expensive patients, folks over age 65. Medicare is very popular. Medicare runs at about 3% overhead, compared with 15-30% overhead with private insurance. Expanding Medicare to cover everyone can hardly be called radical. It,s the most commonsense idea on the table.

As we seek our way forward, let’s hold our heads high and our backs straight. Who can foresee what compromises may have to be made to bring about true universal health care in America, but let’s start our with a clear voice: We want the best health care system in the world! We can have the best. If we walk into the room already compromised and bent over, they will climb on and ride. Stand tall, America. Medicare for All.

Health care summit brings together providers, patients, candidate staffers Jennifer Boen, The News-Sentinel

Article published Sep 25, 2008 Health care summit brings together providers, patients, candidate staffers Jennifer Boen, The News-Sentinel A number of experts who spoke at Wednesday’s health care summit at the downtown library touted the benefits of a system that guarantees people who pay a set amount access to care. America is the only developed country where you have to worry about getting sick and going bankrupt at the same time,  said Dr. Jon Walker of Fort Wayne.  You are one diagnosis away from bankruptcy,  said the retinal surgeon, a member of Hoosiers for a Commonsense Health Plan. According to the journal Health Affairs, 51 percent of bankruptcies in 2005 were related to medical expenses. The summit, organized by the local grassroots advocacy group Public 1, drew less than a handful of people from the general public but featured representatives from both presidential candidates’ campaign staffs, as well as community health care providers serving the uninsured or underinsured. Co-organizer Dan Jehl said the summit will air on public-access TV in the near future. With more than 800,000 uninsured Hoosiers and nearly 22,000 people in the U.S. dying each year because they cannot get health care, Walker said it is obvious the employer-sponsored system is broken. Despite spending more on health care per capita than any developed country in the world, mortality rates and life expectancies lag behind Canada, Germany, Japan and many other countries. The consumer health group Families USA released a report Tuesday showing Indiana health care insurance premiums have risen 7.3 times faster than earnings between 2000 and 2007. Walker contended the root is greed among investor-owned companies, pharmaceutical marketing, cost-shifting to the insured to cover the uninsured and heavy administrative costs. More than 30 percent of all health care dollars are administrative costs. Julia Vaughn, a health care consultant for Citizens Action Coalition of Indiana, called the current system an ineffective mishmash of different systems.  Nobody ever sat down and created the U.S. health care system. We don’t need to spend more on health care. We need to take the system and turn it into a single-payer system.  That could happen if proposed legislation before Congress becomes law. Such a system  think Medicare  for all legal U.S. residents would initially save taxpayers $200 billion, with more savings coming from the ability to negotiate prices for drugs and doctors’ and hospitals’ fees, she said. Although individual taxes would increase about 3.5 percent, people would see an annual savings of at least $1,400 a year. The average family now pays about $12,000 a year in insurance premiums. There is no one single, silver bullet that’s going to be the answer to fix the health care system,  said State Health Commissioner Dr. Judy Monroe.