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February 24, 2009
Dear PNHP Colleagues,
We have some good news, some bad news, and some breaking news!
The good news is that single-payer legislation (H.R. 676) was reintroduced in the 111th Congress on Jan. 26. Supported by 94 representatives in the 110th Congress, the bill is now backed by a new alliance of physicians, nurses, unions and grassroots groups with a base of over 20 million Americans and growing!
The bad news is that Sen. Max Baucus (D-Mont.), chair of the powerful Senate Finance Committee, will not allow consideration of single payer as an option for reform, and Sen. Kennedy (D-Mass.) is, by all indications, poised to promote the flawed Massachusetts health plan at the national level after months of secret meetings with insurance, business, and pharmaceutical company lobbyists.
The breaking news is that PNHP is co-hosting a briefing to refute the Massachusetts model and to promote single payer on Capitol Hill tomorrow (Wednesday, Feb. 25). The congressional forum will be webcast live on our web site at www.pnhp.org starting at 2 p.m. EST, with PNHP founder Dr. David Himmelstein as the first speaker (the forum will be posted for viewing later as well). Last week, PNHP released, with Public Citizen, a report on the Massachusetts plan, along with a letter to Sen. Kennedy signed by 500 physicians and other health professionals in the state, calling on him to return to his earlier support for single payer.
While President Obama has acknowledged that single payer is the best option for reform, and while he opposed a mandate requiring all individuals to purchase private insurance during his campaign, it would appear he is poised to embrace the piecemeal, incrementalist approach that keeps the private insurance industry in place. He may outline more details about his stance tonight when he appears on television to address the nation about the budget. As John Nichols blogged for The Nation, single payer national health insurance would be a huge help to the automakers and the economy as a whole.
In this environment, PNHPers across the country are challenging the "inside the beltway" mentality that believes only incremental reform that retains (or "bails out") the insurance industry is possible. Dr. John Benziger, Dr. John Geyman, Dr. Laura Boylan and PNHP President Dr. Oliver Fein are among the many PNHPers who are writing and publishing op-eds and letters-to-the-editor in support of single payer. Several PNHPers have garnered endorsements from their city councils, most recently in Seattle. And PNHPers from coast to coast responded to the call to host house parties and send messages in support of single payer to Obama over the holidays.
What you can do:
(1) Urge your member of Congress to co-sponsor H.R. 676 (in the House) or encourage hearings on single payer (in the Senate). There are useful lobbying materials at www.pnhp.org/change, and PNHP staff can help you set up an appointment: contact Danielle Alexander at danielle@pnhp.org. There will be a national call-in day for H.R. 676 on April 15 (but you don't have to wait until then!). Plan to visit with your member of Congress during the April 6-17 Easter recess when lawmakers will be at work in their home districts. You may also write them online.
(2) Submit an op-ed or letter to the editor. Feel free to use any PNHP materials as starting points - especially Dr. Don McCanne's single payer "quote of the day."
(3) Speak out in support of single payer. PNHP has slide sets available for this purpose to members at www.pnhp.org/slideshow. The password is "fein."
(4) Encourage grassroots groups to join the new national single payer alliance, The Leadership Conference for Guaranteed Health Care. Requests may be sent to staffer Katie Robbins at healthcarenow08@gmail.com.
For many years, PNHP has been inspired by a quote from Dr. Martin Luther King Jr.: "Of all the forms of inequality, injustice in health care is the most shocking and most inhuman." Lately we have found a new quote from Dr. King that seems very fitting for the newest phase of our struggle: "Although social change cannot come overnight, we must always work as though it were a possibility in the morning."
Thank you for your continued support and especially your priceless efforts for reform,
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Quentin Young, MD
National Coordinator
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Ida Hellander MD
Executive Director
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P.S. PNHP was recently the recipient of a $64,603 grant from CREDO/Working Assets as a result of balloting by their customers. Please help us raise the additional funds needed to meet the challenges of this historic moment by donating or renewing your membership today. Donors of $100 or more will receive a free copy of "Do Not Resuscitate: Why the health insurance industry is dying, and how we must replace it" by John Geyman, M.D., or "10 Excellent Reasons for National Health Care," edited by Mary O'Brien, M.D., and Martha Livingston, Ph.D.
Insurance industry is intimidating lawmakers
By Dr. John Benziger
Kennebec Journal / Morning Sentinel
Feb. 19, 2009
Under pressure from the insurance industry, Obama's health-care reform is poised to completely exclude a single-payer "improved Medicare for all" option. Such a program would save enough money to provide comprehensive benefits for all Americans.
Yet opposition from insurance and drug industry giants continues to intimidate lawmakers. Only the voice of the people, our voices, can fortify our leaders to stand up for the health of the American people rather than the wealth of our richest firms.
Every other developed nation sees health care as a "right" and has some form of national health insurance (NHI). Plus, most spend less than half what we do per person.
Nearly a third of U.S. health-care spending is wasted on administration. In their drive to enroll healthy, profitable patients and screen out the sick, private insurers consume vast sums of money that sustain profits, enrich CEOs and divert resources from patient care. The paperwork they inflict on doctors and hospitals costs billions more each year. This "profit first" mentality has broken our health-care system and led the world into financial crisis.
Only single-payer NHI can fix this broken system and save thousands of lives each year. The concept is popular with the American people and enjoys the support of most doctors.
Right now, "improved Medicare for all" bills are taking shape in the U.S. House and Senate and in the Maine Legislature. Our leaders need to hear from you. Contact them. Voice your support.
Memo to Obama: Seize the Moment for National Health Insurance
By John Geyman, MD
Tikkun magazine
January-February 2009
First off, congratulations to you and your party on your sweeping election results!
Together with a sizable majority of Americans, I am again hopeful for the future of our country. My special concern, however, is for our failing health care system and how it is pricing health care beyond the reach of ordinary Americans. Our system has come to the point where none of the many incremental reforms will work. The business model of insurance has failed, and we need to rebuild the system on a social insurance model.
Let me be direct. Although we have many dedicated health professionals, an abundance of the latest technologies, and many fine hospitals, health care has become just another commodity to be bought and sold in a deregulated market based on ability to pay, not medical need. As you well know, industry profits handsomely from the status quo, raking in money through insurance, pharmaceuticals, medical devices, and so on. Industry has a war chest to defend itself and demonstrates its political power each time any new reform is brought up.
But the situation has become dire. There is no end in sight in controlling health care costs as they soar upwards at three or four times the cost of living and family incomes. We have had three decades of incremental attempts to rein in costs, including managed care and consumer-directed health care. None have worked. We have a solution in plain sight - single-payer National Health Insurance (NHI). Market stakeholders are fighting it fiercely, but it's the only real reform that has a chance to work.
Most of your advisers will likely caution you that NHI is too radical for Americans to accept, that you need to be more centrist, and that it is not politically feasible. But therein lies your trap. You will be persuaded to add one more incremental attempt to fix things, which will not work, will cost more than ever, will delay real reform, and will add to the pain of so many along the way. Your moment of opportunity will have been lost.
Beyond ideology, these facts support NHI as the treatment of choice in 2009.
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Premiums alone for private health insurance have grown by more than 100 percent since 2000, and are projected to consume all of average household income by 2025, clearly an impossibility way before then.
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According to the Milliman Medical Index, the typical American family of four spent $15,600 on total health care costs in 2008, fully one-quarter of the typical combined family income of $60,000; most consider 10 percent of family income to be the threshold of underinsurance.
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The administrative overhead of private insurers is five to nine times higher than not-for-profit Medicare (average for commercial carriers 19.9 percent, investor-owned Blues 26.5 percent, Medicare 3 percent).
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The inefficiency and bureaucracy of our 1,300 private insurers are not sustainable (e.g., according to the Blue Cross Blue Shield Association, there are 17,000 different hea1th plans in Chicago).
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Private insurers offer much less choice than traditional Medicare; there are near-monopolies in 95 percent of HMO/PPO metropolitan markets, enough to trigger anti-trust concerns by the United States Department of Justice.
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Because of costs, about 75 million Americans are either uninsured of underinsured, with large segments of the population forgoing necessary care and having worse health care outcomes; the United States now ranks nineteenth among nineteen industrialized countries in reducing preventable deaths from amenable causes.
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Wall Street is already questioning the future prospects of the private insurance industry; as of November 18, 2008, the average share prices of the top five private insurers were down by between 60 percent and 77 percent, compared to the Standard and Poor's 42 percent.
I expect that none of this is news to you, but what is neglected by almost all economists, "experts" and pundits is that there is already plenty of money in the system, that we waste about one-third of our health care dollar on our inefficient multi-payer financing system and on unnecessary care, and that NHI will save money, not cost more. NHI is the most fiscally responsible thing we can do now about health care. The Conyers bill in the House (H.R. 676) will be financed by payroll and progressive income taxes that will be less than what individuals and employers now pay. The health insurance industry is being propped up by government subsidies to the employer-based system and to privatized public programs. NHI can save some $350 billion through administrative simplification, while offering coverage for all necessary care, full choice of provider and hospital, and mechanisms for cost containment through bulk purchasing, negotiated fees, and global budgets.
NHI by itself will not solve all of our health care problems, but it will provide a structure (as no incremental approach can) to enable other necessary steps. These include acceptance of health care as a right, transition to a not-for-profit system, reimbursement reform, rebuilding of primary care, evidence-based technology assessment, and quality improvement. None of this will be possible by using reforms that leave an obsolete private insurance industry in place, as is more fully discussed in my recent book "Do Not Resuscitate: Why the Health Insurance Industry is Dying, and How We Must Replace It."
FDR almost went for NHI in the mid-1930s, but he backed off, mainly due to the AMA's opposition. Today, the AMA is marginalized with a membership of no more than 30 percent of physicians, and a majority of American physicians now support NHI. Implementing NHI in your presidency can be your FDR-size legacy. It has become an economic, moral, and social imperative. Overnight NHI can bind us together as one society, all of us in the same boat. We can afford it. Yes, we can!
John P. Geyman, M.D., is professor emeritus of family medicine at the University of Washington, and past president of Physicians for a National Health Program. He is a member of the Institute of Medicine.
Single payer: mainstream and 'shovel ready'
The following letter was sent to the editor of The New Yorker on Jan. 22.
In "Getting there from here" (Jan. 26), Atul Gawande suggests that the Massachusetts 2006 mandate plan is a model for national health care reform. He sees his stance as pragmatic, politically feasible, rooted in the particular history of American health care and gifted with the commonsense wisdom that we must start from where we are. Advocates of national health insurance (single payer) are characterized as ideologically driven extremists with "contempt" for pragmatists. I respectfully disagree.
Most Americans, including most physicians, supported national health insurance even before the recent economic collapse, polls show. Endorsers of the single payer bill H.R. 676 (Expanded and Improved Medicare for All) include 93 co-sponsors in the House of Representatives, 450 union organizations in 45 states, and countless others representing a wide range of constituencies. This is not a fringe movement.
High costs are the root cause of Americans' health insecurity. Gawande's analysis is flawed by use of a framework centered on insurance coverage rather than the more fundamental issue of health care value. Gawande sees employer-based coverage as the "path-defining" element of our current system because most people are covered by it. Well, it's all in how you look at it. We need to keep our eyes on the prize, the health care dollar, and follow the money. Government already dominates: tax dollars fund most health care expenditures in the U.S. This is because government covers the sickest and poorest people, tax-favors employer-based private insurance, and covers its own employees. To use Gawande's metaphor, the lifeboat is already bigger than the "main boat" of American health care. This is where we start.
Gawande asserts that Massachusetts "recently became the first state to adopt a system of universal health coverage for its residents." As Yogi Berra said, this is like déjà vu all over again. A nearly identical assertion was made twenty years ago by then Gov. Dukakis about Massachusetts' 1988 reforms. More breathless proclamations heralded reforms in Oregon (1988), Minnesota (1992), Tennessee (1992), Vermont (1992), Washington (1993) and Maine (2003). These plans all had common themes: public spending initiatives, new regulations and mandates, and continued dominance of private insurance in covering low risk populations. None achieved universal coverage. The common denominator of the ultimate failure of all these plans was the absence of effective cost control. Two weeks ago Gov. Deval Patrick of Massachusetts warned that rising costs, "threaten to crush families and businesses and doom Massachusetts groundbreaking experiment with universal insurance."
In the face of economic collapse and soaring unemployment, with a third of Americans forgoing medical care due to cost, "Job No. 1" is getting value for our health care dollar, not preserving employer-based health insurance. The repetition of failed experiments is not pragmatic, it is part tragedy and part farce. Electronic medical records, chronic disease management and more emphasis on prevention are all important for many reasons but we must admit that short- and long-term cost implications are unknown. Some of these measures may actually increase costs. Medicare is not perfect, but it is demonstrably more cost effective than private insurance and beloved by most Americans. It is "shovel ready." Single-payer supporters say: everybody in, nobody out. Burned in the fires of the failed Clinton reforms, I believe Gawande misreads the plate tectonics of political possibility at this moment in history, asserting, "No, we can't" when the opposite is true.
Laura S. Boylan, MD
Clinical Associate Professor of Neurology, New York University School of Medicine
Attending Neurologist, Department of Veteran's Affairs
Board Member, Physicians for a National Health Program Metro NY
There is a cure available for our health care woes
By Dr. Oliver Fein
Atlanta Journal-Constitution
Sunday, December 14, 2008
The report last week that the U.S. economy lost nearly 2 million jobs this year, and 533,000 jobs in November alone, sent shudders through our nation's households. That's the biggest one-month plunge in jobs in 34 years. "Horrendous" was how one economist put it, while others said the number of unemployed, and underemployed, could easily double over the next year.
These job losses spell disaster for our health. Millions of people are losing their employer-sponsored health insurance, joining the 46 million who already lack coverage. Millions more are finding it harder to pay their co-pays and deductibles and are scrimping on their medications and doctor visits. Many go without care, risking their health and often their very lives.
In short, affordable health care has never been more urgently needed. Yet most of the health reform proposals coming out of Washington these days won't get us there.
Sen. Max Baucus (D-Mont.) recently unveiled his proposals for incremental health reform, which largely mirror the ideas of President-elect Barack Obama and Sen. Edward Kennedy (D-Mass.).
However well-intentioned, the Obama/Baucus/Kennedy approaches share a fatal flaw: they preserve a central role for the private health insurance industry.
To varying degrees, they would mandate that everyone buy private health insurance - the private insurance that is failing us today. Some of these plans offer a Medicare-like, public option that people could buy into, but experience with Medicare shows that the private plans refuse to compete on a level playing field. They cherry-pick healthier patients and insist on more than their share of payment.
Experience with mandate-based plans in Washington state (1993), Oregon (1992) and Massachusetts (1988 and today) shows that they simply don't work, achieving neither universal health care nor cost containment.
As long as we rely on private health insurers, universal coverage will be unaffordable. These companies generate immense overhead costs and force doctors and hospitals to spend heavily on billing and paperwork.
Administration consumes about one-third of every health care dollar in the U.S. By contrast, in countries with nonprofit national health insurance, administrative costs consume only half that amount.
There is a cure, however. Eliminating the private insurance industry would save $400 billion annually in administrative costs, enough to ensure that everyone is covered and to eliminate all co-pays and deductibles.
At this critical juncture, a single-payer plan is the only medically, morally and fiscally responsible path to take.
We already have an example of an American single-payer system that works - traditional Medicare. It's not perfect, but people with Medicare are far happier than those with private insurance. Doctors face fewer hassles in getting paid, and Medicare has been a leader in keeping costs down, at least until Washington politicians decided to pay private insurance plans to enroll seniors at a cost 12- to 19-percent higher than traditional Medicare.
Single-payer systems give patients complete freedom to choose their doctor and hospital. They also enhance cost containment through global budgeting, the bargaining power of being the sole buyer, and an emphasis on primary care and prevention.
With a universal plan of this type, doctors and other health professionals could return to their main task: caring for their patients.
Single payer, or an improved Medicare for All, is embodied in the U.S. National Health Insurance Act, H.R. 676, sponsored by Rep. John Conyers (D-Mich.) and 92 other members of Congress.
Opponents of single payer often admit it's the best, most efficient and equitable way to provide quality care, but say it's not politically feasible and is therefore off the table in this round of the debate. How so? A solid majority of physicians, 59 percent, and an even higher percentage of the public, 62 percent or more, support national health insurance, recent surveys show. Single payer should be front and center.
Medicare for All is within reach, but only if we are prepared to take on the private health insurance industry. The time is now. It requires only the political will.
Dr. Oliver Fein is associate dean and professor of clinical medicine and public health, Weill Cornell Medical College in New York and president of Physicians for a National Health Program.
Note: This article was originally published under the title of "There is a cure available for current plan."
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