Butte County Health Care Coalition
Keeping Single-Payer "On The Table"

From the Helena (MT) Independent-Record:

The IR’s editorial of Aug. 28 suggests that the “state needs insurance 
competition, … giving Montanans … choice and competition for their health 
insurance dollars.”

I disagree. The notion that competition and choice between health plans will 
improve care or lower costs is a fantasy; it hasn’t worked for decades. 
Competing plans do little else than drive up administrative costs currently 
costing the public nearly one-third of every dollar spent on health care. 
Health care reform could provide better care at less cost by replacing competing 
insurance companies with a single-payer health plan. An improved Medicare for 
All would reduce administrative costs leaving the state with enough funds to 
provide universal care. Vermont recently passed legislation to move in that 
direction and Montana would be wise to study this option.

Robert W. Putsch, MD, Canyon Creek
Member, Physicians for a National Health Program

A single-payer health care system would work for Oregon  
By Samuel Metz
Oregon Live

Am I crazy, a physician embracing legislative efforts to create a single-payer health care system in Oregon? You be the judge.

It  would create thousands of jobs. It would provide health care to people  whether they work full time, part time or are retired, disabled, sick or  unemployed. It would stimulate Oregon business. It would reduce our  state deficit. And it would provide comprehensive care to every  Oregonian without spending more than we do now.

Where would the  money come from? Oregon businesses and families already spend this  money. But Oregon wastes $4 billion annually in private insurance  
administration. That's premium money that never goes toward health care.  Half is the insurance company overhead. The rest is what hospitals and  providers like me waste collecting payments from insurance companies.  Princeton economics professor Uwe Reinhardt, speaking recently before  the Senate Finance Committee, said of Duke University's 900-bed  hospital: "We have 900 billing clerks at Duke. I'm not sure we have a  nurse per bed, but we have a billing clerk per bed. It's obscene."

For  physicians, it's no easier. A Chicago doctor faces as many as 17,000  different sets of benefits for her patients. Your physician in Oregon  might deal with only 300. But that's still a lot of paperwork that  doesn't provide health care.

Single payer would eliminate these  administrative losses. Diverting $4 billion to real health care is more  than enough to enable comprehensive, no-deductible, no-co-pay,  all-medications-included health care to every Oregonian, young and old.

So  why doesn't everybody embrace single-payer financing? It's a stark  answer: The money is re-labeled as "taxes." And unfortunately many  voters who unknowingly pay thousands of dollars in premiums and  out-of-pocket payments refuse to pay a penny of it as a tax, even when  this tax would buy them more health care at less cost and protect their  families from medical bankruptcy.

Other objections are mere  distractions. Single payer will destroy jobs? No evidence. Single-payer  studies in 14 other states suggest 35,000 new jobs in
Oregon. That's  12,000 more than the entire Oregon insuranceindustry. And because these  new jobs are highly paid medical personnel, they generate $500
million  in new tax revenues.

Will businesses flee Oregon? Single payer  would eliminate labor disputes over health care benefits. It would halve  the cost of human resource departments (no health benefit management).  Entrepreneurs would be free to create new
businesses without fear of  losing health care. Business would flourish.

Worried about our  state deficit? Single payer would reduce government costs to provide  comprehensive benefits to state employees. Couple this with increased  tax revenue and the budget deficit would go down.

A new  single-payer health care bill -- House Bill 3510 and Senate Billl 888 --  would be a win for all Oregon. Families finally would get the health  care they need. Workers would enjoy thousands of new jobs. Employer  costs would go down.

And so would our state government's deficit.

Single-payer health care: It's not crazy. It's good for Oregon, good for you and good for your legislators. Tell them now.

Samuel Metz is a Portland physician.

Dr. King and Health Reform
Claudia Fegan, Past President,
Physicians for a National Health Program
February 8, 2011 by Healthcare-NOW!

It is indeed an honor and a privilege for me to stand here today celebrating the
life and work of Dr. Martin Luther King Jr.

Dr. Garrett Adams, who gave me such a kind introduction, recently learned that my  father was the photographer who took the picture of Emmett Till’s body the night his mother requested the casket be opened so that the public could see what they had done to her baby. That photo became an icon of the civil rights movement.

I was only 7 years old the day my daddy stood behind Dr. King’s right shoulder  and photographed the crowd that stood before him on the Washington Mall as he gave his “I Have a Dream” speech. My father, a steelworker, was also a documentary photographer. I brought one of his photographs of Dr. King at that historic rally with me today.

We learned much from Dr. King, even though he was taken from us too soon. He taught us that “the time is always right to do what’s right.”

As we stand here today, there are 50 million Americans who are uninsured. African Americans are represented disproportionately among the uninsured. I am referring to the fact that while we represent only 12 percent of the population, we are 20 percent of the uninsured. This is our issue.

As a result of not having insurance, we have decreased access to the preventive services that would allow us to live longer, healthier, richer lives. We pay a tremendous price for this.

Our infant mortality rate is about 2.5 times that of whites, our rates of death from heart disease and cancer are 1.5 times that of whites, our rate of death from diabetes is almost 2.5 times that of whites and our rate of death from HIV is 5 times that of whites. African American patients on dialysis are less likely to be referred for evaluation for kidney transplant and therefore, not surprisingly, we are far less likely to get a kidney transplant. This is our issue.

The Institute of Medicine in its 2004 study on “The Consequences of Uninsurance” estimated over 18,000 people a year die as a result of not having access to health insurance:
* Uninsured adults receive fewer and less timely preventive and screening services
* Uninsured cancer patients die sooner due to delayed diagnosis
* The uninsured receive less chronic illness care, poorer hospital care and are more likely to die in the hospital.
* The risk of premature death among uninsured Americans is 25 percent higher than among Americans with health insurance.

This is our reality, the reality of health care for African Americans in this country. We will never get more until we demand more. This is our issue.Physicians for a National Health Program, PNHP, is an organization of 18,000 physicians. Since 1986 we have been trying to convince physicians, patients and politicians that if we tossed out the private insurance industry and made the government the single payer for health care in this country, we could provide coverage for everyone with the same money we are using now to cover only two-thirds of the country poorly.

I have a patient who is 63 years old. Ms. Lenoir has worked all her life, she is active in her church, she cares for her elderly mother and together she and her husband have raised their children to be self-sufficient members of society. Ms. Lenoir does not have health insurance because her employer has never provided that benefit.The problem is Ms. Lenoir needs a new hip. After more than 20 years of arthritis in her hip, the joint is destroyed. She has bone grinding on bone. No amount of anti-inflammatory medication will relieve her pain. I had to plead with her to consider taking a narcotic to relieve her pain so that maybe she could get a good night’s sleep.

I sent Ms. Lenoir to a pain specialist who injected the joint to provide her with temporary relief and who then called me and said, “This woman needs a new hip.” I told her, I know that, but have you got one you can give her? No one will pay for a hip for her until she turns 65 and Medicare will provide her with coverage.I wish you could look into this woman’s eyes each time she comes to see me and feel her pain. Will the legislation passed last year provide her with a new hip before she turns 65 in 2013? No probably not. This is our issue.

In the book “The Heart of Power,” David Blumenthal chronicles the efforts of presidents from Franklin Roosevelt through George W. Bush to achieve access to health care for the American public. “Major health reform is virtually impossible: difficult to understand, swarming with interests, powered by money, and resonating with popular anxiety,” he writes.

The congressional veteran and co-chair of the 9/11 Commission, Lee Hamilton, said, “Health care is so difficult because Congress is an incremental body and health care is a non-incremental issue.”

What Barack Obama did with the passage of the Patient Protection and Affordable Care Act (ACA) was nothing short of miraculous, but it was not enough and it will not solve our problems.

Going forward there will not be a fair, open or honest discourse about this legislation. It is a fact that ACA will do nothing to control costs. That is the major flaw of the legislation.

Why are we still talking about single payer? Because single payer will address the issues of cost, access and quality. Dr. King taught us being right is not enough. We have to win the hearts of the
American public.

We didn’t lose the war to gain access to health care for all Americans. We got battered in an ugly skirmish, but we’re not done.It is time to change our tactics. The opportunity for change is still ahead of us. More recent studies have taught us that actually 45,000 people die each year as a result of not having health insurance which means 180,000 more people will die before implementation of the majority of the ACA legislation. If everything goes exactly as planned, there will still be at least 23 million uninsured once all the changes have taken effect. This is our issue.

Camille Rucks was a security guard for a small company on the South Side of Chicago. In the spring of 2008 she developed breast cancer. She received outstanding care at the University of Chicago and did well. However, in November 2008, which we now know was the beginning of the recession, when her company began to struggle, she was laid off. She thought she was targeted because she had been out sick so much when she was receiving chemo, but it doesn’t matter.
In January 2009, when she had some blood-streaked sputum, her primary care physician (PCP) ordered a chest X-ray that showed a spot that raised the question of maybe her cancer had returned. Her oncologist told her she couldn’t see her because she was no longer insured. Her surgeon never returned her phone calls.

Her PCP called me because she was not able to get the necessary tests done for Camille because she was no longer insured. I told her PCP to have Camille come see me the next day.I said, sure, of course, this is what we do; we’re the County Hospital. In less than a week she had a CT of her chest, and within two weeks she had been seen by pulmonary and oncology. She did have metastatic cancer and we took care of her. I wish I could tell you this story had a happy ending, but it doesn’t. Camille died last year, but she told me she had no regrets. We treated her with dignity and respect.

My question is this: Who doesn’t deserve dignity and respect? Why should you have to pass a wallet biopsy before a health care provider determines she can talk to you, order a test, figure out what is wrong or decide how to treat you? This is our issue.

The Affordable Care Act has not made health care a right. Access to care is a profit center controlled by the insurance industry. We pay them to limit access to care. We spend more per capita on healthcare than any country in the world — more than $8,000 per person — and yet we are ranked only 36th in the world by the World Health Organization for the care we provide.

Under the ACA, everyone will be required to carry or purchase private insurance. For those who can’t afford it, we’re requiring states to either cover them under Medicaid or to provide supplements so they can purchase private insurance. This is an industry that has a history of profiteering by retroactively denying coverage to people with illnesses. So now we’re requiring everyone to buy
coverage, and yes, we have told the insurance companies they can’t deny coverage to those with illnesses.

My question is why can’t we just pay for the care without having to go through the insurance industry? They are not to be trusted. Ask the state of Massachusetts how it has worked out for them with mandating insurance coverage and paying for those who can’t afford it. The cost of premiums has gone up so high so fast in the first year the governor met with the major companies to request they hold off on their premium increases because the costs had exceeded three times the original projections. The state now teeters on insolvency. This is our issue.

We spend enough money on health care in this country. We just let too many people
who aren’t involved in providing care take profit from it. This is about justice. Health care should be a right to which everyone is entitled. Remember we live in the wealthiest country in the world. We spend more on health care than any other country. It is time we got our money’s worth. It is time we got the health care we deserve, not the care the insurance industry is willing to let us have. It is time we made health care a right and not a privilege.

We have to speak up. We have to speak loudly. We have to make our voices heard.The Affordable Care Act is an opportunity: It is not going to work!We have to remind the people — there is still a simpler, easier solution. People want to know, they have questions. They will ask, is this the answer? Will this work? Will this solve the problem?

Multinational Big Pharma charges the American public the highest pharmaceutical
prices in the world, while it sells the very same drugs all over the world at prices one-half, one-third or even one-tenth of the price they charge in the United States. They do this because in the rest of the industrialized world, there is legislation that limits profits for medications, while the U.S. allows these companies to charge whatever the market will bear. The Affordable Care Act does not address this issue. This is our issue.

Dr. King said, “When people get caught up with that which is right and they are willing to sacrifice for it, there is no stopping point short of victory.” The Affordable Care Act was not victory. We now have a House of Representatives that thinks the American public will be appeased by political theater instead of substance. They had planned to spent time reading the Constitution omitting the parts about Blacks being only three-fifths of a person, or the prohibition of alcohol; revisionist history at best, trying not to acknowledge the Constitution has been changed repeatedly throughout history.

They had planned to spend time voting to repeal the law when they knew it was an empty gesture. The shootings in Arizona at least gave them pause for that.

What the American public wants is not so different from what African Americans want and deserve. We want guaranteed access to care, freedom of choice of provider, quality health care and two words you don’t hear in association with health care very much anymore: trust and respect.

We know it can be done because every other industrialized country in the world has figured how to do this. Most of them spend less than half what we do and they have better outcomes with more satisfaction.It is not so complicated what we want: we want a health care system that takes everybody in and leaves nobody out. It is only the phony solutions they are attempting to confuse us with, that are complicated, just so we don’t notice they fail to expand coverage to those who need it and deserve it. That’s why this will be the civil rights struggle of the 21st century, and this is our issue.

I understand people are reluctant to criticize the ACA because our president is under assault from the right and he needs our support. I think Dr. King would tell us it is important to tell the truth. “The time is always right to do what’s right.”

When I think about this struggle I think about a poem my father taught me as a child. It was written by Langston Hughes and is called “Mother to Son.”

*Mother to Son*

Well, son, I’ll tell you:
Life for me ain’t been no crystal stair.
It’s had tacks in it,
And splinters,
And boards torn up,
And places with no carpet on the floor –
But all the time
I’se been a-climbin’ on,
And reachin’ landin’s,
And turnin’ corners,
And sometimes goin’ in the dark
Where there ain’t been no light.
So, boy, don’t you turn back.
Don’t you set down on the steps.
‘Cause you finds it’s kinder hard.
Don’t you fall now –
For I’se still goin’, honey,
I’se still climbin’,
And life for me ain’t been no crystal stair.

The issue of guaranteeing access to care for everyone is an issue of social justice. Battles for social justice are never over, because there will always be reactionary forces waiting in the wings to turn back the clock. There are no easy solutions. We have to be willing to fight for what we believe in and keep fighting.

The night before he was assassinated Martin Luther King said: “Let us stand with greater determination. And let us move in these powerful days, these days of challenge to make America what it ought to be. We have an opportunity to make America a better nation.”

I hope you will join me in saying what we expect from any health care program any politician will offer us:

Everybody in, Nobody out!
Everybody in, Nobody out!
Everybody in, Nobody out!

Thank you.

Source:  http://www.healthcare-now.org/dr-king-and-health-reform/




Viewpoints: Health bill will only entrench power of the insurance industry

Dr. Claudia Chaufan   Sacramento Bee     Published Friday, Mar. 26, 2010

To those led to believe that, as President Barack Obama claimed, the passage of the health care bill is "comparable to the passage of Medicare and Social Security" and that "every American will be guaranteed high quality, affordable health care coverage" as a result of it, my advice is to hold off on uncorking the champagne.

For one, Social Security and Medicare were public programs that from their inception offered immediate benefits to millions of ordinary Americans, who for the first time could rely on old-age pensions and access health care services that until then had been completely out of reach.

By contrast, this "historic bill," instead of eliminating the root of our health care woes, further enriches and entrenches a profit-driven health insurance industry that makes money when it succeeds in not paying medical bills.

How so? It forces millions of Americans to buy the insurance industry's shoddy products or pay a fine, even as it offers eligible ones subsidies – courtesy of taxpayers – to purchase those products.

Sound familiar? It should. The bill consolidates the transfer of wealth from Main Street to Wall Street of the last decades, only second to the recent, similar transfer implemented under the dubious claim that otherwise the economy would disintegrate.

I'm the vice president of the California branch of Physicians for a National Health Program, a group that advocates for a publicly financed, privately delivered national health program.

Some of us have been called party spoilers by continuing to criticize Obama's health reform plan. Yet here are some facts about the bill that supporters of reform need to consider:

• Millions of middle-income people will be mandated to buy commercial health care policies costing up to 9.5 percent of their income. Yet those policies will cover as little as 60 percent of "covered services," leaving them vulnerable to financial ruin if they become seriously ill. So yes, over 30 million Americans will be "covered" by this bill, but by an umbrella full of holes under pouring rain.

• People with employer-based coverage will be locked into their plans' "preferred providers' networks." So yes, workers will "keep their plans if they like them" (assuming they can afford the ever-increasing prices and don't lose their jobs, or their employers don't drop their plans), yet will have to keep them even if they don't like them.

• Insurers will be handed at least $447 billion in taxpayer money to subsidize the purchase of these policies, which will further empower the insurance industry and its ability to block future reform.

• Health care costs will continue to skyrocket because the bill will do nothing to reduce the $400 billion wasted every year pushing paper to market thousands of plans and separate people according to eligibility criteria, services covered, etc.

• The much-vaunted insurance regulations – e.g. ending denials on the basis of pre-existing conditions – are riddled with loopholes. For instance, older people can be charged up to three times more than their younger counterparts, and large companies with a predominantly female work force can be charged higher gender-based rates at least until 2017. Policies can still be canceled in case of "fraud or intentional misrepresentation," the No. 1 excuse insurers use to cancel policies today.

• About 23 million people will remain uninsured nine years out, according to the Congressional Budget Office. That translates into about 23,000 unnecessary deaths annually.

Did it need to be like this? Not at all. All the good provisions in the bill, such as funding community health centers, could have been adopted as stand-alone measures.

Instead, Congress and the Obama administration have chosen to burden ordinary people with a "uniquely American" individual obligation to buy flawed private products.

Social health insurance in the form of single-payer health care will sooner or later have to be adopted, not because it is politically feasible, but because it is inevitable.

As Harvard professor William Tsiao (the brain behind Taiwan's single-payer system) argued, you can have universal coverage, lower costs, and improve the quality of care, but you need a single-payer system to achieve that.

Dr. Claudia Chaufan is an assistant professor of health policy and sociology at the University of California, San Francisco.

The Case For Eliminating Private Health Insurance

by Leonard Rodberg & Don McCanne
July 13, 2007

Private health insurance was an idea that worked during part of the last century; it will not succeed through the 21st Century. With jobs increasingly service-based and short-term, the large employment-based risk pools that made this insurance system possible no longer exist. Medical care has become more effective and more essential to the ordinary person, but also more costly and capital-intensive. The multiple private insurance carriers that emerged during the last century can no longer provide a sound basis for financing our modern health care system.

Alone among the nations of the world, the U.S. has relied upon private insurance to cover the majority of its population. In the mid-20th Century, when medical care accounted for barely 1% of our gross national product, medical technology was limited, and jobs lasted for a lifetime, health care could be financed through such employment-based, premium-financed health insurance. But the time for private insurance has passed.

Health care has now become a major part of our national expenditures. The premium for an individual now averages more than $4,000 per year, while a good family policy averages more than $10,000 per year, comparable to the minimum wage and nearly one-fourth of the median family income. As a consequence, though the US spends far more on health care than any other nation, we leave millions of our people without any coverage at all. And those who do have coverage increasingly find that their plans are inadequate, exposing them to financial hardship and even bankruptcy when illness strikes.

If we believe that everyone should have health care coverage, and that financial barriers should not prevent us from accessing health care when we need it, then it has become clear that the private health insurance system cannot meet our needs. Health care has simply become too expensive to be financed through private insurance premiums.

Supporters of insurance companies claim that they create efficiency through competition. However, the truth is that insurance industry is increasingly concentrated, with three national firms, United Health, Wellpoint, and Aetna, dominating the industry. And the high and rising cost of health care shows that whatever competition there was in the past has not worked to hold down costs.

Supporters of private insurance also claim that it expands consumer choice. However, the choice of plans that these companies offer is not what consumers want; it is the choice of their physician and hospital, exactly the choice that private insurance plans, in the guise of managed care, increasingly deny us.

What has been the response of the health insurance industry to this situation? To protect their markets and try to make premiums affordable, they have reduced the protection afforded by insurance by shifting more of the cost to patients, especially through high-deductible plans. They have also targeted their marketing more narrowly to the healthy portion of the population, so as to avoid covering individuals with known needs for health care. Yet premiums continue to rise each year, increasing by nearly 70% above inflation in just the last six years.

The so-called “universal health care” proposals being put forward by mainstream politicians would simply expand the current system without addressing any of its problems. They would simply mandate that either our employers provide us with coverage or we, as individuals, purchase our own coverage in the private insurance market. These plans cannot work in the face of the high cost of premium-based coverage for even the average person. (Some proposals would offer the option of buying a competing public plan, under the theory that the public program would be more efficient and effective. The flaw here is that the public plan would attract those who are unable to afford private coverage or who are paying high premiums or have no insurance because of pre-existing conditions. Placing these high-cost individuals in a separate government pool would make it unaffordable for most other people. This “death spiral” would cause the public plan to fail.)

The main impetus for renewed interest in health care reform has been the rapid rise in costs over the last few years. Yet, while most of these proposals give lip service to the need to control costs, none actually addresses the problem in a serious way. (The introduction of health information technology and “disease management”, which some of them urge, are mere placebos; they may make politicians feel better, but studies have shown they will do little to reduce costs and may actually increase them.)

Everyone acknowledges that coverage for low-income individuals must be subsidized. But what about the average-income individual and family? If they must now be subsidized as well, we might as well throw in the towel and recognize that a more efficient, more equitable financing system has to be adopted if it has any chance of providing coverage while being affordable to the society. An individual mandate to purchase private insurance cannot provide good coverage while remaining affordable, while employer-provided coverage also can no longer be sustained as the premium costs to the employer become increasingly unaffordable.

The private insurance industry spends about 20 percent of its revenue on administration, marketing, and profits. Further, this industry imposes on physicians and hospitals an administrative burden in billing and insurance-related functions that consumes another 12 percent of insurance premiums. Thus, about one-third of private insurance premiums are absorbed in administrative services that could be drastically reduced if we were to finance health care through a single non-profit or public fund. Indeed, studies have shown that replacing the multiplicity of public and private payers with a single national health insurance program would eliminate $350 billion in wasteful expenditures, enough to pay for the care that the uninsured and the underinsured are not currently receiving.

Such a single payer plan would make possible a set of mechanisms, including public budgeting and investment planning, which would allow us to address the real sources of cost increases and allow us to rationalize our health care investments. The drivers of high cost such as administrative waste, deterioration of our primary care infrastructure, excessive prices, and use of non-beneficial or detrimental high-tech services and products could all be addressed within such a rationalized system.

In sum, we will not be able to control health care costs until we reform our method of financing health care. We simply have to give up the fantasy that the private insurance industry can provide us with comprehensive coverage when this requires premiums that average-income individuals cannot afford. Instead, the U.S. already has a successful program that covers more than forty million people, gives free choice of doctors and hospitals, and has only three percent administrative expense. It is Medicare, and an expanded and improved Medicare for All (Medicare 2.0) program would cover everyone comprehensively within our current expenditures and eliminate the need for private insurance. This is the direction we must go.

Leonard Rodberg is Research Director of the New York Metro Chapter, and Don McCanne, Senior Policy Fellow, of Physicians for a National Health Program. www.pnhp.org


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