Health Care Now
From the Brattleboro Reformer –
The health care committee of the Vermont House is lining up some of the tasks that will have to be finished before the state rolls out the first-in-the-nation single payer health care system, now scheduled for 2017.
Meeting Friday at the Statehouse, the committee heard from legislative staffers who outlined details that will have to be worked out, such as how to ensure the state gets the maximum amount of federal dollars and who would be covered.
There are details such as what would happen if a person living in Vermont works in another state where their employer offers health insurance or if someone from another state worked in Vermont and their employer didn’t offer insurance.
On Tuesday, Gov. Peter Shumlin recommitted the state to the single payer goal.
From the AP –
A government-run health care system in Maine would provide universal coverage to residents, cut down on administrative costs and free businesses from the complexities of providing insurance for their employees, supporters of a single-payer model said Thursday.
Advocates of a single-payer system have long been trying to implement the model in Maine with little success, but said they are hopeful that the steps Vermont officials have recently made to spearhead the effort there can help make it a reality in Maine.
“Our current health care system is complicated, is inefficient, unfair and pretty much broken,” said Julie Pease, president of Maine AllCare, the group behind the measure, which she said will “return our system to one where … our medical profession treats our patients based on their health care needs not on their ability to pay or what kind of insurance they have.”
The bill, sponsored by Democratic Rep. Charlie Priest of Brunswick, aims to create a single-payer health care system in Maine by 2017, as officials are trying to do in Vermont. Beginning in 2017, Vermont will offer a set package of coverage benefits to every resident under the program.
But the idea in Maine faces fierce opposition from insurance companies and questions remain about how the state could afford such an endeavor.
Dan Bernier, a lobbyist for the Maine Insurance Agents Association, said that government should focus its limited resources on the poor, elderly and disabled instead of those who can afford coverage.
“It is not the role of government to provide someone like myself, a lawyer and lobbyist, free health insurance,” he told the Insurance and Financial Services Committee on Thursday.
Supporters argue it would ultimately save the state as much as $1 billion down the line by eliminating unnecessary paperwork and administrative costs. The program would be paid for through taxes like people already do for Medicare and Medicaid, they said.
But the state first has to make a commitment to universal health care before every single detail can be worked out, said Joe Lendvai, a Brooklin resident who advocates on behalf of the bill with Maine AllCare.
“Unless we conceptually agree that we need to cover everyone, that every Maine resident deserves access to health care without any barriers, we are not going to succeed,” he said.
But any proposal to raise taxes would likely be rejected by Republican Gov. Paul LePage, who has vowed not to do so while he’s in office and vetoed the state budget last year because it included tax increases.
Democratic Sen. Geoff Gratwick of Bangor acknowledged that it will be tough to pass the measure in this political and economic environment, when budgets are especially tight. But he said that Maine lawmakers have long-understood the serious problems with the current health care system and want a change.
“This is going to happen whether or not we get it now, two years from now, 10 years from now,” he said. “It’s inevitable because our current system is broken,” he said.
It’s satisfying to watch rats flee a sinking ship. This is because onlookers knew the ship was doomed long ago, and swimming rats signify that the drawn-out tragedy is nearing an end. A collective sense of relief is a natural response.
The rats who propped up the broken boat of Obamacare are a collection of liberal and labor groups who frittered away their group’s resources—and integrity— to sell a crappy product to the American people.
Those in the deepest denial went “all in” for Obamacare— such as some unions and groups like Moveon.org— while the more conniving groups and individuals—like Michael Moore— playacted “critical” of Obamacare, while nevertheless declaring it “progressive”, in effect adding crucial political support to a project that deserved none.
But of course Obamacare was always more barrier than progress: we’ve wasted the last several years planning, debating, and reconstructing the national health care system, all the while going in the wrong direction— into the pockets of the insurance mega corporations. A couple progressive patches on the sails won’t keep her afloat. It’s shipbuilding time.
It was painful to watch otherwise intelligent people lend support to something that’s such an obviously bad idea. So it’s with immense relief that liberals like Michael Moore, labor groups, and others are finally distancing themselves from Obamacare’s Titanic failure. Now these individuals and groups can stop living in denial and the rest of us can proceed towards a rational discussion about a real health care solution.
The inevitable failure of Obamacare is not due to a bad website, but deeper issues. The hammering of the nails in the coffin has begun: millions of young people are suddenly realizing that Obamacare does not offer affordable health care. It’s a lie, and they aren’t buying it, literally.
The system depends on sufficient young people to opt in and purchase plans, in order to offset the costs of the older, higher-needs population. Poor young people with zero disposable income are being asked to pay monthly premiums of $150 and more, and they’re opting out, inevitably sinking Obamacare in the process.
Those young people who actually do buy Obamacare plans—to avoid the “mandate” fine— will be further enraged when they attempt to actually use their “insurance”. Many of the cheapest plans—the obvious choice for most young people— have $5,000 deductibles before the insurance will pay for anything. For poor young people this is no insurance at all, but a form of extortion.
At the same time millions of union members are being punished under Obamacare: those with decent insurance plans will suffer the “Cadillac” tax, which will push up the cost of their healthcare plans, and employers are already demanding concessions from union members in the form of higher health care premiums, co-pays, deductibles, etc.
Lower paid union workers will suffer as well. Those who are part of the Taft Hartley insurance plans will be pressured to leave the plans and buy their own insurance, since they cannot keep their plans and get the subsidy that the lowest income workers get. This has the potential to bust the whole Taft Hartley health care system that millions of union members benefit from, which is one of the reasons that labor leaders suddenly became outraged at Obamacare, after having wasted millions of union member’s dollars propping it up.
Ultimately, the American working class will collectively cheer Obamacare’s demise. They just need labor and other lefties to cheer lead its destruction a little more fiercely.
Surprisingly, most of the rats are still clinging to Obama’s hopeless vessel, frantically bailing water. Sure they’ve put on their life preservers and anxiously eyeing the lifeboats, but they’re also preaching about how to re-align the deckchairs.
For example, in his “critical” New York Times op-ed piece, Michael Moore called Obamacare “awful”, but also called it a “godsend”, singing his same tired tune. Part of Moore’s solution for Obamacare—which was cheered on in the Daily Kos— is equally ludicrous, and follows his consistently flawed logic that Obamacare is worth saving, since its “progress” that we can build on. Moore writes:
“Those who live in red [Republican dominated] states need the benefit of Medicaid expansion [a provision of Obamacare]…. In blue [Democrat dominated] states, let’s lobby for a public option on the insurance exchange — a health plan run by the state government, rather than a private insurer.”
This is Moore at his absolute worst. He’s neck deep in the flooded hull of the U.S.S Obamacare and giving us advice on how to tread water.
Of course Moore doesn’t criticize the heart of Obamacare, the individual mandate, the most hated component.
Moore also relies on the trump card argument of the pro-Obamacare liberals: there are progressive aspects to the scheme—such as the expansion of Medicaid— and therefore the whole system is worth saving.
Of course it’s untrue that we need Obamacare to expand Medicaid. In fact, the expansion of Medicaid acted more as a Trojan horse to introduce the pro-corporate heart of the system; a horse that Moore and other liberals nauseatingly continue to ride on.
But Moore’s sneakiest argument is his advice to blue states to “…lobby for a public option on the insurance exchange…”
Again, Moore implies that it’s ok if we are “mandated” to buy health insurance, so long is there is a public option. But that aside, the deeper scheme here is that Moore wants us to further waste our energy “reforming” Obamacare, rather than driving it to the bottom of the sea.
Moore surely knows that very few people are going to march in the streets demanding a public option at this point; he therefore knows that even this tiny reform of the system is unachievable. He’s wasting our time. Real change only happens in politics when there is a surge of energy among large sections of the population, and it’s extremely unlikely that more than a handful of people are going to be active towards “fixing” Obamacare— they want to drown it.
Moore’s attempt to funnel people’s outrage at Obamacare towards a “public option” falls laughably short, and this is likely his intention, since his ongoing piecemeal “criticisms” of the system have only served to salvage a sunken ship.
Instead of wasting energy trying to pry Obamacare out of the grip of the corporations, Moore would be better served to focus exclusive energy towards expanding the movement for Medicare For All, which he claims that he also supports, while maintaining that somehow Obamacare will evolve into Single Payer system.
Most developed nations have achieved universal health care through a single payer system, which in the United States can be easily achieved by expanding Medicare to everybody. Once the realities of Obamacare directly affect the majority of the population and exacerbates the crisis of U.S. healthcare, people will inevitably choose to support the movement of Medicare for All, the only real option for a sane health care system.
Today marks the beginning of health care coverage under the Affordable Care Act’s new insurance exchanges, for which two million Americans have signed up. Now that the individual mandate is officially here, let me begin with an admission: Obamacare is awful.
That is the dirty little secret many liberals have avoided saying out loud for fear of aiding the president’s enemies, at a time when the ideal of universal health care needed all the support it could get. Unfortunately, this meant that instead of blaming companies like Novartis, which charges leukemia patients $90,000 annually for the drug Gleevec, or health insurance chief executives like Stephen Hemsley of UnitedHealth Group, who made nearly $102 million in 2009, for the sky-high price of American health care, the president’s Democratic supporters bought into the myth that it was all those people going to get free colonoscopies and chemotherapy for the fun of it.
I believe Obamacare’s rocky start — clueless planning, a lousy website, insurance companies raising rates, and the president’s telling people they could keep their coverage when, in fact, not all could — is a result of one fatal flaw: The Affordable Care Act is a pro-insurance-industry plan implemented by a president who knew in his heart that a single-payer, Medicare-for-all model was the true way to go. When right-wing critics “expose” the fact that President Obama endorsed a single-payer system before 2004, they’re actually telling the truth.
What we now call Obamacare was conceived at the Heritage Foundation, a conservative think tank, and birthed in Massachusetts by Mitt Romney, then the governor. The president took Romneycare, a program designed to keep the private insurance industry intact, and just improved some of its provisions. In effect, the president was simply trying to put lipstick on the dog in the carrier on top of Mitt Romney’s car. And we knew it.
By 2017, we will be funneling over $100 billion annually to private insurance companies. You can be sure they’ll use some of that to try to privatize Medicare.
For many people, the “affordable” part of the Affordable Care Act risks being a cruel joke. The cheapest plan available to a 60-year-old couple making $65,000 a year in Hartford, Conn., will cost $11,800 in annual premiums. And their deductible will be $12,600. If both become seriously ill, they might have to pay almost $25,000 in a single year. (Pre-Obamacare, they could have bought insurance that was cheaper but much worse, potentially with unlimited out-of-pocket costs.)
And yet — I would be remiss if I didn’t say this — Obamacare is a godsend. My friend Donna Smith, who was forced to move into her daughter’s spare room at age 52 because health problems bankrupted her and her husband, Larry, now has cancer again. As she undergoes treatment, at least she won’t be in terror of losing coverage and becoming uninsurable. Under Obamacare, her premium has been cut in half, to $456 per month.
Let’s not take a victory lap yet, but build on what there is to get what we deserve: universal quality health care.
Those who live in red states need the benefit of Medicaid expansion. It may have seemed like smart politics in the short term for Republican governors to grab the opportunity offered by the Supreme Court rulings that made Medicaid expansion optional for states, but it was long-term stupid: If those 20 states hold out, they will eventually lose an estimated total of $20 billion in federal funds per year — money that would be going to hospitals and treatment.
In blue states, let’s lobby for a public option on the insurance exchange — a health plan run by the state government, rather than a private insurer. In Massachusetts, State Senator James B. Eldridge is trying to pass a law that would set one up. Some counties in California are also trying it. Montana came up with another creative solution. Gov. Brian Schweitzer, a Democrat who just completed two terms, set up several health clinics to treat state workers, with no co-pays and no deductibles. The doctors there are salaried employees of the state of Montana; their only goal is their patients’ health. (If this sounds too much like big government to you, you might like to know that Google, Cisco and Pepsi do exactly the same.)
All eyes are on Vermont’s plan for a single-payer system, starting in 2017. If it flies, it will change everything, with many states sure to follow suit by setting up their own versions. That’s why corporate money will soon flood into Vermont to crush it. The legislators who’ll go to the mat for this will need all the support they can get: If you live east of the Mississippi, look up the bus schedule to Montpelier.
So let’s get started. Obamacare can’t be fixed by its namesake. It’s up to us to make it happen.
Michael Moore is a documentary filmmaker whose 2007 film “Sicko” examined the American health care industry.
Buried deep in the health reform law is Section 10323. It amends the Social Security Act to extend Medicare coverage to individuals exposed to environmental health hazards in the region defined by the Emergency Declaration of June 17, 2009. That declaration limits this benefit to the area around Libby, Montana.
Section 10323 of the Affordable Care Act (ACA) calls it “deeming of Individuals as eligible for Medicare benefits.” People do not have to be age 65, or wait two years following disability, or to have paid into the Medicare system. The victims of asbestos in Libby were simply “deemed” to be eligible for Medicare. It was described as “discretionary deeming.”
Senator Max Baucus, Chair of the powerful Senate Finance Committee, who hired insurance executive Liz Fowler to write the health reform act, slipped Section 10323 into the law assuring that all those with asbestos-related conditions in the community around Libby, Montana get into Medicare, our single payer program for all those over 65. Further, for this designated group of Montanans, Baucus arranged additional special benefits not normally available to Medicare patients.
It’s true. Senator Baucus “deemed” single payer off the table during the 2009 health care debate. He had physicians and others arrested for insisting that single payer be included in the nation’s discussion. Baucus effectively locked out any consideration of such a plan. But he gave our country’s single payer program, Medicare, to the people of Libby. And they got free drugs, too.
The victims of asbestos exposure in Libby, regardless of age, are eligible for traditional Medicare, plus, under an additional program that Baucus included in the ACA, the government also pays for services not included under Medicare, such as home care, medical equipment, counseling, help with travel, and medications not covered by Medicare prescription plans.
Coverage of drugs can be crucial. Outrageous drug prices continue to threaten all who depend on costly medications. While the ACA bars health insurance plans from refusing to cover those who are sick, insurance companies have found ways to keep patients with cancer, Multiple Sclerosis, AIDS, and other conditions out of their plans. Some insurance companies have made the co-pays on the drugs needed by such patients as high as $1,000 to $6,000 a month, effectively excluding those with pre-existing conditions.
Goodness knows the people of Libby deserve to have Medicare—with free drugs and home care and medical equipment and help with travel and much more. After all, the W. R. Grace company whose vermiculite mine poisoned their entire region left thousands, not just the miners, suffering and dying.
But the senator who helped Libby also made certain that all the rest of us would be left out—that the nation could not even consider the merits of HR 676, the Expanded and Improved Medicare for All Act, that would free our country from the health insurance companies that continue to hold us hostage.
As health reform rolls into a new stage where some who have been left out find help but millions more, both insured and uninsured, find the costs of care still beyond their means, let us look to the Libby solution, publicly-funded single payer, for the answer.
Medicare spends more than 98 cents of every dollar on actual health care, while insurance companies spend only 80 to 85 cents on health care. Under the ACA insurance companies still victimize all of us as their narrow networks deny us access to the doctors and hospitals we need. The insurance companies retain their power to deny tests, procedures, and treatment making life miserable for both patients and doctors.
The United States spends about twice as much per person on health care as the rest of the industrialized world. Yet our life expectancy, infant mortality and other health outcomes lag far behind. As the policy experts of Dartmouth and MIT search in vain for ways to cut health care costs while retaining the profit makers, let us keep in mind that unless we remove the private for-profit insurance companies from our health care, any cut in costs means a cut in care.
To expand care while cutting costs, we have to go to a single payer plan—like HR 676, Expanded and Improved Medicare for All, a bill introduced into every congress since 2003 by Rep. John Conyers, Jr. (D MI). With HR 676, we could save over $500 billion a year while expanding coverage to everyone and improving care to assure dental and eyeglasses and hearing aids and drugs and long term care and all the things we need that are not normally covered. And this coverage would remove all co-pays and all deductibles.
Health care would be paid for publicly and in advance with no payment at the point of care. Patients will choose their doctors and hospitals. When we seek care, the question will not be “How will you pay?” but “Where does it hurt?”
This simple legislation would fix our damaged health care. Medicare was rolled out in six months with only index cards in the time before computers. No need to ask how much you make—it is available to all. That’s what we need–not the twisted double-dealing that wins something special for a few, but, instead, a magnanimous, simple, bold, inclusive plan that finally will allow all of our people to enjoy the life-giving benefits that a wealthy and compassionate nation can offer.
Let us dedicate this new year to building the single payer movement that will make this plan possible.
From UnionsForSinglePayer.org –
U.S. Congressman John Conyers (D MI), chief sponsor of HR 676, was honored at a December 6th Labor Breakfast co-hosted by the New York City Central Labor Council and the Progressive Democrats of America in celebration of the endorsement by the 1.3 million member NYC CLC of HR 676, Expanded and Improved Medicare for All.
Congressman Conyers told of the energy that the endorsement of HR 676 by the NYC CLC brings to the movement of healthcare for all, reports Robert Score, Recording-Corresponding Secretary of IATSE Local One. Score has played a leadership role in advancing HR 676 within New York labor and in union locals across the country.
NYC CLC President Vincent Alvarez, a member of IBEW Local 3, delivered the opening remarks. He said that the forces within the industrial-insurance complex, although powerful, must be confronted before the working class families of our country are completely decimated by the ever increasing costs of health care. He spoke of the necessity for all working people, union and non-union, to have proper healthcare.
Stephen Shaff spoke on behalf of PDA, and special guest television broadcaster Phil Donohue, introduced Congressman John Conyers who has sponsored HR 676 in every Congress since 2003. The legislation currently has a total of 54 co-sponsors, the most recent being Rep. Betty McCollum of Minnesota who has signed on for the first time even though she is in her 4th term.
Conyers noted that four days after Dr. Martin Luther King Jr. was assassinated in 1968, he introduced a bill to make King’s birthday a national holiday.
“It took 15 years before Congress joined with me to make Dr. King’s birthday a national legal holiday. So I’m in this for the long run,” said Congressman Conyers.
Introduced in the Senate, December 9, 2013
Summary of S. 1782, The American Health Security Act of 2013
The American Health Security Act of 2013 (S. 1782) provides every American with affordable and comprehensive health care services through the establishment of a national American Health Security Program (the Program) that requires each participating state to set up and administer a state single payer health program. The Program provides universal health care coverage for the comprehensive services required under S. 1782 and incorporates Medicare, Medicaid, the Children’s Health Insurance Program, the Federal Employees Health Benefits Program and TRICARE (the Department of Defense health care program), but maintains health care programs under the Veterans Affairs Administration. Private health insurance sold by for-profit companies could only exist to provide supplemental coverage.
The cornerstones of the Program will be fixed, annual, and global budgets, public accountability, measures of quality based on outcomes data designed by providers and patients, a national data-collection system with uniform reporting by all providers, and a progressive financing system. It will provide universal coverage, benefits emphasizing primary and preventive care, and free choice of providers. Inpatient services, long term care, a broad range of services for mental illness and substance abuse, and care coordination services will also be covered.
A seven-member national board (the Board) appointed by the President will establish a national health budget specifying the total federal and state expenditures to be made for covered health care services. The Board will work together with similar boards in each of the fifty states and the District of Columbia to administer the Program.
A Quality Council will develop and disseminate practice guidelines based on outcomes research and will profile health care professionals’ patterns of practice to identify outliers. It will also develop standards of quality, performance measures, and medical review criteria and develop minimum competence criteria. A new Office of Primary Care and Prevention Research will be created within the Office of the Director of the National Institutes of Health (NIH).
The Program is designed to provide patient-centered care supported through adequate reimbursement for professionals, a wealth of evidence-based information, peer support, and financial incentives for better patient outcomes. The Program seeks to ensure medical decisions are made by patients and their health care providers.
The Program amends the tax code to create the American Health Security Trust Fund and appropriates to the Fund specified tax revenues, current health program receipts, and tax credits and subsidies under the Affordable Care Act. While the final structure of the financing component is still under consideration and is subject to change, the tax revenues in the draft include a new health care income tax, an employer payroll tax, a surcharge on high income individuals, and a tax on securities transactions.
The federal government would collect and distribute all funds to the states for the operation of the state programs to pay for the covered services. Budget increases would be limited to the rate of growth of the gross domestic product. Each state’s budget for administrative expenses would be capped at three percent.
Each state would have the choice to administer its own program or have the federal Board administer it. The state program could negotiate with providers and consult with its advisory boards to allocate funds. The state program could also contract with private companies to provide administrative functions, as Medicare currently does through its administrative regions. State programs could negotiate with providers to pay outpatient facilities and individual practitioners on a capitated, salaried, or other prospective basis or on a fee-for service basis according to a rate schedule. Rates would be designed to incentivize primary and preventive care while maintaining a global budget, bringing provider, patients, and all stakeholders to the table to best determine value and reimbursement.
Finally, the Program also relieves businesses from the heavy administrative burdens of providing health care coverage, puts all businesses on an even playing field in terms of healthcare coverage, and increases the competitiveness of American companies in the global marketplace. Every other industrialized nation has been able to use the power of a public authority to provide universal health care. The American Health Security Act of 2013 seeks to do just that for all Americans and their businesses.
Former Secretary of State Colin Powell has waded into the health care debate with a broad endorsement of the kind of universal health plan found in Europe, Canada and South Korea.
“I am not an expert in health care, or Obamacare, or the Affordable Care Act, or however you choose to describe it, but I do know this: I have benefited from that kind of universal health care in my 55 years of public life,” Powell said, according to the Puget Sound Business Journal, last week at an annual “survivors celebration breakfast” in Seattle for those who, like Powell, have battled prostate cancer. “And I don’t see why we can’t do what Europe is doing, what Canada is doing, what Korea is doing, what all these other places are doing.”
Europe, Canada and Korea all have a “single-payer” system, in which the government pays for the costs of health care.
Some Democrats who strongly advocated for, and failed to get, a single-payer system in the 2010 Affordable Care Act, still believe the current law doesn’t go far enough to reform the US health system.
A retired four-star general and former chairman of the Joint Chiefs of Staff, Powell told the audience about a woman named Anne, who as his firewood supplier, faced a healthcare scare of her own. Anne asked Powell to help pay for her healthcare bills, as her insurance didn’t cover an MRI she needed as a prerequisite to being treated for a growth in her brain. In addition, Powell’s wife Alma recently suffered from three aneurysms and an artery blockage. ”After these two events, of Alma and Anne, I’ve been thinking, why is it like this?” said Powell.
“We are a wealthy enough country with the capacity to make sure that every one of our fellow citizens has access to quality health care,” Powell. “(Let’s show) the rest of the world what our democratic system is all about and how we take care of all of our citizens.”
Powell, who has taken heat from Republicans for twice endorsing President Obama’s election and reelection bids, said he hopes universal healthcare can one day become a reality in the U.S. ”I think universal health care is one of the things we should really be focused on, and I hope that will happen,” said Powell. ”Whether it’s Obamacare, or son of Obamacare, I don’t care. As long as we get it done.”
From the Daily Beast –
Could anger at the Obamacare rollout make Americans more receptive to a kind of Medicare-for-all system? That’s what activists are hoping—and they’re plotting a state-by-state fight.
As the rollout of Obamacare clunks forward, activists who opposed the law from the beginning say it is time to seize the moment, to tear down the current health-care edifice and start anew, especially now as frustration with the law’s implementation is reaching a peak.
These are not Tea Party activists but advocates for a single-payer health-care system who say some of the problems with the launch of the Affordable Care Act—in addition to built-in problems with the law itself—have made the American public more receptive than ever to a Medicare-for-all kind of coverage system.
On Monday, Sen. Bernie Sanders (I-VT) introduced the American Health Security Act, which would require each state to set up a single-payer health-care system and would undo the exchanges that have plagued Obamacare. Meanwhile, various state-led efforts are under way that advocates hope will sweep the country statehouse by statehouse, as soon as lawmakers see the advantage of a single-payer system. In Vermont, for example, lawmakers have set aside the financing and are already preparing to adopt a single-payer system when the federal government permits it, which according to provisions of the Affordable Care Act will be in 2015. In Massachusetts, Don Berwick, a former top Obama administration health official, is basing his campaign for governor on bringing a single-payer system to the commonwealth. And advocates in New York, Maryland, Oregon, and around the country say they see new energy around their cause.
“As the president fully understands, the rollout has been a disaster, the website has been a disaster,” said Sanders in an interview moments after his bill was introduced in the Senate. “But the truth is, even if all of those problems were corrected tomorrow and if the Affordable Care Act did all that it was supposed to do, it would be only a modest step forward to dealing with the dysfunction of the American health-care system. When you have a lot of complications, it is an opportunity for insurance companies and drug companies and medical equipment suppliers to make billions and billions of profits rather than to see our money go into health care and making people well.”
Democrats conceded that Republican efforts to sabotage Obamacare with endless lawsuits and by declining to set up state-run exchanges have damaged the law’s popularity, but they say the confusion will lead the public inevitably to conclude that a simple single-payer system, one that avoids malfunctioning websites and complicated gold/silver/bronze options, is preferable. Advocates pointed enthusiastically to a tweet last month from John Podesta, the former Clinton White House chief of staff who is joining President Obama to help with health care—“Just applied online for Medicare. Took 5 minutes. Single payer anyone?”—calling it proof that wild-eyed radicals are not the only ones supporting single payer. The notion is gradually becoming more mainstream among the Democratic establishment, advocates said.
“I think the thing that is most interesting about government is that populism gets its biggest support not from Democrats but from what Republicans do,” said former Pennsylvania governor Ed Rendell, who stressed that he did not count himself among the populist members of the Democratic Party. “They torpedo the Affordable Care Act, and I believe we will now have single payer in this country within the next 15 years.”
Opponents to single payer certainly have reasons to believe the momentum is on their side. Further meddling with the American health-care system, after not just the botched rollout of the Affordable Care Act but also the grueling five-year fight to get there, seems unlikely. But proponents of single payer pointed to polls that show a majority of Americans want some version of Medicare for all. It is up to Democratic pols to show leadership on the issue and risk defying the powerful health-care industry, advocates said.
“It is not possible to put together a good program unless you antagonize the powers that be,” said Dr. David Himmelstein, one of the leaders of Physicians for a National Health Program. The White House, he added, “largely played an inside-the-Beltway game in passing Obamacare. They refused to rally the American people for something truly radical which every poll shows that the American people really want.”
Sanders joked that he expected to have his bill passed by chambers of Congress and ready for President Obama’s signature by the time he returns from Nelson Mandela’s funeral in South Africa, but few proponents see much hope of gaining traction for single-payer health care in a Congress that has struggled to pass a routine budget.
Instead they are turning to a legislature-by-legislature fight in statehouses across the country. Advocates in New York and California said they were counting on labor unions’ opposition to the Affordable Care Act—some labor leaders have feared that their members may pay higher premiums under the law and have pushed for exemptions. In Vermont, a single-payer bill passed in 2011, and Dr. Deb Richter, the president of Vermont Health Care for All, said that if anything, the passage of Obamcare slowed the group’s work there.
“We had all the momentum going on the single-payer side, and it was really slowed by the Affordable Care Act,” she said. A state measure similar to Obamacare faltered, she added, because it lacked the appropriate enforcement mechanisms. Now, with the law set to take effect in 2015, advocates are working to calm fears among Vermonters who have been scared off by talk of “socialized medicine.”
“We have all of the right ingredients, but there is a lot of room for mischief. You can confuse people, freak them about rationing and all of that stuff,” said Richter. She said she thought Obamacare’s failure to deal with the spiraling cost of health care would lead more and more people to see the logic of single payer.
“I think that eventually most states will recognize this,” she said. “We keep talking about how the health-care system is unsustainable. We haven’t reached that point yet, but when health care starts eating up 25 percent of GDP and you have hospitals failing, they will look for guaranteed financing, and the only way you get there is through a single-payer system. It is not a matter of if but of when.”
Rep. Jim McDermott of Washington is optimistic that it will come—if we give states the tools to adopt it at their own pace.
When the media frenzy subsides and Republicans run out of scare stories, the country will be faced with the most important question about Obamacare: Can it deliver what it promised? Thanks to the Affordable Care Act, a new business model is rapidly emerging in the medical-industrial complex that, in theory, can dramatically reduce the inflated costs of healthcare while serving everyone—rich and poor, healthy and sick. But the reformed system will also still rely on the market competition of profit-making enterprises, including insurance companies. A lot of liberal Democrats, though they voted for Obama’s bill, remain skeptical.
“In the long arc of healthcare reform, I think [the ACA] will ultimately fail, because we are trying to put business-model methods into the healthcare system,” said Washington Representative Jim McDermott. “We’re not making refrigerators. We’re dealing with human beings, who are way more complicated than refrigerators on an assembly line.” I turned to the Seattle congressman for a candid assessment because he’s the third-ranking Democrat on the House Ways and Means Committee and has been an advocate of single-payer healthcare for decades. Plus, he’s a doctor.
The business transformation under way in healthcare involves the consolidation of hospitals, doctors and insurance companies in freestanding “integrated delivery systems”—nonprofit and profit-seeking—that will have the operating scope and power to eliminate duplications and waste and hold down costs, especially the incomes of primary-care doctors. Major hospitals are buying up other hospitals and private practices, and they’re hiring younger doctors as salaried employees. An American Medical Association survey in 2012 found that a majority of doctors under 40 are employees, no longer independent practitioners.
“The medical-industrial complex is putting itself together so that the docs will be the least of our problem,” McDermott said. “They will simply be serfs working for the system.” The AMA’s market research reports that “hospitals focus on employing primary-care physicians in order to maintain a strong referral base for high-margin specialty service lines.” Big hospitals need a feeder system of salaried doctors, McDermott explained, to keep sending them patients in need of surgery or other expensive procedures.
“It’s possible hospital groups can reduce costs,” the congressman said, “but I look at the consolidations going on and ask myself, ‘Are we going to wind up with hospitals that are too big to fail? Are we going to have hospitals so powerful that we cannot not give them what they want?’ It’s going to be the government against the medical-industrial complex, which is developing very rapidly. If the Little Sisters of Providence [his fanciful example] become a conglomerate and the government says you should close some of your hospitals, they will say, Who says?”
Despite these doubts—not to mention the Republican-promoted hysterical attacks on the ACA on other grounds—McDermott is actually optimistic. He expects stronger healthcare systems roughly resembling single-payer “to spring up like dandelions” around the country—led by progressive states that really want to make it work. “That’s probably going to happen in Vermont, Washington and Oregon,” he said. “California has tried twice to have a single-payer system and was defeated by the forces of money. Jerry Brown in California, maybe Cuomo in New York, maybe Kentucky. The governor in Oregon, John Kitzhaber, and our governor in Washington, Jay Inslee, all want it to happen.”
Having introduced a single-payer bill in Congress every year since 1993, McDermott is developing a different approach this time: a strategy designed to get around the hard-core resistance in so many states. “I now have a bill I’m going to drop in soon as a patch to the ACA,” he said. “What I’m trying to do is let the states that want it to go ahead, whether it’s Tennessee or Illinois. ‘Medicare for All’ sounds wonderful, but the country is so diverse, you have to allow the delivery system to evolve where it can. You have to do it state by state.”
McDermott tried to sell this concept to the Obama administration and to Senator Max Baucus of Montana, chair of the Senate Finance Committee and one of the key Capitol Hill brokers in 2009–10 for what would become the ACA. No sale in either case. Instead, the president rejected the “public option” and made “bad deals” with hospitals, drug companies, the insurance industry and other players, McDermott said. Those interests agreed not to fight new rules on their behavior toward consumers, and in return Obama provided them with millions of new paying customers, subsidized by the government.
Under the ACA, hospital groups must sign a non-discrimination agreement, but as a practical matter they can still find ways to pick and choose which patients they will treat. The rules for Medicaid are set by each state, and enforcement varies widely among them. Typically, many private practices severely limit impoverished patients on Medicaid or refuse to serve any at all because that threatens their rate of return. Less obviously, some of the leading health conglomerates celebrated for their high quality and cost controls do the same. “When you dig down in all these great places like Mayo and the Cleveland Clinic, you see the same sort of thing,” McDermott said. “The Mayo doesn’t go out looking for Medicaid patients, and they don’t take just anyone who walks in the door.”
McDermott’s new legislation would break from the longstanding liberal assumption that the government must enact universal social programs that apply rules and benefits uniformly to all states at once. He figures that would allow the resistance to block single-payer for many years. So he wants to create a special deal for the limited number of states willing to uphold higher standards. State legislatures and governors can win approval to design and operate their own single-payer system, deciding how and where to spend the healthcare money the federal government already pumps into their state. (The Vermont Legislature has already approved, with the governor’s support, a move toward single-payer but can’t implement it until 2017, when it will need a federal waiver to do so.)
The congressman offered his hometown example, known as WWAMI—a five-state cooperative arrangement that includes Washington, Wyoming, Alaska, Montana and Idaho. The University of Washington has the only medical school in the Northwest border region, so the other states send their med students to Seattle and finance their education, in return for the students’ commitment to come home to serve rural communities. This mutual support has functioned for forty years, despite red-blue differences. McDermott believes those five states could do a better job than distant DC of deploying and operating a first-class healthcare system.
To liberals who cry heresy, McDermott invokes Robert La Follette’s famous dictum that the states should be our “laboratory for democracy,” the best place to experiment and develop new solutions to public problems. Conservatives ought to like McDermott’s proposal because it disperses power closer to local decision-making. Liberals can embrace his approach as a practical way to break the stalemate on healthcare and open the way for basic solutions.
The congressman from Seattle thinks it may take a few more years of chaotic conflict before people understand the opportunity. But state governments—even in the neo-Confederate Republican Party—may start clamoring for this new approach once they begin to see the results.
“There are places where this could work,” McDermott said, “and once people see it work in Oregon or Washington, or maybe Kentucky, the people in Tennessee are going to say, ‘Why the hell don’t we have that? Are we not as good as the people in Oregon?’ Then you’re going to get the governor of Tennessee to do an about-face.”
Though battling terminal illness, Tim Carpenter is still busy moving Congress left.
Tim Carpenter is the national director of Progressive Democrats of America (PDA). Founded in 2004 in the aftermath of Rep. Dennis Kucinich’s (D-Ohio) presidential run, the group works what it calls an “inside-outside” strategy—aimed at translating the activism of outside social movements into progressive legislation in Congress. PDA works closely with progressive advocacy groups and about a dozen activist members of the Congressional Progressive Caucus, aiming to push the 72-member voting block to take more aggressive stances on issues as diverse as the welfare state, healthcare, trade and foreign policy. This year, PDA has lobbied Congress and helped organize rallies against reductions in Social Security and pushed for a so-called Robin Hood tax on financial transactions.
A native of Southern California, Carpenter is a longtime activist with history in the grassroots campaigns against anti-nuclear power, the Catholic Worker movement and Democratic Socialists of America. When he is not on the road organizing, he lives with his family in western Massachusetts.
Do progressives in Congress have anything to learn from the Tea Party?
Progressives can learn a lot from the Tea Party in regards to the inside-outside strategy of holding elected officials accountable. The Congressional Progressive Caucus took a number of missteps and miscues leading up to the Affordable Care Act. We should never have abandoned the fight on single payer. We should have never opted for a public option. We divided our forces much too early. What we can learn from the Tea Baggers is to hold elected officials accountable and not give up—certainly not before we’re deep into a fight.
You have been working with the Progressive Caucus since the founding of PDA in 2004. How effective is the caucus?
The Progressive Caucus has been a landing point for progressive activists who are working inside the Democratic Party. If you’re working an inside-outside strategy, you have to have a base to come home to, and the Progressive Caucus has offered us that. In reality, of those 72 members, only about 10 are what we would call leaders within the Progressive Caucus. Our work as Progressive Democrats of America is to strengthen those who are leading. To have a place where we as progressives can come together and work is important. Over the course of the last year or two under the leadership of Rep. Keith Ellison (D-Minn.) and Raúl Grijalva (D-Ariz.), we’ve seen the more progressive wing of the caucus hold the line, particularly in regard to making sure that no missiles were tossed into Damascus.
Some critics of the Progressive Caucus suggest that it would be more effective to have a smaller, more aggressive caucus. What do you think?
I agree. I would rather be in a meeting with 10 people who want to make a difference, get out and lead than be in a room with 60 people who call themselves progressives. I would rather surround myself with those who are willing to roll up their sleeves and go out and risk defeat. An aggressive, focused, principled caucus that held the line on single payer would have served our movement much better through this fight over the Affordable Care Act.
Steve Cobble, a co-founder of PDA, makes this analogy of the horseshoe, saying there are issues in Congress where you can link the left of the Progressive Caucus with some Tea Party, libertarian-minded Republicans. Is that an effective strategy?
We have political opportunities in this Congress, whether it’s the horseshoe analogy or in bed with strange bedfellows—whatever you want to term it. There are libertarians and Tea Baggers out there who agree with us that it’s unconscionable to spend the resources we do on the military budget. And we find agreement on not going into Syria. So if you can find the votes and if you can put together a majority to prevent our president from taking us into an unnecessary, illegal war, you’re going to take those votes wherever you can get them.
What kind of small victories are achievable in this political landscape?
I’m a glass-half-full person, so it’s not that difficult for me to find those little victories, beginning with the food stamp program. We began that fight when the Democratic Party leadership was absolutely silent. We had a phone call with Rep. Jim McGovern (D-Mass.) when PDA activists were delivering letters every month to their members of Congress in defense of food stamps. McGovern told us the Democratic Party leadership was silent on this question and that it was important that we simply have a vote of conscience to save the food stamp program. By the time it went on to the floor, we thought we had 133 votes but ended up with 188 votes [out of a possible 218 needed to win]. That was a victory. A vote of conscience in which 188 folks stood up to save food stamps. At the same time as we were garnering those votes, we were doing street actions in front of the offices of the Democratic leadership, Chief Deputy Minority Whip Debbie Wasserman Schultz (Fla.), Minority Whip Rep. Ste- ny Hoyer (Md.) and Minority Leader Nancy Pelosi (Calif.). By the time the Farm Bill came back around again then for a vote, all of those members in the leadership were on the floor voting to kill that bill.
An example of a major victory would be Syria. Again, our Democratic leadership was silent. Our president was willing to risk another war. And again activists around the country, led by Rep. Barbara Lee (D-Calif.), pushed Congress not to use military force but to begin a course of diplomacy.
What do you say to the critics on the Left who would claim that the PDA mission is ultimately hopeless, that the Democratic Party is not going to be reformed, and that if you really want to build progressive political power, it necessarily has to take place outside of that framework?
We live in a two-party system. Until we change the political realities of our two-party system, whether it be until we can get real public financing or until we can get real proportional representation, the playing field will be skewed. Before we have a third party, we need a strong second party. We’re the insurgency inside the Democratic Party fighting to return it to its progressive roots. We are hopeful that, through the work we do, we can begin to engage on the inside with those who are now on the outside and encourage them to do what they can to level the playing field.
A lot of PDA folks were part of Dennis Kucinich’s 2004 campaign for president. How important do you think it is in 2016 to have a progressive presidential candidate?
That’s a big debate. We need to be realistic. We are not going to elect a progressive president in 2016, just as we weren’t going to elect a progressive president in 2004, though Kucinich certainly didn’t want to hear it at the time. But if we’re going to transform the Democratic Party it’s important that we put in place a vision of what the Democratic Party can look like under a progressive presidency. So for that reason alone we need to have a horse in the race in 2016 who will challenge Hillary Clinton, the presumptive nominee. We need to re- mind folks that Hillary was wrong on the war in Iraq and she was wrong on trade. There are a lot of issues that as progressive Democrats we would want to challenge her on.
The Democratic Party, at its roots, is a progressive party. So my hope is that we would have a candidate who will be the standard-bearer for the progressive Democrats. I see the tide turning. It’s imperative that the progressive movement run a strong, articulate progressive candidate and campaign in 2016.
Given that you are waging an uphill battle against cancer, have you been preparing for what’s going to happen with PDA?
You’re definitely putting the elephant in the room in talking about the fact that I’ve got a terminal illness. It’s a question we’re wrestling with. The short answer is we honestly don’t know. We’re not a card-carrying organization; we’re a community of people. We’re going to meet in February as a community and we’ll talk about it. The work’s going to continue and I hope to be as productive, or even more productive, as we move on to the 2014 election season.
Arts Happening Presents: Mercy Killers
Mercy Killers is a one-man play by Michael Milligan. Joe loves apple pie, Rush Limbaugh, the 4th of July and his wife, Jane. He is blue-collar, corn-fed, made in the USA and proud, but when his uninsured wife is diagnosed with cancer, his patriotic feelings and passion for the ethos of life, liberty and the pursuit of happiness are turned upside down.
Video by Lehman Film Productions — lehmannfilms.com
Performed at Engine Co. 212, future home of the Northside Town Hall — northsidetownhall.org
The nominees are…
UnitedHealth for paying its CEO, Stephen Hemsley, $49 million last year.
Moda Health for paying $40 million for naming rights to the Portland Trailblazers arena.
Anthem Blue Cross for predatory premium increases even while announcing $2.7 billion in net profits.
And last but not least, Humana for charging women over 50% more than men for the same insurance plan.
We will be accepting votes until Tuesday, December 31st.
After that, we will announce the winner and a group of single-payer activists will present the award to the lucky winner.
Doing terrible things is business as usual for all health insurance companies in our healthcare system, we know. That’s why Healthcare-NOW!’s mission is to win expanded and improved Medicare for all–a healthcare system that’s completely free of for-profit health insurers.
This is a joint campaign with Roots Action.
Lost amidst the well-chronicled travails of the Affordable Care Act rollout are the long term effects of people struggling to get the health coverage they need without going bankrupt.
If that sounds familiar, it’s because that’s been the main story line of the US healthcare system for several decades. Sadly, little has changed.
Still, with all the ACA’s highly publicized snafus, and less discussed systemic flaws, there’s no reason to welcome the cynical efforts to repeal or defund the law by politicians whose only alternative is more of the same callous, existing market-based healthcare system.
US nurses oppose the rollback and appreciate that several million Americans who are now uninsured may finally get coverage, principally through the expansion of Medicaid, or access to private insurance they’ve been denied because of their prior health status.
At the same time, nurses will never stop campaigning for a fundamental transformation to a more humane single-payer, expanded Medicare for all system not based on ability to pay and obeisance to the policy confines of insurance claims adjustors.
Website delays – the most unwelcome news for computer acolytes since the tech boom crashed – are not the biggest problem with the ACA, as will become increasingly apparent long after the signup headaches are a distant memory.
What prompted the ACA was a rapidly escalating healthcare nightmare, seen in 50 million uninsured, medical bills plunging millions into un-payable debt or bankruptcy, long delays in access to care, and record numbers skipping needed treatment due to cost.
The main culprit was our profit-focused system, with rising profiteering by a massive health care industry, and an increasing number of employers dropping coverage or just dumping more costs onto workers.
The ACA tackles some of the most egregious inequities: lack of access for many of the working poor who will now be eligible for Medicaid or subsidies to offset some of their costs for buying private insurance through the exchanges, a crackdown on several especially notorious insurance abuses, and encouragement of preventive care.
But the law actually further entrenches the insurance-based system through the requirement that uncovered individuals buy private insurance. It’s also chock full of loopholes.
Some consumers who have made it through the website labyrinth have found confusing choices among plans which vary widely in both premium and out of pocket costs even with the subsidies, a pass through of public funds to the private insurers.
The minimum benefits are also somewhat illusory. Insurance companies have decades of experience at gaming the system and warehouses full of experts to design ways to limit coverage options.
The ACA allows insurers to cherry pick healthier enrollees by the way benefit packages are designed, and as a Washington Post article noted on 21 November, consumers are discovering insurers are restricting their choice of doctors and excluding many top ranked hospitals from their approved “network”.
The wide disparity between the healthcare you need, what your policy will cover, and what the insurer will actually pay for remains.
Far less reported is what registered nurses increasingly see – financial incentives within the ACA for hospitals to prematurely push patients out of hospitals to cheaper, less regulated settings or back to their homes. It also encourages shifting more care delivery from nurses and doctors to robots and other technology that undermines individual patient care, and that may work no better than the dysfunctional ACA websites.
Is there an alternative? Most other developed nations have discovered it, a single-payer or national healthcare system.
Without the imperative of prioritizing profits over care, Medicare for all streamlines the administrative waste and complex insurance billing operations endemic to private insurance. That waste is a major reason why the US has more than double the per capita cost of healthcare of other developed nations, yet lower life expectancies than many.
Medicare for all eliminates the multi-tiered health plans that plague both the individual and group insurance markets that are tied to the girth of your wallet not your need for care. Class, gender, and racial disparities in access and quality of care vanish under Medicare for all.
It’s beyond time that we stop vilifying government and perpetuating a corporatized healthcare system that has abandoned so many. We can, with a system of Medicare for all, we can cut healthcare costs and promote a much more humane society.
Only a few miles separate the Baltimore neighborhoods of Roland Park and Upton Druid Heights. But residents of the two areas can measure the distance between them in years—twenty years, to be exact. That’s the difference in life expectancy between Roland Park, where people live to be 83 on average, and Upton Druid Heights, where they can expect to die at 63.
Underlying these gaps in life expectancy are vast economic disparities. Roland Park is an affluent neighborhood with an unemployment rate of 3.4 percent, and a median household income above $90,000. More than 17 percent of people in Upton Druid Heights are unemployed, and the median household income is just $13,388.
It’s no secret that this sort of economic inequality is increasing nationwide; the disparity between America’s richest and poorest is the widest it’s been since the Roaring Twenties. Less discussed are the gaps in life expectancy that have widened over the past twenty-five years between America’s counties, cities and neighborhoods. While the country as a whole has gotten richer and healthier, the poor have gotten poorer, the middle class has shrunk and Americans without high school diplomas have seen their life expectancy slide back to what it was in the 1950s. Economic inequalities manifest not in numbers, but in sick and dying bodies.
On Wednesday, Senator Bernie Sanders convened a hearing before the Primary Health and Aging subcommittee to examine the connections between material and physiological well-being, and the policy implications. With Congress fixed on historic reforms to the healthcare delivery system, the doctors and public health professionals who testified this morning made it clear that policies outside of the healthcare domain are equally vital for keeping people healthy—namely, those that target poverty and inequality.
“The lower people’s income, the earlier they die and the sicker they live,” testified Dr. Steven Woolf, who directs the Center on Society and Health at Virginia Commonwealth University. In America, people in the top 5 percent of the income gradient live about nine years longer than those in the bottom 10 percent. It isn’t just access to care that poor Americans lack: first, they are more likely to get sick. Poor Americans are at greater risk for virtually every major cause of death, including cancer, heart disease and diabetes. As Woolf put it, “Economic policy is not just economic policy—it’s health policy.”
Tracing health disparities back to their socioeconomic roots adds context to growing calls for pro-worker policies like raising the minimum wage and providing paid sick leave. Lisa Berkman, director of Harvard’s Center for Population and Development Studies, presented a range of evidence indicating that policies supporting men and women in the labor force—particularly low-wage and female workers—lead to better health for themselves and their families.
From the AP –
Democratic candidate for governor Donald Berwick is pushing Massachusetts to take a second look at creating a truly universal health care system.
The former top Obama administration health care official said Thursday that the state should “seriously explore the possibility of a single payer system in Massachusetts” – a system which would effectively guarantee health coverage for all residents.
Massachusetts currently has the highest percentage of insured residents, but the system relies on a patchwork of private and subsidized care and falls short of universal coverage.
Many liberal Democrats have long said the best way to fix the health care system is to essentially offer Medicare to everyone, arguing that it would provide more coverage and is less cumbersome.
Berwick formerly headed the federal Centers for Medicare and Medicaid Services.
By Ralph Nader –
Costly complexity is baked into Obamacare. No health insurance system is without problems but Canadian style single-payer full Medicare for all is simple, affordable, comprehensive and universal.
In the early 1960s, President Lyndon Johnson enrolled 20 million elderly Americans into Medicare in six months. There were no websites. They did it with index cards!
Below please find 21 Ways the Canadian Health Care System is Better than Obamacare.
Repeal Obamacare and replace it with the much more efficient single-payer, everybody in, nobody out, free choice of doctor and hospital.
In Canada, everyone is covered automatically at birth – everybody in, nobody out.
In the United States, under Obamacare, 31 million Americans will still be uninsured by 2023 and millions more will remain underinsured.
In Canada, the health system is designed to put people, not profits, first.
In the United States, Obamacare will do little to curb insurance industry profits and will actually enhance insurance industry profits.
In Canada, coverage is not tied to a job or dependent on your income – rich and poor are in the same system, the best guaranty of quality.
In the United States, under Obamacare, much still depends on your job or income. Lose your job or lose your income, and you might lose your existing health insurance or have to settle for lesser coverage.
In Canada, health care coverage stays with you for your entire life.
In the United States, under Obamacare, for tens of millions of Americans, health care coverage stays with you for as long as you can afford your share.
In Canada, you can freely choose your doctors and hospitals and keep them. There are no lists of “in-network” vendors and no extra hidden charges for going “out of network.”
In the United States, under Obamacare, the in-network list of places where you can get treated is shrinking – thus restricting freedom of choice – and if you want to go out of network, you pay for it.
In Canada, the health care system is funded by income, sales and corporate taxes that, combined, are much lower than what Americans pay in premiums.
In the United States, under Obamacare, for thousands of Americans, it’s pay or die – if you can’t pay, you die. That’s why many thousands will still die every year under Obamacare from lack of health insurance to get diagnosed and treated in time.
In Canada, there are no complex hospital or doctor bills. In fact, usually you don’t even see a bill.
In the United States, under Obamacare, hospital and doctor bills will still be terribly complex, making it impossible to discover the many costly overcharges.
In Canada, costs are controlled. Canada pays 10 percent of its GDP for its health care system, covering everyone.
In the United States, under Obamacare, costs continue to skyrocket. The U.S. currently pays 18 percent of its GDP and still doesn’t cover tens of millions of people.
In Canada, it is unheard of for anyone to go bankrupt due to health care costs.
In the United States, under Obamacare, health care driven bankruptcy will continue to plague Americans.
In Canada, simplicity leads to major savings in administrative costs and overhead.
In the United States, under Obamacare, complexity will lead to ratcheting up administrative costs and overhead.
In Canada, when you go to a doctor or hospital the first thing they ask you is: “What’s wrong?”
In the United States, the first thing they ask you is: “What kind of insurance do you have?”
In Canada, the government negotiates drug prices so they are more affordable.
In the United States, under Obamacare, Congress made it specifically illegal for the government to negotiate drug prices for volume purchases, so they remain unaffordable.
In Canada, the government health care funds are not profitably diverted to the top one percent.
In the United States, under Obamacare, health care funds will continue to flow to the top. In 2012, CEOs at six of the largest insurance companies in the U.S. received a total of $83.3 million in pay, plus benefits.
In Canada, there are no necessary co-pays or deductibles.
In the United States, under Obamacare, the deductibles and co-pays will continue to be unaffordable for many millions of Americans.
In Canada, the health care system contributes to social solidarity and national pride.
In the United States, Obamacare is divisive, with rich and poor in different systems and tens of millions left out or with sorely limited benefits.
In Canada, delays in health care are not due to the cost of insurance.
In the United States, under Obamacare, patients without health insurance or who are underinsured will continue to delay or forgo care and put their lives at risk.
In Canada, nobody dies due to lack of health insurance.
In the United States, under Obamacare, many thousands will continue to die every year due to lack of health insurance.
In Canada, an increasing majority supports their health care system, which costs half as much, per person, as in the United States. And in Canada, everyone is covered.
In the United States, a majority – many for different reasons – oppose Obamacare.
In Canada, the tax payments to fund the health care system are progressive – the lowest 20 percent pays 6 percent of income into the system while the highest 20 percent pays 8 percent.
In the United States, under Obamacare, the poor pay a larger share of their income for health care than the affluent.
In Canada, the administration of the system is simple. You get a health care card when you are born. And you swipe it when you go to a doctor or hospital. End of story.
In the United States, Obamacare’s 2,500 pages plus regulations (the Canadian Medicare Bill was 13 pages) is so complex that then Speaker of the House Nancy Pelosi said before passage “we have to pass the bill so that you can find out what is in it.”
In Canada, the majority of citizens love their health care system.
In the United States, the majority of citizens, physicians, and nurses prefer the Canadian type system – single-payer, free choice of doctor and hospital , everybody in, nobody out.
Rush Limbaugh’s take on the disastrous rollout of the Affordable Care Act could, ironically, warm the hearts of those at the other end of the political spectrum. He contends that President Obama knew all along that the Affordable Care Act would crash and burn, but pushed it through so that the conflagration would clear the way for single-payer health insurance.
The conspiracy charge sounds deranged, but problems with the new health insurance system may indeed revitalize demands for more substantive reforms, which many policy makers and voters set aside in the putative interests of political pragmatism. Whatever the advantages of a single-payer system such as that currently administered by Medicare, one view held, American voters were unlikely to get behind it.
Yet one of the greatest advantages of a single-payer system — its relatively low administrative costs — has been thrown into sharp relief by problems registering with the new health exchanges. Andwhile Republicans despise the Affordable Care Act despite its conformity with many of their earlier proposals, their proposed changes (other than simple rollback) look complicated, kludgy and costly to administer.
The malfunctioning website has magnified problems inherent in coordinating enrollment across many different companies in many different exchanges in cooperation with many different government agencies. The harmonization challenges are orders of magnitude greater than those faced by a single company or a single state, making streamlining difficult. Improved software can do only so much.
In theory, competition and choice should increase efficiency. In practice, health insurance companies are able to take advantage of the complexity and uncertainty surrounding health care choices to make comparison shopping very difficult.
Lack of clear information about the prices of medical procedures, combined with a proliferation of insurance options whose potential benefits will be strongly affected by unpredictable events (such as being involved in an automobile accident or developing cancer), put consumers in a weak position.
The process of negotiating relationships with new health care providers because old ones are “out of network” is physically and emotionally exhausting. Insurance companies benefit from promoting policies that are difficult to understand and make consumers fearful of any change in their coverage. That fear and aversion has spilled over into the transactions required for many people to benefit from the Affordable Care Act.
David Himmelstein and Steffie Woolhandler, co-founders of Physicians for a National Health Program, regularly assert that elimination of the huge paperwork and overhead imposed by private insurance companies could save enough to cover the estimated 31 million of Americans who will remain uninsured under the Affordable Care Act.
My fellow Economix blogger Uwe E. Reinhardt, expanding on this theme, notes that the Institute of Medicine of the National Academy of Sciences recently estimated excess administrative costs of $191 billion, again more than enough to attain truly universal health care coverage.
Most such estimates are limited to the monetary costs incurred by insurers, doctors and hospitals and don’t include the value of the time that health care consumers must devote to managing a torrent of inscrutable paperwork that can become truly frightening for the critically ill.
Even if its rollout becomes more expeditious, the Affordable Care Act does little to reduce the incentives that companies have to barricade themselves behind high information and transaction costs. In the financial sector, I previously noted, this perverse incentive is described as “strategic price complexity.”
A complicated new program applied to a complicated old industry makes it hard for everyone to figure out exactly what they will be getting relative to what they are paying. As a result, many ordinary people and small businesses fall prey to redistributional paranoia.
Accusations of ripoffs proliferate, along with assertions that the Affordable Care Act is unfair to young people or that it simply represents transfers from the affluent to the poor, or from whites to people of color.
The program clearly has redistributive impact, but much of it will be muted over the life cycle. People who pay more for their insurance will get more benefits in return. The biggest transfers will go from the healthy to the sick (who are sometimes poor precisely because they are sick) and from one part of the health care system (emergency room care) to another (insurance-covered routine care).
But the structure of the program seems unintentionally designed to intensify distributional conflict. Its highly means-tested subsidies create strong political resentments and contribute to very high implicit marginal tax rates on lower-income families.
A single-payer insurance system, whether based on an extension of Medicare or on the Canadian model, promises many profoundly important benefits. Right off the mark, it promises simplicity.
No wonder conservative pundits are afraid of it.
Healthcare-NOW! held its annual Strategy Conference this year on October 5 and 6 in Nashville, Tennessee at the beautiful Scarritt-Bennett Center near Vanderbilt University. Over 110 activists converged from more than 23 states to discuss organizing strategy, network, and share skill-building. The conference featured four plenary panels, fourteen workshops, and a keynote speech by Frances Fox Piven, the renowned sociologist and historian of social movements in the U.S.
The Conference kicked off with a workshop on “Southern States Strategy: Growing Together.” Margaret (“Peg”) Nosek, PhD of Healthcare for All Texas kicked this off with a presentation on the unique political history facing single-payer activists in the South, the importance to our movement of succeeding in southern states, and the demographic and political changes that are creating hope and new opportunities to succeed there. You can download the Powerpoint presentation with audio here (.pptx).
This was followed by a plenary of Tennessee organizers (video below) introducing attendees to the fascinating history of health reform in our host state, and looking at the Affordable Care Act through the lens of Tennesseans. Gordon Bonnyman of the Tennessee Justice Center and Tony Garr, formerly of the Tennessee Health Movement, described the rise and fall of TennCare, one of the first attempts by a state to use Medicaid waivers to expand health insurance to everyone in the early 1990s. TennCare was dismantled in 2005, dropping 170,000 residents from the rolls in one of the most catastrophic losses of access to care in the history of the country. Mary Bufwack, CEO at a series of community health centers in Nashville, reported that only about 10% of uninsured patients at her health centers were projected to receive coverage under the ACA, leaving the health centers to continue treating non-paying and low-payment patients. TN is one of many states not planning to expand its Medicaid program, and currently has extremely limited Medicaid eligibility. Dr. Art Sutherland, the coordinator of Tennessee Physicians for a National Health Program, reported on the inspiring organizing work he has accomplished in the state, setting up regional PNHP chapters in western, middle, and northeastern TN.
Saturday night closed with a block of workshops. A workshop on “Labor and Single Payer” brought together union activists and community members to compare notes across states, and discuss the unique impact the ACA is having on some unions. “Challenges and Solutions for State Single Payer Legislation” was a nuts-and-bolts workshop for groups working on state legislation to address legal hurdles and craft a viable implementation plan for state bills. A “Southern States Workshop” continued the discussion where the Tennessee plenary left off, and “The 100 x 100 Campaign” was a hands-on tutorial by New York activists about how they collected 10,000 signatures for single-payer reform in one year to grow their movement and advance state single-payer legislation.
Sunday morning kicked off with a plenary of Physicians for a National Health Program speakers (video below) on “The ACA: Challenges and Opportunities for the Single-Payer Movement,” including Dr. Jim Powers of Middle Tennessee PNHP, Dr. Art Sutherland of Tennessee PNHP, and Dr. Garrett Adams of Kentucky PNHP, who gave an outline of what the ACA does and does not accomplish, and how to message for single-payer during implementation. Emily Henkels, National Coordinator for PNHP, organized an exercise for attendees to identify the strengths and skills they bring to the single-payer movement, and think about the underutilized resources at our disposal collectively going into the organizing workshops.
The second block of workshops included “Winning National Single Payer: State Checker Board Strategy,” organized by the One Payer States network, discussed the strategy of achieving national reform by capitalizing on state legislation first where opportunities arise. States are pursuing a diversity of organizing strategies, including legislation and ballot initiatives. “Connecting the Dots for Healthcare Justice” discussed the importance of single-payer activists and organizations connecting up with broader social movements, and the close early relationship between the Civil Rights movement and the movement for public, universal health care. “Building the Movement by Organizing Around HR 676” discussed how to use John Conyers’s “Improved and Expanded Medicare for All” legislation to show the benefits of single-payer reform over the ACA model, and how to use HR676 endorsements to educate new groups and mobilize them for legislative co-sponsorship. Lastly, “Real World Online Organizing” was a skills workshop about how to use email and social media effectively by connecting online with offline actions, establishing a consistent communications schedule, and how HCN can help out local groups.
Frances Fox Piven delivered a keynote address (video below) that put the single-payer movement in the broader context of sweeping changes to the political landscape in the United States. She discussed how American politics on the heels of the New Deal appeared to be rapidly moving towards joining European nations in the guarantee of basic economic rights, including national health insurance. Today, what minimal protections were established for the poor earlier in the century are threatened in ways unthinkable thirty years ago, in a “cloud of wild propaganda” from the base and the top of the right wing. Piven made the case that the current politics in the U.S. resemble that of the 1840s and ‘50s, when the abolitionist movement led to the fracturing of existing political parties, giving rise to new political configurations and the Civil War. Today, growing inequality of wealth has become incompatible with democracy, leading to growing conflict and the appearance of “crazy” politics in the U.S. We see the tension it is creating within the existing political parties today, and the coming turbulence will create new openings for social movements oriented towards equity like single-payer.
The last workshop block brought a discussion of “Winning Congressional Support for Single Payer in the Obamacare Era” organized by Progressive Democrats of America, which focused on PDA’s ‘inside-outside’ strategy, working with the Progressive Caucus within Congress and social movement organizations to apply pressure from the outside. “Answering Questions About HR676” allowed participants to hone their ability to effectively and concisely answer the toughest arguments single-payer advocates commonly face. A workshop from the “Divestment Campaign for Healthcare” talked about the movement to divest investor dollars from for-profit insurers. The workshop focused on the importance of providing a watchdog function as insurers attempt to evade the ACA, and to do more college campus organizing. Finally, “Exploring Our Direct Action Potential” tried to get participants beyond messaging and policy talk, to figure out how the single-payer movement can exercise real social power by identifying its core constituencies and leveraging their power through action rooted in our lived experience.
From Bloomberg Businessweek –
Life expectancy in the U.S. has been growing more slowly than in other developed countries and is now more than a year below the developed-country average, according to a new report (PDF) from the Organisation for Economic Co-operation and Development.
Even though Americans, on average, live to be almost 80, this is not good news. Life expectancy at birth is affected by trends in everything from infant mortality, accident rates, and violence to chronic diseases and care for the elderly, which makes it a highly sensitive indicator of a nation’s economic development.
U.S. life expectancy in 2011 was 78.7 years. That was an increase of a little less than eight years since 1970. Impressive, but not as big as the 10-year gain for the OECD as a whole. “Life expectancy [in the U.S.] is now more than a year below the OECD average of 80.1,” the OECD said in a press statement, “compared to one year above the average in 1970.”
Why has the U.S. fallen off pace? The OECD report sums up some American studies by the National Research Council and the Institute of Medicine that suggest some causes. None of the theories reflect well on the U.S.:
1. The highly fragmented nature of the U.S. health system, with relatively few resources devoted to public health and primary care, and a large share of the population uninsured;
2. Health-related behaviors, including higher calorie consumption per capita and obesity rates, higher consumption of prescription and illegal drugs, higher deaths from road traffic accidents and higher homicide rates;
3. Adverse socioeconomic conditions affecting a large segment of the U.S. population, with higher rates of poverty and income inequality than in most other OECD countries.