September 1, 2010
By Don McCanne
Speaker John Perez of the California State Assembly, on the very last day of the legislative session, pulled SB 810, the single payer bill, from the Assembly floor.
This highly unusual move of pulling a bill that had cleared all legislative hurdles except for the final Assembly floor vote was to protect Democrats from having to cast a health care reform vote in a difficult political environment three months before the next election.
Democrats feared a backlash from those who are opposed to the recently enacted federal health care legislation should they vote for the bill, and they feared offending their progressive base should they vote against the bill. Since a veto by Gov. Schwarzenegger was a given, it was decided that it would be safer to avoid the political risks by simply pulling the bill.
But did they really avoid that risk? Are the single payer advocates expendable? Don't think so.
Fortunately, Senator Mark Leno is not to be deterred. He has vowed to reintroduce the bill in the next legislative session which begins in January.
The Democrats are worried about their political base, but maybe that's not the framing we should be looking at. Perhaps the single payer advocates should be reassessing their own base instead.
Not all Democrats have been supportive of single payer, and several Republicans who are not part of the prevailing lock-step bloc do understand the benefits of the single payer model. The Patient Protection and Affordable Care Act is proof that we can't rely on the Democrats to do the right thing. Most importantly, everyone understands the benefits of Medicare as a social insurance program (even if there is a fringe reactionary element that would emasculate it).
The Tea Party is proving that passionate voices can be heard. Maybe we can learn from them, though our message should contain more than simple platitudes. Our message needs to convey the principled substance of health care justice, and it needs to be loud, clear and highly infectious.
"You can always tell if you're succeeding by the viciousness of the opposition." — Dr. Quentin Young, PNHP National Coordinator
By Nicholas Skala. Updated by Chris Gray, July, 2010
As the movement for single payer expands, attacks on single payer in the media by the far right have increased. In addition to misleading articles and op-eds, several books attacking single payer by conservative pundits were published in recent years, including one endorsed by former GOP Speaker of the House Newt Gingrich.
The PNHP National Office has identified 20 right-wing think tanks that employ full-time health policy "scholars" to oppose national health insurance and advocate for health care privatization, deregulation and market-based reforms. These groups are funded with millions of dollars from wealthy far-right foundations such as the Lynde & Harry Bradley Foundation, the Charles Koch Foundation, the John Olin Foundation, the Adolph Coors family’s Castle Rock Foundation and the Scaife Family Foundations, which share an ultra-conservative social agenda.
The Right-Wing "Echo Chamber": Although they masquerade as legitimate research institutions, most of these policy think tanks are little more than PR firms for those who want to obscure the facts about health care in America. Many, such as the Fraser Institute, produce bogus research and purposely avoid peer review. Instead, they provide "experts" with fancy titles to write editorials and appear on TV news programs to spread misinformation. Each of these institutions is funded by the same small group of ideological foundations, and it is extremely common for these "experts" to cite each other's bogus research in their commentaries, giving the impression of wide scientific credibility for their views. Twenty of the top "think" tanks are detailed below. Members are encouraged to take the lead on behalf of PNHP in responding to misinformation spread by these and other groups.
Thursday, September 30, 2010 9:54 AM EDT
You load sixteen tons, what do you get?
Another day older and deeper in debt.
Saint Peter, don’t you call me ’cause I can’t go
I owe my soul to the company store
Senate Republicans last week protected the Company Store again by blocking the DISCLOSE ( Democracy Is Served by Casting Light on Spending in Elections) act for the second time. The DISCLOSE act would have required corporate CEO’s to appear on the television attack ads they bought. We have no way of knowing till months after the fact, and then only if we are relentless in seeking the information, what corporation sponsored the mendacious propaganda on our screen. The Bush appointed Roberts/Alito Supreme Court damaged free and fair elections this January by ruling that corporations ( aka the Company Store) have the right to dump unlimited, unidentifiable cesspools of bucks directly into any election they choose. We perhaps should require that candidates dress like NASCAR drivers, with the corporations that bought them printed in large letters all over their jumpsuit.
Want to run for office in West Virginia on a platform requiring compliance with mine safety? You lose. CEO Don Blankenship of Massey Energy, owner of the mine that killed 29 miners this past May after hundreds of safety violations, can buy up all the air time, newsprint space with gazillions of profits made from endangering his workers. No one will hear you. Used to be government was the referee, us looking out for each other. Decades of social legislation from 1900 on had made for a large, stable middle class. Since the Reagan revolution, the Company owns the referee. The anger of the Tea Party is understandable, but they have it wrong, it isn’t the government that is hurting us, in fact taxes are lower than they have been in 60 years. It is the unregulated corporation that crashed Wall Street, took your job and home, profits from your healthcare and owns the store.
Before the Citizens United Supreme Court ruling Cincinnati billionaire and principal shareholder of American Financial Group Carl Lindner could contribute only a maximum of $4,800 to Republican Senate candidate Rob Portman. On August 2nd American Financial Group donated 83 times that amount, $400,000 to American Crossroads. In mid-August American Crossroads spent $454,000 on a statewide television ad backing Portman. American Crossroads was founded by former Bush operative Karl Rove as one of hundreds of front groups taking in billions of corporate dollars for Company Store friendly candidates. American Crossroads’ take in August alone was $2.6 million, $7.9 million from January up to August. $2 million of the August booty for American Crossroads came from two Texas businessmen.
“This is perhaps the best example to date of a big dollar impact in Ohio stemming from the high court’s Citizens United campaign finance decision..” (quotation, figures from “Court ruling boon to Ohio campaign”, Columbus Dispatch 22 September 2010 p. B1). Democratic Party Senate candidate Lee Fisher notes “This is an election, not an auction. Our democracy is about one person one vote… and should not be subverted by corporate spending without transparency.” Ohio Democratic Senator Sherrod Brown adds “It’s especially essential that the public knows who these people are giving this money.” Brown further noted that many outside groups, including an arm of American Crossroads aren’t required to ever disclose their donors. (“Brown: TV ad donors should be revealed” Columbus Dispatch 23 September 2010 p. A8)
A new Associated Press poll found that Americans who think the Patient Protection and Affordable Care Act of 2010 (PPACA) does not do enough to make healthcare more available outnumber 2:1 those who oppose the law believing that government should not be involved in healthcare. Four out of ten Americans believe the new law does not go far enough, one in five oppose the PPACA citing opposition to government involvement. (Washington Post 26 September 2010) One would think the nation was overrun with Tea Partiers screaming and packing firearms to health reform town halls based on FOX news reports. The fact is, Americans wanting further reaching reform outnumbered those fearing government two to one.
How then did we end up the health insurance industry/pharmaceutical company friendly PPACA? Part of the answer is Rick Scott, former CEO of Columbia/Hospital Corporation of America who was forced to resign after his company was fined $1.7 billion for fraud, kickbacks and understaffing of hospitals to cut costs. Scott founded “Conservatives for Patient’s Rights” to fight healthcare reform. Scott’s group spent $20 million, just a fraction of the $1 million industry spent every day of 2009 to insure Company Store friendly reform. (Geyman, J., MD; Hijacked; The Road to Single Payer in the Aftermath of Stolen Health Care Reform, p.79) As former CEO of a criminal healthcare corporation, I question Scott’s concern for patient rights.
This November, before you vote, consider that much of what you see and hear about candidates was financed by the Company Store. Consider which candidate and which political party has consistently stood up for the middle and working class.
Dr. Cotton is a member of Physicians for a National Health Program while working full-time in the emergency department, one of the few places in America that treats everyone based solely on need.
By: Sarah Kliff
Sens. Scott Brown (R-Mass.) and Ron Wyden (D-Ore.) will introduce legislation Thursday allowing states to opt out of the controversial individual-mandate requirement of the health care reform law far sooner than they would under the law passed by Democrats earlier this year.
Tuesday, December 14, 2010
By Josh Goodman, Stateline Staff Writer
Congress never really considered a single-payer health plan run by the government. Vermont is planning for one. This isn’t some liberal fantasy. Vermont lawmakers are serious. To understand how serious, you only have to look at the resumes of William Hsiao and Jonathan Gruber.
Hsiao, a Harvard economist, is credited with designing Taiwan’s single-payer system. Gruber, an M.I.T. economist, helped design Massachusetts’ near-universal health care system and the federal health care reform law itself. They’re on the team that the Vermont legislature contracted with this year to explain how single-payer would work there. In other words, the nation’s 49th most populous state is deploying some of the world’s leading experts to redesign its health care system. Their report is due early next year, after which Vermont will decide whether to become America’s first single-payer state.
If Vermont decides on that course of action, the experiment will serve as a test of whether more aggressive government intervention can improve health care and reduce costs. Long before the results of that experiment would be known, Vermont’s project could serve as a test of something that even the state’s conservative counterparts elsewhere are interested in finding out: just how much power states have over their own health care systems.
Vermont is perhaps an unlikely place to try something dramatically new in health care. That’s because by most standards, Vermont’s health care system already is one of the nation’s best. The United Health Foundation has ranked Vermont the healthiest state in the country four years in a row. Fewer than 10 percent of Vermonters lack health insurance, one of the lowest rates in the country.
If the state’s only concern were getting insurance to the comparatively few people who lack it, Vermont could sit back and wait for the new federal law, with its promise of near-universal coverage, to kick in. But expanded access is only part of what the state wants — and it isn’t the part that officials tend to mention first.
“For Vermont, it’s all about containing costs,” Peter Shumlin, the governor-elect, told Stateline. He points out that the annual cost of health care in Vermont — for individuals, businesses and government — has doubled to roughly $5 billion a year over the past 8 years. “It’s killing small businesses,” Shumlin says, “kicking the middle class in the teeth.”
Vermont’s problems paying for health care aren’t much different than the problems other states face. What makes Vermont different is that many of its top officials believe the solution is to have only one entity providing health insurance. In their boldest schemes, they’re hoping to drive private health insurance providers out of existence and to free employers from the responsibility of providing health insurance to their employees.
That includes Shumlin, who led the state Senate when it approved the legislation approving the study that Hsiao is leading. The five-way Democratic primary for governor had other single-payer supporters, but none was more forceful than Shumlin. He won the primary by 203 votes, then won the general election by 2 percent.
Providing health insurance to everyone is, of course, a very costly endeavor. But Shumlin and many of the Democrats who run the legislature think single-payer can save money in a couple of ways. For one, they note that hospitals and doctors’ offices spend a lot of money filling out paperwork and coding claims for insurers. These administrative costs aren’t especially high in Vermont compared to many other states, but supporters of the single-payer plan believe that if health care providers could deal with one insurer, they’d be able to focus more on providing care and less on processing claims.
Supporters also see single-payer as an antidote to the fragmentation of Vermont’s health care system. For example, state Representative Mark Larson, who’s expected to chair the House Health Committee next year, laments that his local hospital, Fletcher Allen Health Care in Burlington, is planning to sell off its outpatient dialysis units.
Fletcher Allen made the move because it was losing money on dialysis. The reimbursements it was receiving from all of Vermont’s various public and private health insurance providers weren’t enough to pay for the costs. In the current system, even if it were clear that the cheapest and best way to care for dialysis patients was for Fletcher Allen to own the units, the state’s power to do anything is limited. The structure of health care is subject to the vagaries of Medicare and private insurers, not coherent planning.
Under single-payer, that would change. “It’s very hard to direct a strategy for accomplishing long-term savings in health care — to manage care better, to minimize unnecessary procedures, to invest in strategies that have demonstrated savings in quality and cost — without some system of financing and payments to direct those efforts,” Larson says.
There remains one huge question: Can wholesale reform work in a single small state? State Representative George Till, a member of the legislature’s Health Care Reform Commission, is skeptical of single-payer.
Till points out all the different entities that provide health insurance to Vermont patients. There are the state’s private insurers. There’s the state itself, through Medicaid and through its coverage of state employees. There’s the federal government, separately through Medicare and the Veterans Health Administration. There are some larger companies, such as IBM, that self-insure. And there are many people whose health insurance isn’t even based in Vermont. “At the hospital that I work for, we deal with 14 different insurers from New York,” says Till, who is a doctor.
Due to those complications, what Vermont is trying to do is, at its heart, a test of the power of state government. Can a state wrest total control of health insurance from the federal government and private companies?
The simple answer is that it can’t without federal permission. Companies that insure their own employees at their own expense are exempted from state health care regulation under the federal Employee Retirement Income Security Act, known as ERISA. Medicare and the VA, of course, fall under federal purview. The new federal health care law forbids states from receiving waivers from its provisions until 2017, although some senators are working to change that date to 2014, when the law’s most consequential provisions kick in.
If those efforts succeed, states would gain a lot more freedom to do what they please. For now, though, the definition of single-payer is in doubt, even among the people who are designing Vermont’s programs. “The last thing we want to do is create the perfect policy that can’t be implemented,” says Steven Kappel, a Vermont-based health care researcher who is part of the Hsiao-Gruber team.
The question is whether single-payer without Medicare patients or without VA patients or any other piece of the pie would really be single-payer at all — and whether leaving a piece out would undermine the advantages of the change that Vermont expects. The researchers are charged with developing other plans beyond single-payer: One is a government plan open to all Vermonters with conventional private insurance as an alternative. Despite Shumlin’s commitment to single-payer, it’s possible another option might look more appealing in the end.
Chance to lead
For now, though, those obstacles haven’t compromised the incoming governor’s commitment to the single-payer concept. In fact, he doesn’t think he has much of a choice.
Shumlin’s view is that health care interests are powerful enough in Washington that aggressive cost containment isn’t really possible there. “I believe that the states will have to lead true, meaningful health care reform,” he says. “We have a real opportunity to lead the country in health care if we have the courage.” But Shumlin and others also argue that, despite some of the difficulties, Vermont is the perfect place to try.
The biggest advantage Vermont has is the political environment in the state. Blue Cross Blue Shield Vermont, the state’s largest private insurer, has stayed neutral on single-payer. “We don’t think it’s our role,” says Kevin Goddard, the company’s vice president of external affairs. Even the state chamber of commerce, while somewhat dubious of the concept in its purest form, isn’t actively opposed yet.
What everyone agrees upon is that some very smart people are thinking about the best way to structure Vermont’s health insurance system. The initial report is due next month. Even critic Till says, “I think people will listen very carefully to what Dr. Hsiao comes back with.”
— Contact Josh Goodman at firstname.lastname@example.org
Irony on the Ides of March:
The Problem and Solution Share the 31st Floor
By Mary Nichols-Rhodes
By 8am on Tuesday, 3/15, SPAN Activists Alice Faryna, Arlene Sheak, Bob Krazen, Connie Hammond, Dick Bozian, Don Rucknagel, John Ross, Kurt Bateman, Debbie Silverstein, and I were trickling in to the Riffe Building in Columbus to set up shop on the 31st Floor, Conference Room South A for a full day of citizen lobby visits and a program about the Health Care For All Ohioans Act prepared for legislators and their staff.
I was oriented to the 31st Floor by the Riffe Building Manager -- location of the restrooms down the hall, large kitchen around the corner -- and advised that around noon, much of the 31st floor would be restricted to public access and we could not pass barriers marked as such. Mysterious and curious since the Governor was planning to release the Budget on 3/15 at an undisclosed location.
We set up the room in preparation for the afternoon Teach In and after a brief overview and planning for our scheduled meetings, teams of SPAN members fanned out in Riffe Center and to the Capitol Building for SPAN citizen lobby visits over several hours, at the offices of State Senators Brown, Hughes, Kearney, Stewart, Sawyer, Schiavoni, and Wilson, and State Representatives Carney, Celeste, Clyde, Driehaus, Fende, McGregor, and Pillich.
Region 6 Coordinator Debbie Silverstein has compiled an amazing book of information about the Health Care For All Ohioans Act addressing it's positive impact on business and the economy, related supportive articles, a list of SPAN endorsers, and hard-data tables that specifically note what Ohio schools and counties are spending on health insurance and the millions of dollars that would be saved by each under a single payer plan. This union printed and professionally bound book was explained and presented to each of the legislative offices visited.
SPAN teams returned to South A to eat lunch and discuss results/reactions to the HCFAO Act at their lobby meetings. There was tremendous positive feedback and appreciation for the data listed in the Lobby Book, though many said that the reality is, they likely wouldn't co-sponsor the HCFAO Act but if it came up for a vote, they would vote yes.
However, in previous sessions when Democrats held the majority and were Committee Chairs, the HCFAO Act was not given sufficient hearings and proponent testimony. Therefore the likelihood of this bill being acted upon in the current political anti-people climate is nil. As Senator Skindell told us recently, the winds of change will not come from inside the legislature, it must come from those of us on the outside, applying pressure and making the case that this is what the people demand.
As 1pm approached, participants from several legislator's offices arrived, yet there were many suspiciously missing, including Kurt Bateman. When he and others arrived later, we learned that the Security on the 31st Floor had intensified to the point that elevators full of people, including Representatives Foley, Yuko, and Heard, were intercepted on the 30th Floor and told to disembark; people were being restricted from the 31st Floor. They were eventually escorted by State Troopers through redirected freight elevator routes and brought to the 31st Floor.
Yes indeed, Governor Kasich was on the 31st Floor in another conference room presenting Ohio's Budget and security was tight. Dozens of protesters had already found their way on to the floor and were gathered around the elevators chanting, "Kill the bill."
Inside South A, I welcomed the 30 or so attendees and the SPAN program began with a skit based on an article written by Dr. James Fieseher of New Hampshire called, "Why for Profit Health Care Makes No Sense." John Ross played a man calling 911 to report that his house is being burglarized and Deb Silverstein was the operator who
blocked his access to the help he needed by asking for his insurance number, being told he gave last year's policy number, that his insurance plan does not cover the crime being committed, that the quality of the help that would be sent would depend on the co-pay he was willing to pay, was questioned why he didn't purchase better or supplemental insurance to increase his coverage, and that it would take quite a long time for someone to respond since the police dept. close to his home was "out of network," while his wife, played by me, was being assaulted, which was "good news" for the caller according to the operator, since assault was covered on his policy. It was a very effective was to expose the absurdity of our current health care industry.
Dr. Ross presented an informative and interesting power point about single payer and Deb followed with a power point showing how the whole economy suffers from one industry receiving so much of the money since it can't be spent elsewhere and noted the more than $1 billion that would be saved just by Ohio schools. Both were excellent. Kurt then gave closing remarks and some good discussions and networking followed.
How interesting that on the foreboding day of March 15th, a Budget that will cut funding from education and people's needs was released by the governor using budget shortfall as a reason, and at the same time just doors away, the Health Care For All Ohioans which would save the state at least as much money as the shortfall, stimulate the economy, create jobs, and provide comprehensive quality health care to every Ohioan was being presented. The problem and solution were sharing the 31st Floor on Tuesday. But access was limited. We must share the solution until we are heard.
21 April 11
Earlier this week, The Times reported on Congressional backlash against the Independent Payment Advisory Board, a key part of efforts to rein in health care costs. This backlash was predictable; it is also profoundly irresponsible, as I'll explain in a minute.
But something else struck me as I looked at Republican arguments against the board, which hinge on the notion that what we really need to do, as the House budget proposal put it, is to "make government health care programs more responsive to consumer choice."
Here's my question: How did it become normal, or for that matter even acceptable, to refer to medical patients as "consumers"? The relationship between patient and doctor used to be considered something special, almost sacred. Now politicians and supposed reformers talk about the act of receiving care as if it were no different from a commercial transaction, like buying a car - and their only complaint is that it isn't commercial enough.
What has gone wrong with us?
About that advisory board: We have to do something about health care costs, which means that we have to find a way to start saying no. In particular, given continuing medical innovation, we can’t maintain a system in which Medicare essentially pays for anything a doctor recommends. And that’s especially true when that blank-check approach is combined with a system that gives doctors and hospitals — who aren’t saints — a strong financial incentive to engage in excessive care.
Hence the advisory board, whose creation was mandated by last year’s health reform. The board, composed of health-care experts, would be given a target rate of growth in Medicare spending. To keep spending at or below this target, the board would submit “fast-track” recommendations for cost control that would go into effect automatically unless overruled by Congress.
Before you start yelling about “rationing” and “death panels,” bear in mind that we’re not talking about limits on what health care you’re allowed to buy with your own (or your insurance company’s) money. We’re talking only about what will be paid for with taxpayers’ money. And the last time I looked at it, the Declaration of Independence didn’t declare that we had the right to life, liberty, and the all-expenses-paid pursuit of happiness.
And the point is that choices must be made; one way or another, government spending on health care must be limited.
Now, what House Republicans propose is that the government simply push the problem of rising health care costs on to seniors; that is, that we replace Medicare with vouchers that can be applied to private insurance, and that we count on seniors and insurance companies to work it out somehow. This, they claim, would be superior to expert review because it would open health care to the wonders of “consumer choice.”
What’s wrong with this idea (aside from the grossly inadequate value of the proposed vouchers)? One answer is that it wouldn’t work. “Consumer-based” medicine has been a bust everywhere it has been tried. To take the most directly relevant example, Medicare Advantage, which was originally called Medicare + Choice, was supposed to save money; it ended up costing substantially more than traditional Medicare. America has the most “consumer-driven” health care system in the advanced world. It also has by far the highest costs yet provides a quality of care no better than far cheaper systems in other countries.
But the fact that Republicans are demanding that we literally stake our health, even our lives, on an already failed approach is only part of what’s wrong here. As I said earlier, there’s something terribly wrong with the whole notion of patients as “consumers” and health care as simply a financial transaction.
Medical care, after all, is an area in which crucial decisions — life and death decisions — must be made. Yet making such decisions intelligently requires a vast amount of specialized knowledge. Furthermore, those decisions often must be made under conditions in which the patient is incapacitated, under severe stress, or needs action immediately, with no time for discussion, let alone comparison shopping.
That’s why we have medical ethics. That’s why doctors have traditionally both been viewed as something special and been expected to behave according to higher standards than the average professional. There’s a reason we have TV series about heroic doctors, while we don’t have TV series about heroic middle managers.
The idea that all this can be reduced to money — that doctors are just “providers” selling services to health care “consumers” — is, well, sickening. And the prevalence of this kind of language is a sign that something has gone very wrong not just with this discussion, but with our society’s values.