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.
On March 10, 2011 Ohio State Senator Michael Skindell filed SB112 which establishes the Ohio Health Care Plan.
Call Congress and Ohio Legislators to restore funding:
Ohio ADAP (Aids Drug Assistance Program)
Joint federal/state funding just like Medicaid
People rely on this program due to economic strain from job loss and loss of insurance.
July 4 2010, budget reductions put a freeze on new enrollees, and changed income requirements which dropped 300+ people from the program.
Patients on these medications are less likely to infect others.
We care about others and this strengthens our community.
Stopping these treatments causes a viral rebound, and the virus that arises after treatment is stopped, is resistant to the medication.
Assistance for these medications can save lives and supports the freedom for patients to lead a productive and fulfilling life.
This month show some love and call on political leaders to empathize with patients who are struggling to stay healthy.
US Congress switchboard: (202) 224-3121 Ask for your Senator or Representative’s office.
Reach Ohio Senators at: www.ohiosenate.gov
Vermont moves closer to enacting Single Payer system
Less than one month after receiving the final system designs from Dr William Hsiao, Vermont Governor Peter Shumlin unveiled his proposal for moving Vermont to a single payer type universal access health care system in presentations to the Vermont legislature Feb 8th and 9th.
All the groups supporting single payer in Vermont are coalescing around Governor Shumlin’s proposal. It starts by developing an exchange under the PPACA then establishes funding and delivery criteria to morph into a single payer system by 2014. Federal waivers are required to accomplish this proposal so it’s important all state-based organizations support waiver amendments to the PPACA. Click the "News & Opinion" tab at SPANOhio.org for a screen shot picture of Vermont’s health reform timeline.
SPAN Ohio’s 8th Annual State Conference set for April 16th
Join fellow advocates from across Ohio at the 8th annual SPAN Conference. Speakers include Donna Smith of CNA/NNU (National Nurses United). Donna, a journalist by trade, came to national attention when her medical bankruptcy was exposed in the movie “SICKO”. She works today helping organize nurses and advocates a humane and sustainable single payer system for America. Also speaking is David Steil, newly elected President of healthcare4allPA. A former PA legislator David served sixteen years in the PA assembly as a Republican. Mr. Steil also is owner and president of a manufacturing concern in PA. His focus: the business perspective on healthcare reform. All attendees will have the choice of attending workshops after a provided luncheon and will receive gift bags including SPAN pen, notepad and a copy of “Hijacked” by Dr John Geyman. Brochures will be in the mail next week or register online at spanohio.org.
Kurt Bateman, Director
As we celebrate the life and accomplishments of Dr Martin Luther King Jr., it is fitting that we recall his observation about what has become SPAN’s purpose:
“Of all the forms of inequality, injustice in healthcare is the most shocking and inhumane.” Rev Dr Martin Luther King Jr.
It is undeniable that health care is a fundamental human need. Indeed the concept of access to care as an unalienable human right exists in the philosophical tenets of every faith tradition. This fact was reiterated at a health conference hosted at the Vatican in November.
Caring for one another is at the heart of our modern democracy as well. These values are set forth in both the Declaration of Independence and the preamble of the US Constitution. However, without health none of the later enumerated rights are able to be realized. I say the people are losing their freedom due to lack of health care every day.
Dr King understood: “because the arc of the moral universe is long, but it bends toward justice" that no one bill passed or law enacted would achieve justice. We must be always advancing the cause. For as long as one person suffers from the lack of care we all suffer.
Today we recommit to fighting for universally accessible care, for all, without regard to individual economic means or the ability to pay.
Kurt Bateman, Director
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
By: Sarah Kliff
November 17, 2010 07:54 PM EST
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.
"States shouldn't be forced by the federal government to adopt a one-size-fits all health care plan. Each state's health care needs are different," Brown saysin a statement accompanying the legislation. "Our bill provides flexibility, and allows states like Massachusetts to opt out of portions of the health care law."
The bill is a significant step on both sides of the aisle. It's an effort by a Senate Democrat to ease one of the law's requirements. And it's the first Republican-sponsored effort to modify - rather than repeal - a provision in the law.
The Affordable Care Act allows states to set up health care systems without a mandated purchase of health insurance, as long as they meet minimal requirements established by the Department of Health and Human Services. States can begin applying for mandate waivers in 2017, three years after the individual mandate is set to take effect.
But Wyden, who co-authored health reform's waiver provision with Sen. Bernie Sanders (I-Vt.), has previously spoken out against the 2017 start date as problematic: States would have to go through the motions of setting up a mandate-centered system only to dismantle it a few years later.
This new legislation would roll the waiver date back to 2014, when the individual mandate comes into effect.
In an interview with POLITICO, Wyden described the legislation as a natural fit for Oregon and Massachusetts, two states that have experimented significantly with their health care systems.
"Oregon and Massachusetts are ideal bookends on this," he said. "Oregon was one of the first to start using institutional dollars on home care, essentially giving seniors more of what they wanted. Sen. Brown obviously has an interest in Massachusetts, where Mitt Romney and Ted Kennedy have come from.
"He was easy to work with in a divisive political climate. We kept the focus on state innovation and the opportunity to get away from one-size-fits-all, federal, cookie-cutter reform. "
Wyden pushed back against those who might interpret his legislation as a form of resistance to health reform.
"Clearly by HHS putting in place the coverage framework, you make it clear a state can't go off and do nothing," he said. "They have to have all kinds of services that are more in line with the spirit of coverage. The state will obviously work with the federal government, which will be looking on."
Wyden pressed CMS administrator Don Berwick on the issue at a Senate Finance Committee hearing Wednesday morning, asking him for his views on how much flexibility states will receive. He got a positive reaction.
"The cliché about states as laboratories of democracy is not just a cliché, it's true," Berwick said at the hearing. "The diversity of approaches that we're seeing emerge state by state has been there for a long time. I think we should be doing everything we can to encourage it."
Wyden has also pursued Oregon's Health Authority Office on the issue, indicating his intentions to introduce legislation rolling back the waiver date and encouraging the state to apply.
"Section 1332 is scheduled to go into effect in 2017. I intend to introduce legislation shortly to accelerate that date to 2014," Wyden wrote in a letter in September. "Moreover, if the bipartisan legislative leadership and the executive branch were in support, I would like to explore the possibility of Oregon moving forward with a federal waiver even earlier."
Massachusetts voters have, for the second straight election, overwhelmingly affirmed their support for single payer health reform by turning in majority ‘Yes’ votes in all fourteen districts where local single payer ballot questions appeared on November 2. The ballots spanned 80 different cities and towns in a state of 351 municipalities, winning in every city and town reporting results so far except two. Five of the districts backing single payer reform voted for Scott Brown in last year’s special senate election, which was largely seen as a referendum on national health reform, showing that the goal of improved and expanded Medicare for All is supported by a diverse range of communities across the state. It is also striking that in a year of political change, and in a year of drawn-out economic suffering, residents recognize that single payer health reform offers the promise of a more just and humanitarian health care system, which would actually cost us less as a society and lift the burden of sky-rocketing health costs from thousands of households, employers, and taxpayers.
AP Photo/Toby Talbot
(Host) Governor-elect Peter Shumlin says he's optimistic that he can persuade the Obama administration to grant Vermont a special waiver to implement a single payer health care system.
Shumlin says he's already raised this issue with the president, and he'll do it again when he visits the White House early next month.
VPR's Bob Kinzel reports.
(Kinzel) The possibility of Vermont winning a federal waiver to put a single payer health care system in place was a top issue in the gubernatorial campaign.
Republican candidate Brian Dubie said that 2014 is the earliest a waiver could be issued under the new national health care reform law.
But Democrat Peter Shumlin argued that Vermont's congressional delegation could petition the Obama administration to make it happen sooner.
Speaking on VPR's Vermont Edition, Shumlin says he's already spoken to the president about this issue.
(Shumlin) "I had the privilege of talking to the President of the United States earlier today. He called me from Air Force One. A lot of bizarre things have happened to me in the last five days, but that's one of them. You know, you pick up the phone and there's the president at the end of the line. It was a real honor."
(Kinzel) And Shumlin says he doesn't think getting a federal waiver will be the toughest part of implementing a single payer system in Vermont.
(Shumlin) "The waivers is the easy part. The hard part is designing a single payer health care system that works and that delivers quality health care, gets insurers off our providers' backs, has a reimbursement system that makes sense. ... I believe if we design that system, we can sell it."
(Kinzel) The Legislature is expected to receive a special study this winter that will outline several different health care reform plans. One of them will be a single payer approach.
Once that report has been released, Shumlin says he wants to bring together a diverse group of businesspeople, health care providers and consumers to hammer out a workable plan. The governor-elect says it should have 4 specific goals.
(Shumlin) "Delivers quality health care to all Vermonters, where health care is right and not a privilege. Second, is affordable. The current system is going to drown us and will bankrupt us. We can't spend a million dollars more a day than we did the day before. Third, provide outcomes-based medicine so that providers are reimbursed for keeping us healthy, not the number of tests they put us through. And finally, fourth, and perhaps most important, using technology."
(Kinzel) Shumlin admits that making major changes to the state's health care system isn't going to happen overnight. But he's hopeful that significant progress can be made during his first term in office.
For VPR News, I'm Bob Kinzel in Montpelier
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.