What If Everyone Had Medicare?

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San Francisco Chronicle

September 24, 2010

What if everyone had Medicare?

By Henry Abrons

The Census Bureau released its annual report on income, poverty and health insurance coverage in the United States earlier this month, and it's no surprise to learn that we're in bad shape. The number of people living in poverty was 43.6 million (14.3 percent), up sharply from 2008, and real per capita income declined 1 percent.

Looking at health insurance, the situation is truly dire. There was a dramatic spike in the uninsured - 4.3 million more, to a record 50.7 million - in spite of the expansion of government health insurance rolls by nearly 6 million.

Those opposing government health insurance should ponder the fact that private health insurance coverage dropped to the lowest level since comparable data were first collected in 1987. On the other hand, those who look to the new health reform law - the Patient Protection and Affordable Care Act (PPACA) - for a solution should be deeply disturbed.

PPACA was not designed to provide universal coverage. In fact, if the new law works as planned, in 2019 there will still be 23 million uninsured. Yet the consequence of being uninsured can be lethal: Research published last year shows about 45,000 deaths annually can be linked to lack of coverage. That number is probably more than 50,000 today.

As Don McCanne, senior health policy fellow at Physicians for a National Health Program, has observed, PPACA is an underinsurance program. Employers, seeing little relief, will expand the present trend of shifting more insurance and health care costs onto employees.

Individuals buying plans in the new insurance exchanges (which won't start until 2014) will discover that subsidies are inadequate to avoid financial hardship. Inevitably, they will end up with underinsurance, spotty coverage and high deductibles.

And workers who are unemployed or without employment-based insurance will move into Medicaid (Medi-Cal in California), where providers are reimbursed at such low rates that many will not accept patients.

When Congress passed the new law last spring, it based its decision on a faulty assumption - namely, that the rest of the population will have sustainable private health insurance. But between 2008 and 2009, the number of people covered by private health insurance decreased from 201.0 million to 194.5 million, and the number covered by employment-based health insurance declined from 176.3 million to 169.7 million.

If this trend continues, as it's bound to do under current economic conditions, the ranks of the uninsured will expand and the new law will fall far short of the mark - either the cost will exceed projections, or coverage will be need to be reduced.

The Census Bureau report underscores the urgency of going beyond the Obama administration and swiftly implementing a more fundamental reform - a single-payer national health insurance program - improved Medicare for all.

Improved Medicare-for-all, by replacing our dysfunctional patchwork of private health insurers with a single, streamlined system of financing, would save about $400 billion annually in unnecessary paperwork and bureaucracy. That's enough to cover all of those now uninsured and to provide every person in the United States with quality, comprehensive coverage.

A single-payer plan would also furnish us with effective cost-control tools, like the ability to negotiate fees and purchase medications in bulk. It would permit patients to go to the doctor and hospital of their choice.

Short of a full national plan, some states, like ours, are eyeing a state-based single-payer model. The new health law allows states to experiment with different models of reform, but not until 2017. Congress should move that date forward. There is no time to waste.

(Henry Abrons, M.D., is a member of Physicians for a National Health Program-California - www.pnhpcalifornia.org.)

http://articles.sfgate.com/2010-09-24/opinion/24086986_1_health-insurance-health-reform-law-universal-coverage

Comment:  Henry Abrons' message is certainly very familiar to supporters of an improved Medicare for all, but we have to keep repeating it over and over until more people start listening.

Related articles by Zemanta

• Alice M. Rivlin: Health Reform: Last Call for Competitive Markets? (huffingtonpost.com)
• "The Census, Uninsurance, And Health Reform" and related posts (wonkroom.thinkprogress.org)
• Uninsured Rate Soars to All-Time High of 50 Million (health.change.org)
• Time to bring back the public option? (blogs.forbes.com)
• Aaron E. Carroll: What a Difference a Year Makes (huffingtonpost.com)

Don't Drink the Bong Water

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Published on Friday, October 23, 2009 by the San Francisco Chronicle

A Tale of Two Supermen

by David Sirota

For better or worse, our American Idiocracy has come to rely on athletes as national pedagogues. Michael Jordan educated the country about commitment and just doing it. A.C. Green lectured us about sexual caution. Serena Williams and John McEnroe taught us what sportsmanship is - and is not. So when a single week like this one sees both the Justice Department back states' medical marijuana laws, and a Gallup poll show record-level support for pot legalization, we can look to two superjocks - Lance Armstrong and Michael Phelps - for the key lesson about our absurd drug policy.

This Tale of Two Supermen began in February when Phelps, the gold-medal swimmer, was plastered all over national newspapers in a photo that showed him hitting a marijuana bong. USA Swimming suspended Phelps, Kellogg pulled its endorsement deal and the Associated Press sensationalized the incident as a national decision about whether heroes should "be perfect or flawed."

The alleged imperfection was Phelps' decision to quietly consume a substance that "poses a much less serious public health problem than is currently posed by alcohol," as a redacted World Health Organization report states. That's a finding confirmed by almost every objective science-based analysis, including a landmark University of California study in 2006 showing "no association at all" between marijuana use and cancer.

Alcohol, by contrast, causes roughly 1 in 30 of the world's cancer cases, according to the International Journal of Cancer. And a new report by Cancer Epidemiology journal shows that even beer, seemingly the least potent drink, may increase the odds of developing tumors.

Which brings us to Armstrong. This month, the Tour de France champion who beat cancer inked a contract to hawk Anheuser-Busch's alcohol. That's right, less than a year after Phelps was crucified for merely smoking weed in private, few noticed or protested the planet's most famous cancer survivor becoming the public face of a possible carcinogen.

The data prove the answer to "why the double standard" isn't about health, and our culture proves it isn't about widespread allegiance to "Just Say No" abstinence. After all, whether through liquor commercials, wine magazines, beer-named stadiums or cocktail-drenched office parties, our society is constantly encouraging us to get our liquid high.

No, the double standard is about know-nothing statutes and attitudes promoting the recreational use of alcohol and banning the similar use of marijuana - all thanks to retrograde mythologies of post-'60s Americana. In our now-dominant backlash folklore, the patriots are the straight-laced Joe and Jane Sixpacks - and the Armstrongs who encourage their drinking. Meanwhile, the supposed evildoers are the pot-smoking Cheeches, Chongs and Phelpses, whose marijuana use allegedly underscores a dangerous hippieness.

Ergo, the moral of this Tale of Two Supermen: To end contradictions in narcotics policy and permit safer recreational drug choices, we have to first reject the outdated Silent-Majority-versus-counterculture iconography that defines so much of our politics. We must, in other words, replace caricatures with scientific facts and mature into something more than an Idiocracy.

We should all be able to imbibe - or inhale - to that.

Copyright 2009 Creators.com

David Sirota is the author of the best-selling books "Hostile Takeover" and "The Uprising." He hosts the morning show on AM760 in Colorado and blogs at OpenLeft.com. E-mail him at ds@davidsirota.com.