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.

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Study Shows Universal Health Benefits

BMC Health Services Research

August 4, 2010

The impact of universal National Health Insurance on population health: the experience of Taiwan

By Yue-Chune Lee, Yu-Tung Huang, Yi-Wen Tsai, Shiuh-Ming Huang, Ken N Kuo, Martin McKee and Ellen Nolte

Background

Taiwan established a system of universal National Health Insurance (NHI) in March, 1995. Today, the NHI covers more than 98% of Taiwan's population and enrollees enjoy almost free access to healthcare with small co-payment by most clinics and hospitals. Yet while this expansion of coverage will almost inevitably have improved access to health care, however, it cannot be assumed that it will necessarily have improved the health of the population. The aim of this study was to determine whether the introduction of National Health Insurance (NHI) in Taiwan in 1995 was associated with a change in deaths from causes amenable to health care.

Methods

Identification of discontinuities in trends in mortality considered amenable to health care and all other conditions (non-amenable mortality) using joinpoint regression analysis from 1981 to 2005.

Results

Deaths from amenable causes declined between 1981 and 1993 but slowed between 1993 and 1996. Once NHI was implemented, the decline accelerated significantly, falling at 5.83% per year between 1996 and 1999. In contrast, there was little change in non-amenable causes (0.64 percent per year between 1981 and 1999). The effect of NHI was highest among the young and old, and lowest among those of working age, consistent with changes in the pattern of coverage. (This result is consistent with our expectations as 77% of the working age population were already covered by the pre-existing social insurance; thus they were inevitably going to be affected less by the introduction of NHI.) NHI was associated with substantial reductions in deaths from circulatory disorders and, for men, infections, whilst an earlier upward trend in female cancer deaths was reversed.

Conclusions

NHI was associated in a reduction in deaths considered amenable to health care; particularly among those age groups least likely to have been insured previously.

Policy Implications

These findings have implications for other countries that do not have universal health insurance coverage. The implementation of NHI in Taiwan was associated with a sustained reduction in deaths from causes amenable to health care, which surpassed the underlying decline in other causes. It is reasonable to expect that the introduction of universal coverage elsewhere might also have beneficial effects.

Looking ahead, while the Taiwanese NHI has succeeded in terms of cost (3.4% of GDP), satisfaction (77.5% satisfied in 2007), low administrative cost (1.49%), and equitable financial burden, the system is not without problems. For example, as a publicly-managed program, it is difficult to insulate it from political interference, a factor that has contributed to a continuing financial deficit. Thus, the existing budget may be inadequate to sustain the current level of performance.

http://www.biomedcentral.com/1472-6963/10/225/abstract

Full article (provisional):

http://www.biomedcentral.com/content/pdf/1472-6963-10-225.pdf

United States has worst rate of amenable mortality:

http://www.pnhp.org/news/2008/january/united_states_has_wo.php

Comment:  Taiwan's 1995 introduction of a single payer system of universal National Health Insurance provides us with a natural experiment on the impact of single payer reform on health outcomes. The results are dramatic. The rate in reductions of deaths due to disorders that are amenable to health care were nine times the reductions in deaths from non-amenable causes. Nine times!

The United States should be especially interested in these results since, in a study of nineteen industrialized nations, we have the worst rate of amenable mortality (link above). We have over 100,000 excess deaths per year due to disorders amenable to health care.

Will the Patient Protection and Affordable Care Act (PPACA) erase this blemish on our health care system? Most of our dysfunctional financing system will remain in place. Some will receive care under an expansion of Medicaid, but as a chronically underfunded program with insufficient numbers of willing providers, access problems are inevitable. Others will receive care under the private plans in the insurance exchanges, but financial barriers to access will remain because of the low actuarial values of the plans and inadequate subsidies. There is little reason to believe that the tweaks of PPACA will have much impact on amenable mortality.

After enacting a single payer system, Taiwan not only greatly reduced amenable mortality, but it was done at a fraction of our spending, with great patient satisfaction, with extremely low administrative costs, and with a financing system that is equitable. Maybe Taiwan needs to spend more, but just think of what we could have with the amount that we are already spending. Besides, saving 100,000 lives a year seems to be a worthy policy goal.

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FAIR Criticizes PBS's Frontline On Single Payer Omission

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Fairness & Accuracy In Reporting (FAIR)

Frontline Edits Out Single-Payer
Documentary misrepresented advocates as supporters of a public option

4/23/10


Silencing supporters of single-payer, or Medicare for All, is a media staple, but PBS's Frontline found a new way to do that on the April 13 special Obama's Deal--by selectively editing an interview with a single-payer advocate and footage of single-payer protesters to make them appear to be activists for a public option instead.

The public option proposal would have offered a government-run health insurance program to some individuals as an alternative to mandatory private health insurance. Not only is this not the same thing as Medicare for All, it's an idea many single-payer advocates actually opposed, arguing that it would leave the insurance industry intact as dominant players in the healthcare business (PNHP.org, 7/20/09).

In the report, Frontline explained that insurance industry lobbyists pushed a bill in the Senate Finance Committee chaired by Sen. Max Baucus (D.-Montana) "that would include the mandate to buy insurance and kill the public option." That "didn't sit well with the president's liberal supporters," the Frontline narrator told viewers. After a clip from public-option supporter Howard Dean, a full minute and a half focused on protests: "The left counterattacked in May.... Liberal outrage arrived in Baucus' own hearing room as healthcare activists, one after another, shouted him down." Several of these protesters are seen in action, with a clip of an interview with Margaret Flowers of Physicians for a National Health Program (PNHP) saying that these were members of her group shut out of the hearings.

Now, Flowers and PNHP are leading single-payer advocates--but you'd never learn that from watching the Frontline program, which never mentions the single-payer concept. Instead, viewers were left to assume that Flowers and the protesters were public-option proponents, since that was the only progressive proposal that had been discussed. As Flowers explained (Consortium News, 4/15/10):

When the host, Mr. [Michael] Kirk, interviewed me for Obama's Deal, we spoke extensively of the single-payer movement and my arrest with other single-payer advocates in the Senate Finance Committee last May. However, our action in Senate Finance was then misidentified as "those on the left" who led a "counterattack" because of "liberal outrage" at being excluded.

Viewers saw more footage of protesters being handcuffed and led away, with an unidentified voiceover from Amy Goodman of Democracy Now! describing the arrests, and finally a voice was heard saying: "This option cannot be part of the discussion at a Senate hearing? Now, I think that's wrong."

The audience could only conclude that "this option" referred to the public option, but this conclusion would be incorrect; this voice was actually MSNBC host Ed Schultz, a single-payer supporter, and a fuller version of his quote (5/7/09) would have made it clear that he was complaining about single-payer being excluded from the hearing:

Now, let me explain single-payer for just a minute. The money comes from one source, the government. Now, you and I pay taxes, OK. The government pays the bill. It's that simple. Patients are not caught in the middle between doctors and insurance companies, no game-playing here. There's no middleman. You know? There's no decision-makers between you and your doctor. It's a clean deal.

So what Chairman Baucus has decided, this option cannot be part of the discussion at a Senate hearing? Now, I think that's wrong. I don't think it's fair.

Frontline's editors responded to Flowers' complaints, saying that they "understand the frustration of Dr. Flowers and others in what she calls the 'single-payer movement,'" but that "it's the work of journalism to report widely on a topic, then find the sharpest focus for the reporting, unfortunately leaving out much strong material along the way to shaping the clearest communication possible in the time or space allowed."

The statement also argued that

the section that included Dr. Flowers was focused on the power of the insurance lobby and showed how activists like Dr. Flowers were excluded from the debate over the bill. The protesters themselves said they were protesting the fact that they had been excluded from the debate, so we believe we presented the protests in the proper context.

But in Frontline's presentation, "activists like Dr. Flowers"--that is, single-payer advocates--didn't even exist. Having itself excluded their perspective from the debate--and even misrepresented them as supporters of a position that many of them actually oppose--there's some irony in Frontline claiming to have put this exclusion in the "proper context."

This is not the first time that Frontline has decided that a conversation about healthcare reform should exclude single-payer (FAIR Action Alert, 4/7/09). The March 31, 2009, Frontline special Sick Around America avoided discussions of national healthcare plans. This omission led Frontline correspondent T.R. Reid--who had hosted a previous Frontline special (4/15/08) that examined various public healthcare models--to withdraw from the project.

When Frontline pushed single-payer out of the debate last year, PBS ombud Michael Getler (4/10/09) weighed in on the side of critics, calling it a "missed opportunity." Getler today (4/23/10) published a column about the latest Frontline omissions, once again finding that ignoring a popular policy like single-payer is problematic:

It seems to me that to ignore something that was out there and popular with millions of people and thousands of healthcare professionals, but not really on the table, was a mistake. Although obviously tight on time, the producers should have found 30 seconds to take this into account, because many Americans support it, yet the deal makers never mention it, nor is the politics of discarding it addressed.

We're thankful that Getler has once again taken this view and encouraged a more inclusive discussion of healthcare on PBS. However, his criticism misses the critical journalistic fact that single-payer advocates were not only marginalized by Frontline--they were misrepresented.

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Kucinich Explains Vote

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Published on Wednesday, March 17, 2010 by CommonDreams.org
Why I'm Voting 'Yes'

by Dennis Kucinich
The following are the prepared remarks offered by US Rep. Kucinich today regarding his plans for the upcoming health care vote:

Each generation has had to take up the question of how to provide for the health of the people of our nation. And each generation has grappled with difficult questions of how to meet the needs of our people. I believe health care is a civil right. Each time as a nation we have reached to expand our basic rights, we have witnessed a slow and painful unfolding of a democratic pageant of striving, of resistance, of breakthroughs, of opposition, of unrelenting efforts and of eventual triumph.

I have spent my life struggling for the rights of working class people and for health care. I grew up understanding first hand what it meant for families who did not get access to needed care. I lived in 21 different places by the time I was 17, including in a couple of cars. I understand the connection between poverty and poor health care, the deeper meaning of what Native Americans have called "hole in the body, hole in the spirit". I struggled with Crohn's disease much of my adult life, to discover sixteen years ago a near-cure in alternative medicine and following a plant-based diet. I have learned with difficulty the benefits of taking charge personally of my own health care. On those few occasions when I have needed it, I have had access to the best allopathic practitioners. As a result I have received the blessings of vitality and high energy. Health and health care is personal for each one of us. As a former surgical technician I know that there are many people who dedicate their lives to helping others improve theirs. I also know their struggles with an insufficient health care system.

There are some who believe that health care is a privilege based on ability to pay. This is the model President Obama is dealing with, attempting to open up health care to another 30 million people, within the context of the for-profit insurance system. There are others who believe that health care is a basic right and ought to be provided through a not-for-profit plan. This is what I have tirelessly advocated.

I have carried the banner of national health care in two presidential campaigns, in party platform meetings, and as co-author of HR676, Medicare for All. I have worked to expand the health care debate beyond the current for-profit system, to include a public option and an amendment to free the states to pursue single payer. The first version of the health care bill, while badly flawed, contained provisions which I believed made the bill worth supporting in committee. The provisions were taken out of the bill after it passed committee.

I joined with the Progressive Caucus saying that I would not support the bill unless it had a strong public option and unless it protected the right of people to pursue single payer at a state level. It did not. I kept my pledge and voted against the bill. I have continued to oppose it while trying to get the provisions back into the bill. Some have speculated I may be in a position of casting the deciding vote. The President's visit to my district on Monday underscored the urgency of this moment.

I have taken this fight farther than many in Congress cared to carry it because I know what my constituents experience on a daily basis. Come to my district in Cleveland and you will understand.

The people of Ohio's 10th district have been hard hit by an economy where wealth has accelerated upwards through plant closings, massive unemployment, small business failings, lack of access to credit, foreclosures and the high cost of health care and limited access to care. I take my responsibilities to the people of my district personally. The focus of my district office is constituent service, which more often then not involves social work to help people survive economic perils. It also involves intervening with insurance companies.

In the past week it has become clear that the vote on the final health care bill will be very close. I take this vote with the utmost seriousness. I am quite aware of the historic fight that has lasted the better part of the last century to bring America in line with other modern democracies in providing single payer health care. I have seen the political pressure and the financial pressure being asserted to prevent a minimal recognition of this right, even within the context of a system dominated by private insurance companies.

I know I have to make a decision, not on the bill as I would like to see it, but the bill as it is. My criticisms of the legislation have been well reported. I do not retract them. I incorporate them in this statement. They still stand as legitimate and cautionary. I still have doubts about the bill. I do not think it is a first step toward anything I have supported in the past. This is not the bill I wanted to support, even as I continue efforts until the last minute to modify the bill.

However after careful discussions with the President Obama, Speaker Pelosi, Elizabeth my wife and close friends, I have decided to cast a vote in favor of the legislation. If my vote is to be counted, let it now count for passage of the bill, hopefully in the direction of comprehensive health care reform. We must include coverage for those excluded from this bill. We must free the states. We must have control over private insurance companies and the cost their very existence imposes on American families. We must strive to provide a significant place for alternative and complementary medicine, religious health science practice, and the personal responsibility aspects of health care which include diet, nutrition, and exercise.

The health care debate has been severely hampered by fear, myths, and by hyper-partisanship. The President clearly does not advocate socialism or a government takeover of health care. The fear that this legislation has engendered has deep roots, not in foreign ideology but in a lack of confidence, a timidity, mistrust and fear which post 911 America has been unable to shake.

This fear has so infected our politics, our economics and our international relations that as a nation we are losing sight of the expanded vision, the electrifying potential we caught a glimpse of with the election of Barack Obama. The transformational potential of his presidency, and of ourselves, can still be courageously summoned in ways that will reconnect America to our hopes for expanded opportunities for jobs, housing, education, peace, and yes, health care.

I want to thank those who have supported me personally and politically as I have struggled with this decision. I ask for your continued support in our ongoing efforts to bring about meaningful change. As this bill passes I will renew my efforts to help those state organizations which are aimed at stirring a single payer movement which eliminates the predatory role of private insurers who make money not providing health care. I have taken a detour through supporting this bill, but I know the destination I will continue to lead, for as long as it takes, whatever it takes to an America where health care will be firmly established as a civil right.
Rep. Dennis Kucinich is a Democratic Congressman from Ohio.

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Minnesota Health Plan Touted

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Published on Tuesday, February 2, 2010 by CommonDreams.org
Single Payer Solution for Obama

by MN Senator John Marty

"If anyone...has a better approach that will bring down premiums, bring down the deficit, cover the uninsured, strengthen Medicare for seniors, and stop insurance company abuses, let me know."
-- President Obama, State of the Union
January 27, 2010

An open letter in response to President Obama's State of the Union request for a better approach to health care reform:

Dear President Obama,

During your State of the Union address, you explained why you are fighting for health care reform, expressed frustration at the lack of success, and invited others to suggest a better approach.

I'm taking you up on that invitation and offer a bold suggestion:

Take a look at our Minnesota Health Plan -- a proposal that covers everyone, saves money, and creates a logical health care system to replace the dysfunctional non-system which currently exists. It is a proposal that would provide health care to everyone, not merely health insurance for many. Our MN Health Plan (mnhealthplan.org) could be readily adapted as a nation-wide plan. It would meet each of the five requirements you mentioned in your State of the Union request:

Bring Down Premiums. Most Americans would see a big reduction in premiums because the plan would be significantly cheaper than our current health care non-system. Because the premiums for the MHP would be based on ability to pay, everyone's premiums would be affordable. Some would pay more, but overall, costs would go down. Most people would save money, while getting the care they need and deserve. The total costs for the plan would be less than we now are paying for premiums, co-pays, deductibles, and taxes for medical programs.

Bring Down the Deficit. By keeping people healthier and by delivering quality health care efficiently, it would save hundreds of billions of dollars for the federal government, and even more for states. For example, by covering chemical dependency treatment and providing comprehensive mental health services, it would cut crime and human service costs (such as out-of-home placement of children), some of the biggest and fastest growing expenses facing state and local governments.

Cover the Uninsured. It would cover the uninsured and the under-insured. In fact it would cover everyone -- 100% of the public.

Strengthen Medicare for Seniors (and everyone else). It would cover prescription drugs -- with no "doughnut hole." It would cover long term care, in-home care, dental, eye care, physical therapy, and medical supplies -- it would cover all medical needs. And, they would have their choice of doctor, hospital, clinic, dentist -- complete freedom to choose their medical providers.

Stop Insurance Company Abuses. There would be no "pre-existing conditions" to worry about, no underwriting, no denials of coverage, no "out of network" problems. I like to use the analogy of police and fire protection. When you return home to find a burglary in process and call 911, the police dispatcher does not ask if you qualify. They do not ask if you have police insurance. They do not ask whether your policy covers home burglary. They don't ask if you have pre-existing conditions that would disqualify you. They don't waste time and money having you fill out forms so your insurance company can be billed. The police response does not depend on your insurance status. Everyone is treated equally. It's the American way. It is time to treat health care the same way.

As a 23 year member of the Minnesota Senate, let me comment briefly on the politics of this proposal:

The MHP is a single payer proposal. You have acknowledged that single payer is the only way to cover everyone. Seven years ago you said that single payer health care is "what I'd like to see. But... we may not get there immediately. Because first we have to take back the White House, we have to take back the Senate, and we have to take back the House." Now that we have taken back the White House and the Congress, it is time to act.

I recognize, as you do, that you do not have the votes to pass truly universal health care at this time. The insurance and pharmaceutical industries contribute so much to members of Congress -- they control the debate -- so health care for everyone isn't even on the table.

This, however, is your opportunity for leadership. If you propose and fight for health care for all, as FDR did with Social Security in 1935, the voters would respond. If you don't win this year, ask the American people to elect candidates who will stand with you. Make it the issue of the campaign: Health Care for All vs. Health Insurance for Some. Instead of losing Democratic members of Congress this year -- as Massachusetts illustrates -- you would gain votes and could actually pass the bill next year.

Dr. Martin Luther King stated, "Of all the forms of inequality, injustice in health care is the most shocking and inhumane."

Almost a half century later, we still have not addressed the injustice in health care that Dr. King described as the most inhumane. Ignoring this injustice is immoral and it is economically unsustainable. People are hurting, some are literally dying, businesses are folding, and it is crushing our national economy.

Please, restore the Hope that you raised in all of us, bring back the inspiration that made the American people so excited by your inauguration. I urge you to step back, reconsider, introduce a health care plan that is truly universal, and fight for it.

Justice requires no less.

Respectfully,

John Marty
John Marty is a state Senator from Minnesota, who is currently a Democratic candidate for governor. John currently chairs the Minnesota Senate Health, Housing and Family Security Committee. He is author of the Minnesota Health Plan, a bold single-payer health plan that would cover all Minnesotans for all their medical needs, including mental health and chemical dependency. He has been successful in gaining the support of one-third of the state's legislature as co-authors.

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Senate Fails at Reforming Health Care

'Party of No' Blocks Debate on Bernie Sanders' Real Reform

by John Nichols

The Senate almost debated health care reform this seek. No, not the tepid tinkering proposed by Senate Majority Leader Harry Reid, D-Nevada, in the compromised for demanded by Senator Joe Lieberman, I-Insurance Industry. We're talking real reform.
Vermont Senator Bernie Sanders has always understood that the real reform involves a lot more than enriching insurance companies with massive new infusions of federal money.
The real reform takes the insurance companies out of the equation and replaces them with a single-payer Medicare-for-All system that provides care to all Americans and cuts costs by eliminating corporate profiteering.
The Medicare-for-All reform has always been the right fix. Barack Obama, as a U.S. Senate candidate in 2003, said as much.
"I happen to be a proponent of a single payer universal health care program," he told a crowd of union activists. "I see no reason why the United States of America, the wealthiest country in the history of the world, spending 14 percent of its Gross National Product on health care cannot provide basic health insurance to everybody. And that's what (reformers are) talking about when (they say) everybody in, nobody out. A single payer health care plan, a universal health care plan. And that's what I'd like to see."
Obama was right six years ago. Unfortunately, he has opted for compromise and the result is the unfocused, lobbyist-driven, spin-defined debate over so-called "reform."
Sanders has kept to the real reform path and, on Wednesday, he was supposed to get a vote on a proposal to amend the Senate health-care reform bill to replace all the compromises with a single-payer plan that would provide health care and dental coverage for every American, save money, and improve health care results.
"In my view, the single-payer approach is the only way we will ever have a cost-effective, comprehensive health care system in this country," explained the independent senator from Vermont. "One of the reasons our current health care system is so expensive, so wasteful, so bureaucratic, so inefficient is that it is heavily dominated by private health insurance companies whose only goal in life is to make as much money as they can."
Like many of the amendments proposed by Democratic and Republican senators during the current wrangling over health-care reform, the Sanders amendment was not going to pass. But the prospect of the debate on it offered a rare opportunity for the Senate to engage in real debate about what needs to be done to provide care for all and eliminating unnecessary costs.
The Sanders amendment offered senators a chance to get serious about the fiscal responsibility they are so very inclined to discuss but so very disinclined to embrace.
As Sanders and his aides explained in their argument for the amendment: "The 1,300 profit-making private insurance companies administer thousands of separate plans and waste about $400 billion a year on administrative costs, profiteering, high CEO compensation packages, and advertising. Health care providers spend another $210 billion on administrative costs, mostly to deal with insurance paperwork. As a result, the United States spends $7,129 per person on health care, almost double the amount spent by nearly any other industrialized country. Nevertheless, 46 million Americans lack health insurance, 100 million Americans cannot access dental care, and 60 million Americans do not have access to primary care."
Compare that $7,129 per person figure for the U.S. with per capita health spending figures for countries with genuine national health care plans, such as Canada's $3,895 and Austria's $3,763 on health care costs. Both of these countries provide fuller care for people who live longer and healthier lives than do Americans.
Those are the facts, and those facts terrify "Party of No" Republicans and the many Democrats who imagine that they represent the insurance industry rather than constituents who need more care at less cost.
How terrifying?
Rather than allow the Sanders amendment to be debated as every other proposal to improve a fundamentally flawed Senate proposal, Republican senators engaged in extreme obstructionist tactics to block consideration of the amendment. Rejecting Senate tradition and standard practice during the current debate, several conservatives demanded that the clerk of the Senate read every word of the 767-page amendment Sanders proposed.
Recognizing that the move would stall action not just on health care reform but on a host of economic issues that are critical to unemployed Americans, Sanders had no choice but to pull the amendment off the floor. But he was not happy about what happened.
"The fact that 17 percent of our people are unemployed or underemployed, one out of four of our children are living on food stamps, we've got two wars, we've got global warming, we have a $12 trillion national debt, and the best the Republicans can do is try to bring the United States government to a half by forcing a reading of a 700 page amendment. That is an outrage," Sanders said. "People can have honest disagreements, but in this moment of crisis it is wrong to bring the United States government to a halt."
Opponents of real reform made the sad and frustrating spectacle that is the current debate all the more sad and frustrating.
But Sanders still has history on his side.
"At the end of the day -- not this year, not next year, but sometime in the future -- this country will come to understand that if we are going to provide comprehensive quality care to all of our people, the only way we will do that is through a Medicare-for-all, single-payer system," the senator says.
That is the truth, uttered by an honest reformer, in the midst of a debate on which Americans will one day look back in anger. Real reform is not coming this year or next. But it will, it must, come. And when it does, it should be remembered that Bernie Sanders tried to get the Senate to do the right thing.

Copyright © 2009 The Nation

John Nichols is Washington correspondent for The Nation and associate editor of The Capital Times in Madison, Wisconsin. A co-founder of the media reform organization Free Press, Nichols is is co-author with Robert W. McChesney of Tragedy & Farce: How the American Media Sell Wars, Spin Elections, and Destroy Democracy - from The New Press. Nichols' latest book is The Genius of Impeachment: The Founders' Cure for Royalism.

Time for us to Call Our Senators

Image via Wikipedia

Published on Monday, November 23, 2009 by CommonDreams.org

Before You Carve that Turkey: All In for Bernie Sanders

by Donna Smith

Those millions of us who support a Medicare for All, single-payer, reform for the healthcare crisis in this nation have some work to do over the next few days.  Senators are on their way to their home states for the one-week Thanksgiving recess - and they need a little up close and personal constituent attention before dinnertime on Thursday.
Senator Bernie Sanders of Vermont is a stalwart supporter of doing the right thing for his state, our healthcare system and this nation - and he has said repeatedly that moving toward a just and economically sound system is possible through Medicare for All, single-payer.  In the purest sense of giving patients control over their own healthcare, single-payer gives us all control over our choice of providers - and it gives our healthcare professionals the freedom they need to advise us on the basis of health rather than payment source.
So, even though the current Senate bill is not what we want - Senator Sanders will offer an amendment that would be a substitute for that bill and is mirrored on S. 703, The American Health Security Act.
We need to make it clear before our Senators are immersed in their own holiday events and then in traveling  back to Washington, DC, that we want them to support Senator Sanders' amendment. 
Call today, call tomorrow and keep calling until the home offices of the Senators close for the holidays - and many will stay open until Wednesday at noon.  Tell the staff you want to talk turkey about the Senate effort.
Time is drawing short for our Senators to hear from us.  Debate will begin on November 30 on the current Senate bill.  Senator Sanders needs support.  He has already told us that he does not expect a win on his amendment.  But we are all laying groundwork for this nation to move in the right direction before long - we know that the current bills do not "bend the cost curve" enough and we know they certainly do not bend the death or bankruptcy curve nearly enough to make the bills what this nation needs.
Additionally, we want the legislation to contain language that will allow states that opt in to a single-payer system to be able to do so with the appropriate waivers from federal legal provisions which might otherwise present obstacles to doing so.
So, the ask of our Senators - each and every one, liberal, centrist or conservative - is two-fold and urgent:

1.       Vote with and for Sanders' S. 703 substitute amendment; and
2.       Support state single-payer enabling language in the final bill.

Calls to DC won't be effective this week.  We can all return to that effort next week.  Thanksgiving week calls must go to your Senators' offices in your state.  Look them up here, using your zip code: http://www.votesmart.org/
Tell friends, neighbors and relatives.  This year, talk a little turkey about healthcare.  Ask folks how thankful they would be to have healthcare as a basic human right for their neighbors and for themselves.  And then help them look up their Senators' contact information and tell them how easy it really is to call and log your concerns and your expectations for an affirmative vote for the Sanders' amendment.
Oh, and don't forget to thank one another for caring enough to join in the struggle.  It matters.   Everybody in, nobody out.  Thank you all for believing that together we can change this, because we can.

Donna Smith is a community organizer for the California Nurses Association and National Co-Chair for the Progressive Democrats of America Healthcare Not Warfare campaign.

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Some Single Payer Advocates To Oppose Health Bill

Published on Monday, November 23, 2009 by CommonDreams.org

Single Payer Activists to Congress: Defeat Democratic Health Bill

by Russell Mokhiber

The Democratic health care bill is a massive bailout of the private health insurance industry.
It is convoluted and complicated.
And it should be defeated.
That's the take of a number of leading single payer activists.
They will hold a press conference the day before Thanksgiving.
And call on Congress to defeat the more than 2,000 page bill.
Start from scratch.
And pass single payer, Medicare for all, national health insurance.
The press conference will be held in the Murrow Room at the National P ress Club in Washington, D.C. on Wednesday, November 25, 2009 at 10 a.m.
The press conference is being organized by Single Payer Action.
Speakers include:

• Russell Mokhiber, Single Payer Action.
• Dr. Margaret Flowers, Physicians for a National Health Program.
• Kevin Zeese, Prosperity Agenda.
• Dr. Carol Paris, Physicians for a National Health Program.

Mokhiber, Flowers, Zeese and Paris are four of the Baucus 8 - the eight protesters who were ordered arrested and charged with "disruption of Congress" by Senator Max Baucus (D-Montana) in early May 2009 after they rose to ask Baucus why single payer was taken off the table by the Democrats.
Baucus had scheduled 41 health care experts to testify over three days of hearings of the Senate Finance Committee.
Not one of the 41 experts was an advocate for a single payer system.
This despite national polls showing a majority of Americans and a majority of doctors support a Canadian-style, Medicare-for-all single payer system.
On Wednesday, the Baucus Four will call on single payer supporters in the Congress - like Senator Tom Harkin (D-Iowa), Senator Bernie Sanders (I-Vermont) - and the 88 members of the House who are sponsors of HR 676 - the single payer bill - to stand with Congressmen Dennis Kucinich (D-Ohio) and Eric Massa (D-New York) - and vote against the pending legislation.
HR 676 is about 30 pages in length.
It's simple.
It covers everyone.
And it saves money.
Kucinich and Massa were the only single payer supporters in the House who voted last week against Obama and the Democratic leadership.
Kucinich called the Democratic bill "a bailout under a Blue Cross."
Massa said the bill would "enshrine in law the monopolistic powers of the private health insurance industry."
"The Obama health care legislation is a 2,000-page turkey," said Mokhiber. "It should be defeated and served up to the American people as an example of what happens when corporate lobbyists hijack Congress."
Dr. Marcia Angell, former editor-in-chief of the New England Journal of Medicine, earlier this month called on Congress to do nothing instead of passing the Democratic bill.
"Is the House bill better than nothing?" Angell asked. "I don't think so. It simply throws more money into a dysfunctional and unsustainable system, with only a few improvements at the edges, and it augments the central role of the investor-owned insurance industry. The danger is that as costs continue to rise and coverage becomes less comprehensive, people will conclude that we've tried health reform and it didn't work. But the real problem will be that we didn't really try it. I would rather see us do nothing now, and have a better chance of trying again later and then doing it right."
Healthcare-Now! - a coalition of labor unions and other single payer activists - adopted a resolution earlier this month at its national strategy conference in St. Louis - calling on Congress to defeat the legislation.
The Healthcare-Now! board is co-chaired by Leo Gerard, president of the United Steelworkers Union, Rose Ann DeMoro, executive director of the California Nurses Association, Dr. Quintin Young of Physicians for a National Health Program, and Jim Winkler of the United Methodist Church.

Harvard Study Debunks Health IT Claims

Projections of Savings from Health IT are Baseless, Harvard Researchers Say

National survey of U.S. hospitals shows information technology has yielded neither administrative efficiencies nor cost savings

WASHINGTON - November 20 - The increased computerization in U.S. hospitals hasn't made them cheaper or more efficient, Harvard researchers say, although it may have modestly improved the quality of care for heart attacks.
The findings, published in today's [Friday's] online edition of The American Journal of Medicine, contradict claims by President Obama and many lawmakers that health information technology (health IT), including electronic medical records, will save billions and help make reform affordable.
"Our study finds that hospital computerization hasn't saved a dime, nor has it improved administrative efficiency," said lead author Dr. David Himmelstein, associate professor at Harvard Medical School and former director of clinical computing at Cambridge Hospital in Massachusetts. "Claims that health IT will slash costs and help pay for the reforms being debated in Congress are wishful thinking."
The study uses data from the most extensive survey ever undertaken of hospital computerization. Data from approximately 4,000 hospitals for the years 2003 to 2007, including those on a list of the "100 Most Wired," were analyzed for evidence of increased quality, cost savings or improvements in administrative efficiency.
The data came from the authoritative Healthcare Information and Management Systems Society (HIMSS) Analytics annual survey of hospital computerization; Medicare Cost Reports that virtually all hospitals submit annually to the Centers for Medicare and Medicaid Services (CMS); and the 2008 Dartmouth Health Atlas, which compiles CMS data on costs and quality of care.
Although the researchers found that U.S. hospitals increased their computerization between 2003 and 2007, they found no indication that health IT lowered costs or streamlined administration, even in the "most wired" institutions. While U.S. hospital administrative costs increased slightly, from 24.4 percent in 2003 to 24.9 percent in 2007, hospitals that computerized most rapidly actually had the largest increases in administrative costs. (By way of comparison, older studies have estimated administrative costs in Canadian hospitals at 12.9 percent).
The study found no evidence of lagged effects, e.g. lower costs in 2007 resulting from information technology introduced in 2003.
Modest quality gains were noted in the treatment of heart attacks (acute myocardial infarction) in more-computerized hospitals, but even these small improvements may merely represent better documentation rather than actual gains to patients.
Himmelstein said a report from the Congressional Budget Office in 2008 signed by Peter Orszag, now Obama's budget director, expressed skepticism about claims by the RAND Corp. and others that health IT could generate $80 billion annually in savings.
"Part of the CBO's skepticism was based on the limited information available to the RAND study and similar studies," Himmelstein said. "But this new, detailed, national survey of diverse hospitals shows such doubts are well-founded. Information technology can't rescue us from our national health care crisis."
Dr. Steffie Woolhandler, professor of medicine at Harvard and study co-author, said several factors may explain why health IT has failed to reduce administrative costs.
"Any savings may have been offset by the costs of purchasing and running new computer systems," she said. "In addition, most software is designed around the accounting and billing needs of hospitals, not the clinical side."
She noted that a computer success story in recent years has been at the Veterans Administration, where global budgets eliminate most billing and internal cost accounting, allowing physicians to focus instead on delivering care.
"The VA system now has our nation's highest quality and patient approval ratings," Woolhandler said. "Congress should take note: to get the most benefit from our health care dollars and from health IT, we should adopt a single-payer, Medicare-for-all program. Nothing short of that will allow us to reap the full potential of computerization or to provide comprehensive, quality and affordable care to all."
******
"Hospital computing and the costs and quality of care: a national study," David U. Himmelstein, M.D., Adam Wright, Ph.D., and Steffie Woolhandler, M.D., M.P.H., The American Journal of Medicine, Nov. 20, 2009 (online).

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Physicians for a National Health Program is a single issue organization advocating a universal, comprehensive single-payer national health program. PNHP has more than 15,000 members and chapters across the United States.

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Physicians For National Health Program (PNHP) Links:

• Home
• Press Center
• Action Center

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August Doldrums

Local Bias had a guest cancellation and is repeating the interview with May Ristich.
May teaches meditation and spiritual philosophy at the Renaissance Center in Gill Ma.
Our next scheduled guest is singer/songwriter Laura Siersema who is currently promoting her recent CD release "Talon of the Blackwater".
Most of the crew are on vacation and I'll be looking for a couple of volunteers to assist in the August 20th production.
While the TV show has been quiet lately, events in our community continue and I invite readers of this blog to send me notices and columns which I will do my best to post in a timely manner.
Several issues in particular pique my interest: Health Care, Energy policy including efforts to shut down Vermont Yankee, Bio Mass, Tax policy, and yes, the debate about Big Box development. Personally, I want to see Vermont Yankee closed, single payer health care, no Bio Mass facility as presently planned in Greenfield and a return to the progressive tax policies which would help curtail the abuses perpetrated by our financial system.