Category: Single Payer Health Care

Senate Finance Committee Hearing on Expanding Health Care Coverage

“Roundtable Discussion on “Expanding Health Care Coverage”
May 5 , 2009, at 10:00 a.m., in 106 Dirksen Senate Office Building

Over at the PNHP Blog, Don McCanne points out that the voices for single payer are being stifled and excluded because of the view of most in the Congress that it is a politically unviable proposition, though he “respects” their views.

Even more problematic was an exchange later in the hearings between Sen. Pat Roberts and Scott Serota, CEO of the Blue Cross and Blue Shield Association.

Sen. Roberts told the tale of how a group of surgeons and anesthesiologists surrounded him after his knee surgery and told him and said they’d all quit if we went to a national health plan or even, I believe, to a public option and their reimbursements were to be decreased.

I don’t have the transcript, but he went on to say something along the lines of how there was no way to control costs in a national health system and then asked Serota what he thought.

Of course, Serota explained in that patrician way of so many how there was no way in the world to produce high quality and lower costs than we have in the US now with private insurance.

Now, if Sen. Baucus doesn’t want single payer advocates around because he doesn’t think it is politically viable, that is one thing. But what he doesn’t seem to realize is that having a knowledgeable single payer advocate and someone knowledgeable about international comparative health care in the room would have resulted in the particular line of BS that Roberts and Serota were peddling to be swatted down without breaking a sweat.

That is why it is so critical to have a broader range of views at the table. There was no one there willing to point out the obvious: Reducing future surgeons’ income from $500 K to $400 K, for example, will not bring the world to a halt. Essentially every country in the world controls costs and maintains quality at massive savings compared to the disastrously inefficient US private insurance industry.

But there was no one at the table willing to tell them that.

Groups strategize for single-payer plan – Politico.com Print View

Groups strategize for single-payer plan – Politico.com Print View:

“President Barack Obama and Senate Finance Committee Chairman Max Baucus (D-Mont.) rarely pass up a chance to snub single-payer health care — a term that means a government-run system. So opponents on the left who want their voices heard in the debate over health care reform are planning to yell a little bit louder as Congress considers creating a public insurance plan to compete with private insurers.

“Their strategy is simple: By pushing hard for single-payer health care, a robust public insurance option ends up looking like a compromise Democrats could accept.

““The best way to get half the pie is ask for the whole pie,” said Katie Robbins, assistant national coordinator of Healthcare-Now, which will not endorse the public plan but acknowledges the strategy. “It is like horse trading.””
…

“And here is a hint about why proponents and opponents of the public plan talk so frequently about “choice”: It polls really, really well. Support for the public plan jumped to 78 percent when people were told it would give consumers more options. “

Achieving a High-Performance Health Care System with Universal Access: What the United States Can Learn from Other Countries — American College of Physicians, — Annals of Internal Medicine

Achieving a High-Performance Health Care System with Universal Access: What the United States Can Learn from Other Countries — American College of Physicians,:

When we were talking last week about the lack of single payer advocates at last week’s summit, I didn’t realize that ACP was there. The President of the ACP was there, though I don’t know his persoanl feelings about reform, I did go back and look at the recommendations published by ACP last year.

“Paying for Health Care

“Recommendation 1a: Provide universal health insurance coverage to assure that all people within the United States have equitable access to appropriate health care without unreasonable financial barriers. Health insurance coverage and benefits should be continuous and not dependent on place of residence or employment status. The ACP further recommends that the federal and state governments consider adopting one or the other of the following pathways to achieving universal coverage:

“1. Single-payer financing models, in which one government entity is the sole third-party payer of health care costs, can achieve universal access to health care without barriers based on ability to pay. Single-payer systems generally have the advantage of being more equitable, with lower administrative costs than systems using private health insurance, lower per capita health care expenditures, high levels of consumer and patient satisfaction, and high performance on measures of quality and access. They may require a higher tax burden to support and maintain such systems, particularly as demographic changes reduce the number of younger workers paying into the system. Such systems typically rely on global budgets and price negotiation to help restrain health care expenditures, which may result in shortages of services and delays in obtaining elective procedures and limit individuals’ freedom to make their own health care choices. [CMHMD Note: I guess it shows how complicated this all is. ACP considers Japan single payer and France a hybrid sytem, but most consider both single payer. In any case, neither have significant problems with waiting times.]

“2. Pluralistic systems, which involve government entities as well as multiple for-profit or not-for-profit private organizations, can assure universal access, while allowing individuals the freedom to purchase private supplemental coverage, but are more likely to result in inequities in coverage and higher administrative costs (Australia and New Zealand). Pluralistic financing models must provide 1) a legal guarantee that all individuals have access to coverage and 2) sufficient government subsidies and funded coverage for those who cannot afford to purchase coverage through the private sector. (See the ACP’s proposal for expanding access to health insurance as an example of how a pluralistic system can achieve universal coverage [69].)

“Recommendation 1b: Provide everyone access to affordable coverage—whether provided through a single-payer or pluralistic financing model—that includes coverage for a core package of benefits, including preventive services, primary care services—including but not limited to chronic illness management—and protection from catastrophic health care expenses.

“Recommendation 1c: Until there is political consensus for achieving universal coverage at a federal level, Congress should encourage state innovation by providing dedicated federal funds to support state-based programs with an explicit goal of covering all uninsured persons within the state. (See the ACP position paper, “State Experimentation with Reforms to Expand Access to Health Care” [70].)

“[ACP]Comment: Universal health care insurance is necessary to ensure that everyone within the United States has access to needed health care services of high quality. The federal government should assure that all persons within the borders of the United States also have access to health care services without undue financial barriers and that health care services provided are adequately reimbursed. The ACP recommends 2 alternatives: a system funded solely or principally by government (federal and state), commonly known as a single-payer system, or a pluralistic system that incorporates existing public and private programs with additional guarantees of coverage and with sufficient subsidies and other protections to assure that coverage is available and affordable for all. The ACP has proposed a step-by-step plan that would achieve universal coverage while maintaining a pluralistic system of mixed public and private sector funding.”

——————————————

SO, ACP advocates either a single payer model, or a social health insurance model (i.e., a hybrid system) as the path to paying for universal health care. This is where I come down as well. I think it would be very useful if we could get a majority of physicians to accept this either/or approach with the caveat that we vigorously campaign to allow NOTHING LESS than this to be our line in the sand.

Updated:Action Alert: Call The White House: Let Single Payer In | Physicians for a National Health Program

Action Alert: Call The White House: Let Single Payer In Physicians for a National Health Program:

***Update***

The White House has reversed itself and extended invitations for two single payer supporters to attend Thursday’s Healthcare Summit.
Congressman John Conyers, author of HR 676 single payer legislation in the House, and Dr. Oliver Fine, who currently heads Physicians for a National Health Program (PNHP), received invitations on Wednesday.

“On Thursday, March 5, 2009, the White House will host a summit on how to reform the healthcare system.

“The 120 invited guests include lobbyists for various interest groups including the private-for-profit insurance industry (AHIP), some members of Congress including Senate Finance Chairman Max Baucus who has already ruled single payer “off the table,” and various others concerned with healthcare.

“No single payer advocates have been invited to attend.”

A disappointing turn of events. My letter to the White House and Senator Casey (my Senator, who is now on the HELP Committee.)

RE: March 5th Health Care Summit

I am disappointed that Single-Payer Health Care advocates are not going to be represented at the Summitt. If this is because Single-Paye is “off the table,” then I suggest you disinvite all those representing the status quo, as I understand that that option is also off the table.

I personally favor transitioning to Universal Health Care via the Swiss or German Societal health Insurance model, but by not having Single Payer advocates at the table, a vast swath of serious intellectual and scientific thought is cut out of the discussion. This is NOT acceptable if we are to have a serious debate about the faith of Health Care in the US.

Thank you, etc.

To Senator Casey:

Dear Senator Casey,

I was very pleased to see that you have joined the HELP Committee. It represents a very important opportunity to do “to the least among us,” what we would want for ourselves and our children.

I hope you will push for a very strong intellectual debate on health care reform, in particular.

I was very disappointed in a recent decision by President Obama to exclude those who advocate for a Single Payer system in the US from his upcoming Health Care Summit.

If this is because Single-Payer is “off the table,” then I suggest disinviting all those representing the status quo, as I understand that that option is also off the table.

I personally favor transitioning to Universal Health Care via the Swiss or German Societal Health Insurance model, but by not having Single Payer advocates at the table, a vast swath of serious intellectual and scientific thought is cut out of the discussion. This is NOT acceptable if we are to have a serious debate about the faith of Health Care in the US.

Although I do not expect you to be able to change what will happen on March 5th, I hope you will use your position on the HELP Committee to ensure a robust, inclusive debate on health care reform.

Thank you etc.

You can get more details at the PNHP site, including that Rep. Conyers, the sponsor of HR 676 asked to be invited and was not at the PNHP site. And the WH phone numbers.

FORA.tv – Zeke Emanuel: Scrapping the Health Care System

FORA.tv – Zeke Emanuel: Scrapping the Health Care System (Audio only here– You may have to register.)

A lecture done for the Commonwealth Club of California on January 8, 2009.

As in his book, “Healthcare Guaranteed“, he lays out his case for Health Care reform, which is for a social health insurance program. I actually agree with him, and he makes his case well. I think he gets a couple things wrong, in a way that is not helpful.

First, he spends some time being very dismissive of the single payer option. His arguments are two-fold. First, making a system work for 300 million people is impossible. Second, that continuing a fee for service system makes cost control impossible.

I happen to agree that working for a social insurance model is the best way to go, for a variety of reasons, that he covers well.

However, he is almost patronizing of those who advocate for single payer. This wouldn’t be so bad if he hit the mark on his criticisms, but he does not. And it irritates and antagonizes those who would naturally on his side, if he persuaded instead of ridiculed.

Regarding managing 300 million accounts/people/policies: Our current Medicare system does not attempt to manage all of its members within a single entity. Medicare functions as the central agency, but regional carriers handle the day to day operations. And in Canada, the single payer system is broken into manageable chunks by province. There is no reason we could not implement our system in such manageable chunks.

His second argument is that fee for service is the real problem, not insurance company waste, and that we will get the most bang for our buck with payment reform rather than cracking down on insurers.

Maybe there are single payer advocates who advocate for the current reimbursement system, but I don’t know any of them. So, in that sense, it is a straw man, but he really loses me when he he argues that we cannot have high performing, efficient organizations like the Cleveland Clinic or the Mayo Clinic under fee for service. I’m sorry, but those systems operate in a fee for service payment system. They have done some unique things within that system, but they are a model of how to make a fee for service system work properly. So, attacking single payer because it mandates no reform in payment models is silly and it antagonizes people who should be engaged, not belittled.

He additionally makes the case that insurance companies are not to blame for our problems and indicates that most of us would behave as these execs and employees would if placed in the same circumstances. Fine, I’ll concede that, but the problem, single payer advocates point out is that the circumstances are the problem, not the employees. A system that rewards denial of care leads to massive bureaucracies designed to deny care. So, sorry, they are a big part of the problem.

And, while I’m in a critical mood, I do have a problem with suggesting VAT as a method of payment. We already have the most byzantine taxation system in the world. Why add another layer of complexity that will surely be more regressive into the mix. If you want to fund via taxes, fund via taxes. At least the income tax is somewhat progressive. And people are not completely stupid: if you tell them their taxes will go up $8000 but they won’t have to pay $12,000 in health insurance premiums and another $1000 or two or three out of pocket, they’ll get it.

This is intended in a spirit of constructive criticism so that we can advance the debate together.

FRONTLINE: sick around the world: five countries: health care systems — the four basic models | PBS

FRONTLINE: sick around the world: five countries: health care systems — the four basic models PBS:

“These four models should be fairly easy for Americans to understand because we have elements of all of them in our fragmented national health care apparatus. When it comes to treating veterans, we’re Britain or Cuba. For Americans over the age of 65 on Medicare, we’re Canada. For working Americans who get insurance on the job, we’re Germany.

For the 15 percent of the population who have no health insurance, the United States is Cambodia or Burkina Faso or rural India, with access to a doctor available if you can pay the bill out-of-pocket at the time of treatment or if you’re sick enough to be admitted to the emergency ward at the public hospital.

The United States is unlike every other country because it maintains so many separate systems for separate classes of people. All the other countries have settled on one model for everybody. This is much simpler than the U.S. system; it’s fairer and cheaper, too.”

From the truly terrific PBS/Frontline site for “Sick Around the World”

Single Payer Debate at Duquesne U, 3/10/08

SEPP Organization – SEPP Events

(The link above takes you to the details of the event.)

I attended the debate last night among Dr. Scott Tyson and Gariel Silverman, arguing the single payer case, and Sue Blevins and Nameed Esmail, arguing against at Duquesne University last night. First, props to Duquesne: Great venue in the Power Center, easy parking, nice facility all around. And props to both groups for getting attendance to a surprisingly high level (over 200, I’d guess). Pro-single payer were in the majority, I’d guess, by a significant amount.

I’ll cut to the chase: Jerry Bowyer, moderator, at the end of the evening, asked if the discussion had changed anyone from their pro or anti single payer or undecided camps, and only a handful of hands went up. Sigh. But, not, of course, unexpected.

To those of us who are familiar with the issues and arguments for and against single payer, and familiar with the players (esp. Mr. Esmail’s Fraser Institute), there were not many surprises. My most pleasant surprise was Dr. Tyson’s excellent performance. Powerful, personal and passionate, Dr. Tyson did a very good job of making the moral, practical and economic case.

As my bias is obvious, I won’t pretend to disguise it. I found the same old arguments from the status quo/free market/every man for himself side very tiresome indeed. I’ll just toss out a few “highlights.”

Single Payer advocates see Canada as a Panacea solution for America’s woes. I don’t know of any, but it somehow forces single payer advocates into the silly position of defending Canada’s system, even though it is not the one we would emulate. From now on, we should respond to the Canada graphics with ones comparing us to Germany, France, Belgium, Japan, or almost anyone, and leave Fraser to shit on their own country as they seem wont to do. Heaven forbid they offer constructive solutions. And by this, I mean ones that at least 30 or 40% of the Canadian population would at least consider.

Showing a spending chart showing Canada at the high end of spending on healthcare compared to the rest of the world, and omitting the US, cause we’re so off the charts as to make the chart look laughable.

Arguing that taxation sufficient to pay for healthcare would strangle economic growth. This is just too brain-dead to answer, especially sitting in a country that spends 16.5% of its GDP on healthcare. And especially from an economist who said, specifically, that there is no “government money” only our money in government’s hands.

Waiting times in Canada are intolerable and/or deadly. Please click here.

$32 Billion in Medicare fraud annually is an outrage and a scandal. I don’t know the source or veracity of this figure, but the 2006 Medicare expenditures were $408 billion, meaning 92% of the money gets where it’s supposed to, which needs work, but isn’t awful. And the suggestion that I think Ms. Blevins made was that she preferred private insurer’s solution: deny care first, and then sort out who was trying to scam you, rather than covering claims in good faith and then going after the perps. I’m all for getting the perps, but not until I’ve made sure the patients are taken care of first. Silly me.

Patients in Canada often have to wait 10 or 12 hours to get a hospital bed when admitted through the ER. Imagine our shock. (He did know Pittsburgh was in America, right?)

Veterans Administration hospitals are horrible places. Dr. Tyson did try to set Ms. Blevins right on this one, though I think she didn’t believe him.

You cannot pay for treatment in Pennsylvania outside of your contract with your health insurer.
This one got my attention. I hope somebody will post a comment for me about it, because I’d never heard this before, and it seems exceedingly odd.

The usual “anecdote-off,” for which I’ll just refer you to our special section.

I was pleased to see Mr. Esmail’s praise of other systems, particularly those of Switzerland, Japan, France, Sweden, Germany and some others. He rightly pointed out that the old PNHP proposal, from 1993, was fairly beholden to the Canadian model, but there are newer proposals from PNHP, and besides, they are not the only proposals out there. As has been often pointed out by our side, and always ignored by theirs, we need a uniquely American system, pulling from the best of all other extant systems. Though Mr. Esmail did seem gratified to sear Dr. Tyson say this, I doubt it was the first time he heard it. (You don’t suppose he didn’t watch Sicko, even as an academic exercise?) Oh, and Esmail even admitted we were rubbish for Mental Health care, too.

Oh, and a personal shout out to Scott Tyson for his wonderfully dismissive treatment of HSAs. Made me chuckle and even snort a bit!

OK, folks, that’s all I can remember at this late hour, but please add your comments to remind me of things I forgot to mention….

Cheers,

Evening Sun – Universal health care: Advocate discusses Pennsylvania single-payer plan

Evening Sun – Universal health care: Advocate discusses Pennsylvania single-payer plan:

“‘The only way (health-care reform) can happen is if concerned citizens learn the facts and get their representatives to do the right thing,’ she said.

The Family and Business Health Care Security Act needs 102 of 203 votes in the House, 26 of 50 in the Senate, and the governor of Pennsylvania to approve the bill in order for it to become law.

Pennachio says this is an easy bill to pass if the citizens want it. He said community members should lobby their state legislators and make them aware that that they support the bill.
For more information, visit http://www.healthcare4allpa.org.”

Just wanted to get that link in there at the end…

Health Insurance: It’s Always Something, Isn’t It?

“So long as insurance companies are for profit enterprises, their goal will not be the best health care possible. It will be this — not paying claims. That is the truth of it, because that is how they profit. For real change, we need better, smarter folks elected to represent OUR interests, not just the lobbyists and insurance companies.”

Nice post to add to our “anecdote-off” section, but it also leads to some good posts by Ian Welsh:
On Healthcare and Social Justice:
http://firedoglake.com/2008/01/12/morality-and-health-care-in-the-us-let-the-lazy-buggers-die

If you follow the link to Digg on this one, the Ayn Randers are out in force. It occurs to me that they represent the only philisophical school on the planet that rejects social justice in any way, shape or form. So, how some of them still delude themselves into thinking they are Christians or Jews or aven secular humanists is amazing.

And on why we don’t do something about heathcare (and drug policy and…):
http://firedoglake.com/2007/05/14/hard-and-complicated-arent-synonyms

Cheers,

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WSJ.com – Commentary: Edwards and Organ Transplants

Argues that because Americans are more likely than Europeans to get a transplant, and more likely to survive it too, that this would not be possible in an American Single Payer system.

The author argues that, “Organ transplantation, like many areas of medicine, provides a poor basis for his political thesis that single-payer health care offers a more equitable allocation of scarce resources, or better clinical outcomes.”

He is partially correct; a high tech treatment like organ transplant is not a good way to decide how to reform American Health Care. The staunchest advocates for Single Payer Healthcare never, ever, disparage American medicine’s ability to deliver the best care in the world in areas such as organ transplant, trauma, intensive care and other high tech endeavors. But these areas are only a sliver of overall clinical outcomes. Even at the quoted 18.5 liver transplants per million done in the US annually, this is only 5000 or so patients. So, while not being dismissive of these patients, they are not reflective of healthcare outcomes of our population. They only reflect what we already know: We spend tons of money on advancing high tech medicine and we are darn good at it. As I view the transition to single payer, I see no reason, other than “conservatives” wailing about unnecessary spending on healthcare as the system matures, for us to continue to do well in our “American specialty” of bleeding edge healthcare.

Yet, the point about a single payer system not offering a more equitable allocation strikes me as intuitively, obviously false, and I don’t believe the author tries to refute the point other than pointing out that we do more liver transplants in the US than elsewhere. A strange point is also made about the threat of the government deciding who gets the organs. I think most of us would gladly take a standard set of criteria developed by the NIH, UNOS, or other agency, applied fairly and equitably across all socioeconomic and ethnic categories by a Medicare-like agency, rather than the inherently conflicted interests of a private insurer!

And finally, since we spend twice as much on healthcare, shouldn’t we do twice as much of everything, not just liver transplants? Preventive care and prescription drug benefits come to mind immediately, but you can pick your own favorite.

Cheers,

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