Insurance, health interests fill Baucus' coffers

By Mike Dennison, Billings Gazette, State Bureau, published June 14

As Sen. Max Baucus has taken the lead on health reform legislation in the U.S. Senate, he also has become a leader in something else: campaign money received from health and insurance industry interests.

In the past six years, nearly one-fourth of every dime raised by the Montana Democrat and his political action committee has come from groups and individuals associated with drug companies, insurers, hospitals, medical supply firms, health service companies and other health professionals.

These donations total about $3.4 million, or $1,500 a day, every day, from January 2003 through 2008.

Baucus, who chairs the Senate Finance Committee, which is drafting a major health care reform bill this month, insists that this cascade of money is not unduly influencing his work.

"No matter the issue, Max always puts Montana first," said his spokesman, Ty Matsdorf. "Max will continue to do what's right for our state, and groups like SEIU (a union representing thousands of health care workers) and AARP (a senior citizens' group) wouldn't line up in support of his health care reform effort if this wasn't true."

Baucus' office also lists numerous examples of how his proposed reforms are challenging the health care and insurance industries, such as requiring insurers to accept all customers, regardless of health condition.

Yet some reform activists and others who watch the political system say it's foolish to think this money doesn't hold some sway.

"When you spend so much of your time raising money, as members of Congress do, from those who have a compelling interest in the outcome of legislation, it has to change what you think about it, and the viewpoints that you have," said David Donnelly, director of Campaign Money Watch, a Washington, D.C., group that tracks money in politics. "It's just human nature. ... and members of Congress are human."

Advocates of national, public health insurance for all -- a proposal largely excluded from the health reform debate -- say their exclusion points to the power of moneyed interests in Congress.

"I'm convinced that this (money) has a profound influence," said Quentin Young, national coordinator for Physicians for a National Health Program. "Otherwise, how could Baucus, an otherwise respected and wise politician, say categorically that single-payer (national health insurance) is off the table?"

Only Baucus' Republican counterpart on the Finance Committee, Sen. Charles Grassley of Iowa, rivals him in terms of percentage of funds from these business sectors.

The Gazette State Bureau examined fundraising data for Baucus, Grassley, Sen. Edward M. Kennedy (who chairs the Senate Health Committee, which is drafting health reform legislation), the other two members of Montana's congressional delegation, and President Barack Obama.

The data are compiled by the Center for Responsive Politics, a nonprofit group that tracks and sorts campaign donors by profession and industry. Here's a summary of what the State Bureau discovered:

From 2003 to 2008, the Baucus campaign and his Glacier PAC, which raises money and distributes it to other candidates, received 23 percent of their $14.8 million from health care and insurance interests.

The $3.4 million from these sectors includes $853,000 from pharmaceutical and health products, $851,000 from health professionals, $467,000 from hospitals and nursing homes, $466,000 from health service and HMO interests, and $784,000 from insurance.

The insurance sector money includes donations from all types of insurance company interests, including health insurance.

• Five of the top 10 specific donor sources for Baucus were drug companies, health insurers or health-related firms. For example, employees of Schering-Plough Corp., a major drug firm, gave him $92,000 over the period, more than any other single source.

• Grassley, the highest-ranking Republican on the Finance Committee, received 23.5 percent of his funds from health and insurance interests but a lesser dollar amount than Baucus ($2.3 million out of $9.8 million total funds).

• Kennedy, a Massachusetts Democrat and a longtime advocate of health care reforms, received only 7.5 percent of his funds from health and insurance interests, or about $1.2 million.

• Sen. Jon Tester, D-Mont., and Rep. Denny Rehberg, R-Mont., had minimal contributions from the health and insurance sectors.

• Obama, whose campaign raised a whopping $745 million in 2007 and 2008, received a relatively small share from health care interests ($19 million, or 2.5 percent) and insurance interests ($2 million, or 0.3 percent).

Baucus has been leading the charge on health care reform in the U.S. Senate since early 2008, holding numerous hearings and Finance Committee meetings on the issue. He released a lengthy "white paper" last November, outlining his reform ideas, and a major bill is expected to be introduced this month.

The general thrust of his proposals is to require all citizens to buy health insurance while also forcing the private insurance industry to stop practices that make coverage unaffordable for many. He supports subsidies to those who may have trouble affording insurance.

However, on a reform bitterly opposed by the insurance industry and most health care interests - a public, nonprofit insurance plan offered by the government - Baucus has been more ambivalent, saying he supports the idea but declining to specify in what form.

Baucus's office supplied nearly 20 examples of stances he has taken in direct opposition to drug, insurance and banking interests that have donated to his campaign funds.

He has supported importing lower-cost prescription drugs from Canada, allowing the government to negotiate for lower drug prices for Medicare recipients, funding research that would show when generic drugs are a better deal than brand-name drugs and reducing Medicare payments to private insurers by $13 billion over five years.

His office also points to an April 2007 Wall Street Journal article in which Baucus was quoted as telling medical industry contributors at a fundraiser, "You should worry about me coming after you."

Donnelly, the Campaign Money Watch director, says the proof on health care reform will be in the final product - and that he's not terribly optimistic.

Health and insurance interests are clearly targeting Baucus and his Finance Committee, which often have shown themselves to be receptive to their influence, he said.

"This debate on health care is a microcosm ... that even after a 'change' election, how much the special interests view (Washington) as their fiefdom," Donnelly said.

Supporters of national health insurance are even less optimistic, noting how Baucus, Obama and leaders in Congress won't even consider their proposal, which they believe would have broad public support.

"I can't think of any reason other than fidelity to your donors, to explain why they would keep us out of the debate," said Young of the physicians group. "Until we get campaign finance reform, it will be very difficult to do anything to challenge the status quo (in health care), and the status quo had better be challenged, because it's a very bad status quo."

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Up in Smoke: Health insurers hold billions in tobacco stocks

by Desiree Evans, published at Facing South, the Journal of the Institute for Southern Studies

A recent study published in the New England Journal of Medicine found that major U.S., Canadian and British life and health insurance companies are investing billions of dollars in tobacco company stock.

Researchers first revealed that health and life insurance companies had major investments in tobacco companies in 1995 in an article in the British medical journal Lancet. More than 10 years later, insurance companies are still deeply invested in "big" tobacco, despite the national calls upon them to divest.

"Despite calls upon the insurance industry to get out of the tobacco business by physicians and others, insurers continue to put their profits above people's health," said Wesley Boyd, the new report's lead author and a faculty member of Harvard Medical School. "It's clear their top priority is making money, not safe-guarding people's well-being."

The report found that seven health and life-insurance companies in both the United States and overseas have nearly $4.5 billion invested in companies whose affiliates produce cigarettes, cigars and chewing tobacco.

"Although investing in tobacco while selling life or health insurance may seem self-defeating, insurance firms have figured out ways to profit from both," Boyd said. "Insurers exclude smokers from coverage or, more commonly, charge them higher premiums. Insurers profit -- and smokers lose -- twice over."

The study highlights New Jersey-based Prudential Financial Inc., which sells life insurance and long-term disability coverage. With total tobacco holdings of $264.3 million, Prudential Financial is a major investor in three tobacco firms, including America's biggest cigarette maker, Virginia-based Philip Morris.

Health advocates point out that these private, for-profit insurers have repeatedly put their own financial gain over the public's health. "It's the combined taxidermist-and-veterinarian approach: either way, you get your dog back," study co-author David Himmelstien explained. "If you own a billion dollars [of tobacco stock], then you don't want to see it go down, you are less likely to join anti-tobacco coalitions, endorse anti-tobacco legislation, basically, anything most health companies would want to participate in."

Moreover, healthcare advocates point to this study as another reason why health insurance coverage should not be left in the hands of private insurers. Himmelstein asked, "Is this who we want running our health care system?"

Going Down Tobacco Road
Worldwide, tobacco is considered the leading cause of lung cancer and a major risk factor for heart attack, stroke, pulmonary disease and cancer. It is the leading cause of preventable deaths, and the leading cause of cancer deaths among men and women, according to U.S. and world health officials. Each year, about 443,600 people in the United States die from tobacco-related illnesses, and worldwide it is a contributing factor in 5.4 million deaths a year. Tobacco kills more Americans than alcohol, car accidents, suicide, AIDS, homicide, and illegal drugs combined, according to the American Cancer Society.

Tobacco is an issue that the South knows a lot about, considering the region's historical dependence and ties to the tobacco industry. Experts have shown that strong economic and cultural ties to tobacco in the South have often correlated with high rates of tobacco use. While cigarette consumption has been declining and is expected to continue to decline nationwide, the consumption of smokeless tobacco - snuff and chewing tobacco - has actually increased over the past decade, especially in the South. Several Southern states lead the nation in smokeless tobacco use, including West Virginia, Alabama, Kentucky, North Carolina, South Carolina, Tennessee and Mississippi. Yet, research has shown that smokeless tobacco can be just as dangerous as cigarette smoking. Not only can it lead to mouth cancer, smokeless tobacco may also play a role in other cancers, heart disease and stroke.

Several of the Southern states that lead in smokeless tobacco use and have traditional ties to the tobacco industry also comprise what health experts have come to refer to as the "stroke belt" - a swath of states that include North Carolina, South Carolina, Georgia, Tennessee, Alabama, Mississippi, Arkansas, and Louisiana. Americans living in this region have a 15-percent higher stroke risk, and the death rate from stroke is 30 to 40 percent higher than in the rest of the country. Health experts suspect that tobacco use could be one of the contributing behaviors leading to these high rates.

Sweeping Legislative Changes around Tobacco
This has been an exciting week for health advocates. Sweeping changes in how the government controls tobacco are likely to be approved by the Senate despite strong opposition from tobacco interests and the tobacco lobby. The U.S. Senate is set to vote on new laws that for the first time will permit the Food and Drug Administration to regulate the production, sale, and marketing of tobacco products, including limiting how much nicotine is in each cigarette, and banning advertising and marketing aimed at children.

Tobacco regulation has been a long, hard fought for cause due to the power and influence of "big " tobacco and its lobby. Congress has been trying for more than a decade to give the FDA powers over tobacco products, particularly after a 2000 Supreme Court decision that the FDA could not regulate tobacco unless Congress changed the law.
 
A final vote on the bill is expected Thursday, and Democrats say they have enough votes to win final passage. The House passed a very similar bill earlier this year, and resolution of the minor differences would send the bill to President Obama, who supports it. The lone Democrat voting against the move to end debate on the bill Wednesday was Senator Kay Hagan, the newly elected official from North Carolina, one of the historically recognized tobacco growing states.

Supporters of the legislation, including health advocacy groups, have linked reducing the financial costs of tobacco illnesses, about $100 billion a year, to the overall drive to improve the healthcare system. The bill's opponents have voiced concerns that the changes could prove costly in tobacco-growing states such as Kentucky and North Carolina.

Single-Payer Off the Table?
A step forward and a step back, some say. While health advocates celebrate the changes in tobacco laws, the health reform debate of the last couple of months has instead left health advocates with much to be desired.

Currently, the Obama Administration is pushing Congress to pass a healthcare reform bill by the end of the year that would cover most of the nation's 47 million uninsured. As Reuters reported:

Obama has declared this summer "make-or-break" time for healthcare reform and has called on Congress to pass comprehensive legislation by the end of the year, saying America can no longer afford the costs of a system dominated by profit-driven insurance and healthcare companies which leaves 46 million people uninsured.

Though he is leaving the details to Congress, Obama has said reform must ensure a public health insurance option operating alongside private plans, a reduction in basic costs, and assurance that no one is denied insurance.
But healthcare reform advocates are upset that lawmakers have taken a "single-payer" plan off the table. For years health advocates have been calling for a government-financed nationalized health plan - in the form of single-payer legislation. Even though most physicians, health officials and health advocates support single-payer legislation, the option has been excluded from the current debate in Congress. In a single-payer system, as envisioned by most advocates, the federal government would pay for basic medical care delivered by public and private health professionals. The money would come from taxes, and medical bills would go directly to a government insurance plan, similar to Medicare.

Last month, single-payer advocates took to the streets across the country to protest the exclusion of single-payer medical plan from the debate to revamp the nation's troubled health system. During Senate Finance Committee hearings in May, 13 doctors, nurses, lawyers and activists stood up to complain that no single-payer proponent had been invited to take part and were arrested for disrupting the proceedings.

The Harvard doctors involved in writing the recent study published in the New England Journal of Medicine also support a single-payer plan and point to their report as just another reason why health insurance coverage shouldn't be left in the hands of private insurers. Boyd and his colleagues also believe that their findings call into question whether insurers ought to have a voice in the ongoing debate in Washington over healthcare reform.

As they write in their letter published in NEMJ:
"The Obama administration is proposing a major overhaul of the U.S. health care system, and the insurance industry is poised to play a major role in the process. Insurance firms, like any business, are driven by profit, and this fact compromises any health care plan that includes them. In case there is any doubt that insurers place profit above health, consider their investments in tobacco.
...
These facts should discomfit Canadian and British readers as their countries consider further privatization of health insurance. For those of us in the United States, these data are a reminder of the true priority of the insurance industry, which is making money, not ensuring health and wellbeing. These data raise a red flag about the prospect of opening vast new markets for private insurers at public expense, as has happened in our state of Massachusetts, whose recent health care reform is often cited as a model for national reform.
Not only have health insurers and drugmakers contributed millions of dollars to members of Congress, but the powerful private health insurance lobby, along with other corporate and political interests, have been derailing efforts at healthcare reform for years. Observers say this intense lobbying is likely the reason the single-payer option has been largely dismissed from the healthcare reform debate.

Currently Democrats are debating several alternative options for "public" plans, some of which could include a government-financed purchasing pool that people could buy as an alternative to individual health policies offered by private insurers. Private insurers would play a role in all of the proposed plans.

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Single payer health care is the only way to control costs

by Dr. Peter Mahr
Our current healthcare system is a mess for both those who carry health insurance and those without. Only a single payer national health insurance program that provides public financing for privately delivered healthcare services can clean up this mess and provide all Americans access to needed medical services regardless of ability to pay.

In a study released last week we learned that healthcare debt contributed to 62% of personal bankruptcies in 2007. And, surprisingly, 77% of those going bankrupt were insured when they first fell ill. The same year 47% of Americans reported some medical debt or payment problem and 16% of Americans had been contacted by medical debt collection agencies. Despite spending 16% of GDP on healthcare and increases in insurance premiums that dwarf growth in family income, millions are left bankrupt and 50 million more are uninsured. These figures highlight, in the starkest terms, how broken our employer-based private for-profit health insurance system is.

For all our money spent, the result is a fragmented complex healthcare system with poor outcomes. We are far behind other industrialized nations in terms of public health measures. Regional healthcare spending varies dramatically and has more to do with how many doctors there are per capita than other factors. The United States performs poorly on benchmark measures of preventative care and our management of chronic illness mirrors our chaotic and disorganized payment system. We consistently fail to meet evidence-based guidelines for chronic illnesses like diabetes and chronic lung disease.

At the same time business is booming for those who profit from healthcare. From 2003- 2007, the profits of the nation’s largest insurers rose 170.2 % to $12.6 billion. Pharmaceutical companies continue to gross billions of dollars with the top ten firms profiting a total of $75 billion in 2008. For-profit hospital chains and dialysis centers make millions while delivering worse outcomes when compared to non profit alternatives. Surgical sub-specialists make 3-4 times what generalists make.

So what do we do with a healthcare non-system that is a big money maker for insurers, some hospitals and the pharmaceutical industry but leaves one in seven people lacking insurance and most with insurance that is too costly and inadequate? How do we repair a delivery system that is expensive, focuses on moneymaking services rather than primary and preventative care and has little emphasis on evidence-based medicine?

Clearly the solution is to adopt a single payer national insurance program: publicly funded and privately delivered. We already pay for our current system with out of pocket payments and taxes.

Personal income taxes pay for Medicare, Medicaid, public employee health insurance, tax breaks to employers who provide health insurance to their employees and healthcare coverage for military personnel and veterans. The sum total comes to 60% of our total health insurance costs. In essence, we are paying for national health insurance now. We just aren’t getting it. Instead, a single payer system would use tax dollars to provide true comprehensive healthcare coverage for all.

Furthermore, a single payer system is the only reform proposal that would drastically reduce the staggering administrative costs that accompany our private insurance industry. Profit margins, overhead and administrative costs associated with our current private insurance industry remove $350 billion from the healthcare system each year. In reducing administrative costs a single payer plan would save enough money to cover the 50 million uninsured.

Single payer health insurance also holds great promise for reforming the delivery of healthcare. With single payer, a reimbursement system can realign the delivery of healthcare services from one of maximizing profit to one in which we maximize health. Reimbursement for primary and preventative care can be emphasized while specialist and end of life care can be more rationally utilized. Regional spending can be leveled. And a one payer system can bargain effectively with the pharmaceutical
industry, driving down medication costs which currently add $98 billion a year to the cost of our healthcare system.

In short, only a single payer system that eliminates for-profit, private health insurance can generate the cost savings to pay for a truly universal healthcare system. And, only a single payer system, with the tools of bulk purchasing, negotiated fees and global purchasing, can realign our delivery system to emphasize primary preventative care while bringing sanity to our skyrocketing healthcare s pending. A majority of the public and a majority of physicians support the adoption of single payer health insurance.

Now is our chance to embrace true reform.

Dr. Mahr is a family physician who works for the Multnomah County Health Department at East County Health Center in Gresham, OR. He is also chairman of the Portland Oregon chapter of Physicians for a National Health Program.

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Max Baucus, the "Senator for K Street," Should Not Be Deciding Health Care for America

by Kevin Zeese. Published by the Baltimore Chronicle on May 31

Why aren’t single payer advocates allowed to testify before Baucus’ committee? Follow the money.

Senator Max Baucus and the Senate Finance Committee are too corrupted by corporate health industry profiteers donations to give America the health care policy it needs.

Health care is 15% of the U.S. gross domestic product. U.S. health care expenditures, which have been rising rapidly for several years, surpassed $2.4 trillion in 2007, more than three times the $714 billion spent in 1990. The cost of health care is projected to reach $4.4 trillion by 2018. There is a lot of room for corporate profiteering in the increasing cost of health care. The millions the health care industry has invested in Baucus and the Senate Finance Committee could therefore turn out to be very profitable.

It is evident that any bill that comes out of the Senate Finance Committee will be a pro-industry bill that will ensure trillions in profits for the health insurance industry, HMOs and the pharmaceutical industry.

Baucus has held two hearings so far and has refused to allow advocates for the most popular reform—a single payer national health policy—to even testify. Single payer "improved Medicare for all" is favored by more than 60% of Americans as well as majorities of doctors, nurses and economists. It is the most cost-effective and efficient way to provide health care to all Americans from cradle to grave.

Why aren’t single payer advocates allowed to testify before Baucus’ committee? Follow the money. Campaign donations explain why, and demonstrate that the Senate Finance Committee should not be in charge of health care. Senator Reid should remove the health care reform bill from Baucus and start all over before the Health Committee in the Senate.

Here’s why Baucus is not doing the people's business:

According to OpenSecrets.org, over his career he has taken donations from:

* The Insurance Industry: $1,170,313
* Health Professionals: $1,016,276
* Pharmaceuticals/Health Products Industry: $734,605
* Hospitals/Nursing Homes: $541,891
* Health Services/HMOs: $439,700

Baucus has shown his bias and should be removed from leading the health care reform effort by the Democratic Party leadership.

That is a grand total of $3,902,785. Can we trust Baucus to put aside the profits of the industries that have kept him in the Senate? Will he put the people’s necessities ahead of the profits of his contributors? Baucus has shown his bias and should be removed from leading the health care reform effort by the Democratic Party leadership.

In 2008 Baucus had virtually no challenger in Montana. A little-known Republican was on the ballot, and Baucus won with 73% of the vote. But, Baucus sought big donations from big business anyway. He used his connections to corporations with business before his committee to raise an immense campaign fund of more than $11 million. In 2008, 91% of his donations come from individuals living outside of Montana, which is why he is more the “Senator for K Street” then the Senator for Montana. Corporate health profiteers who invested in Baucus will now benefit from his stewardship over health care reform. His 2008 donations from health care profiteers included:

* Insurance: $592,185
* Health Professionals: $537,141
* Pharmaceuticals/Health Products: $524,813
* Health Services/HMOs: $364,500
* Hospitals/Nursing Homes: $332,826

That is $1,826,652 Baucus took from these industries, and now he can reward them by deforming health care reform.

The health care profiteers knew that Baucus would determine their fate and ponied up. Now the only thing standing between them and their payback is a single payer national health care plan. Yet single payer, which would end private insurance and control the cost of pharmaceutical drugs, is not being considered—not even allowed to participate in the conversation before Baucus.

It is not just the chairman of the committee who has received massive donations. The full Finance Committee is a gluttonous embarrassment of campaign pay-offs. In 2008 the committee members received a total of $13,263,986 from industries affected by health care reform. Can we trust this committee to put the interests of the people before their donors?

The donations to the Finance Committee in 2008 included:

* Insurance: $5,103,900
* Pharmaceuticals/Health Products: $3,308,831
* Hospitals/Nursing Homes: $2,809,353
* Health Services/HMOs: $2,041,902

These industries expect to be rewarded with billions, even trillions, in profits and hundreds of millions in corporate welfare. Senator Baucus’s behavior shows they have made a good investment—they've bought themselves a senator who should be called Chairman Blagojevich. He is doing his best to make sure the single payer message is not heard because he knows it is the fairest, most efficient and cost-effective way to ensure health care access for all Americans—but he can't let that be implemented because it would put some of his donors out of business and control the profits of others.

It is time to remove Baucus from the leadership of health care reform. It is time to move the critically important priority of reforming America’s health care system from the Finance Committee and put it before the Senate Health, Education, Labor and Pensions Committee. At least their mission is health care, not money.

Kevin Zeese is the executive director of the FreshAirCleanPolitics.net, which is urging a single payer national health care system as part of its ProsperityAgenda.US project. Along with seven others, Zeese was arrested when he testified from the audience of a recent Senate Finance Committee meeting on health care. See the video on YouTube.

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Doctor Critical of Baucus Promotes Single-Payer Plan

by Mike Dennison. Published on June 6 by The Billings Gazette (Montana).

Maryland psychiatrist Carol Paris is calling herself one of the "Baucus 13" these days - in other words, one of the 13 doctors, nurses and activists arrested last month while protesting before a Washington, D.C., health reform hearing chaired by Sen. Max Baucus, D-Mont.

On Friday, Paris was in Montana, doing what got her arrested: urging Baucus, Congress and the president to consider a single-payer system of national health insurance that covers all citizens equally.

Psychiatrist Carol Paris, one of 13 people arrested last month while protesting before a health-reform hearing chaired by Sen. Max Baucus, spoke at a rally Friday in Helena in favor of single-payer insurance. (Eliza Wiley Independent Record)

"The next 60 days are critical," she told a rally of 150 single-payer supporters in Helena. "We need to keep the heat on Sen. Baucus (and Congress and the president)."

Single-payer advocates held rallies in six Montana cities on Friday.

Paris, 56, is a member of Physicians for a National Health Program, whose 16,000 members are pushing for a national, publicly funded insurance plan that would replace private health insurance. The group paid for her trip to Montana.

In an interview Friday with the Gazette State Bureau, Paris said she used to believe that the private health insurance market could be reformed to improve health care, and she spent several years lobbying the Maryland Legislature.

"After a few years, I came to the conclusion that it was just a phenomenal waste of time," she said. "At that point, I just said, there has to be a better place for me to put my time and energy."

That was just six months ago, when she joined PNHP, to push for a single-payer system.

But Paris and other Maryland-area members found themselves basically ignored by Congress. They planned to protest - and get arrested - at a Senate Finance Committee hearing on health reform, chaired by Baucus.

Paris and her colleagues showed up the morning of May 5, spread themselves among the gallery and, one by one, interrupted Baucus as he started the meeting.

"I interrupt this so-called public hearing to bring you the following unpaid political announcement: Put single-payer on the table," Paris said before she was arrested. "My name is Dr. Carol Paris, and I approved this message."

Capitol police arrested the protesters, who have been charged with disrupting Congress.

Baucus, a key senator in drafting health reform legislation, said last week that he'll ask that the charges be dropped. He's said repeatedly that a single-payer system won't be considered as a reform and is backing changes that maintain private health insurance.

Baucus spokesman Ty Matsdorf said Friday that the senator and single-payer advocates have the same goal of providing "quality, affordable health care to every American," and that Baucus is confident that Congress will pass meaningful reform to "make this goal a reality."

Paris, however, said her experience in private practice has convinced her that true reform can happen only if private health insurance is replaced with national, public insurance for all.

No longer would physicians' staff have to spend hours dealing with multiple insurers on billing, no longer would patients have to do the same, and no longer would patients have to worry about which doctor is "in network," she said. "You can go to any doctor you want," Paris said. "It's the private insurance industry where you can't go to any place you want."

Paris's arrest was covered prominently by her local newspaper but received little or no attention from national news outlets.

She said she's not surprised: "The mainstream, national media have blacked us out as much as Congress has. ... I would say they're following the lead of the president and Congress and simply not giving us a voice."

Yet Paris said the reaction from her patients, as well as many fellow physicians, has been overwhelmingly positive.

She said she hears "over and over and over again" how people are frustrated by the current system, particularly dealing with their insurer, and that as soon as they understand how single-payer would work, they usually support it.

"I think that the only thing that keeps this from happening is the lack of political will by the president and our Congress," Paris said.

© 2009 Billings Gazette

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Facing Down the Private Insurance Industry

by Robert Kuttner. Published on June 4 by The Boston Globe
Despite budget pressures, President Obama has not backed off his commitment to universal healthcare reform. But the devil is in the details. And if he is not careful he could end up with a reform worse than nothing.

A crucial question is whether the law will include a public, Medicare-style plan. This public plan could be used by people who otherwise lack good insurance, or by employers who conclude that the public plan is a better deal for themselves and their workers.

The public plan would be the gold standard of both good coverage and cost-containment. Without the public option, a system to cover everyone by relying on the existing private insurance industry will realize few cost savings. The result would be increased pressures over time to cut care and shift out-of-pocket costs from insurers to consumers.

The administration's projections have relied heavily on the supposed savings of better use of computerized medical records. However, absent a single unified system, or a strong public option, better computerization will not realize major savings.

The US healthcare system is the most expensive and least cost-effective in the advanced world mainly because private insurance companies waste about 25 cents on the dollar on claims, profits, administration, and marketing. They have no serious financial incentives to emphasize prevention, and every possible incentive to avoid sick people. Doctors and hospitals, meanwhile, make their money from increasing costs.

Other countries get better results at lower cost because a universal system naturally emphasizes wellness and prevention, and spends its money on the most cost-effective treatments, not the most expensive ones. Every nation faces similar inflationary pressures because of advances in technology and an aging population; but other advanced countries, using single-payer systems, do a fine job of covering everyone for 10 percent of gross domestic product or less, while we spend upwards of 15 percent and leave out nearly 50 million souls and under-insure tens of millions more.

Obama's plan is a variant of an astute strategy first proposed by the political scientist Jacob Hacker as a solution to two political obstacles to health reform. First, how do you enlist the uninsured and the anxious insured in the same coalition? Second, how do you build momentum for a single-payer system recognizing that there are not the votes to legislate it all at once?

Hacker's insight was that if the government offered a public insurance option, people who liked their present private insurance could keep it, while others could elect the public plan. Coalition problem solved. And the superior efficiencies of the public plan would gradually overtake the rival private plans. Momentum problem solved.

But Hacker neglected one key political detail - the immense power of the private insurance industry. Not surprisingly, the industry's stance is that any public plan must compete on disadvantageous terms. And most Republicans oppose a public plan outright.

Obama, the great conciliator, has chosen to work with the private insurance industry rather than targeting it as the primary obstacle to meaningful health reform. Periodic leaks from the White House suggest that if push came to shove, Obama would ditch the public plan in order to get a bill through Congress.

Senator Max Baucus of Montana, chair of the Senate Finance Committee, is no enthusiast of a public plan. After the New York Times last week reported Baucus sparring with Senator Ted Kennedy on whether to include a public plan, the two senators quickly cobbled together a statement insisting they were really in harmony.

However, in the push to get legislation in the face of fierce industry and Republican opposition, a good public plan could well be tossed overboard. That would leave a legacy of expanded coverage, but a time bomb of exploding costs, underinsurance, and a squeeze on actual care.

I would much rather see Obama battling for public health insurance, making it clear to Americans that the obstacle to real reform is the private health insurance industry. That, however, is not the president we have.

We'll see what kind of public plan, if any, survives.

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Media Quarantine of Single-Payer Continues: Fifteen Years Later, Public Health Insurance Still Taboo

by Julie Hollar & Isabel Macdonald. Published on Thursday, June 4, 2009 by Extra!, a publication of Fairness and Accuracy in Reporting. Reposted on Commondreams.org

As a big healthcare policy debate looms once again in Washington, one thing remains as certain as it was in 1993: A single-payer plan that would provide government health insurance to everyone is off the media agenda.

CNN senior medical correspondent Elizabeth Cohen recently explained why healthcare "reform" is more possible now than it was under the Clinton administration (3/5/09): "Fifteen years ago you sometimes heard-actually you heard quite a bit-people saying: 'Let's have a single-payer system like in Canada. The government is going to be the health insurer for everybody.' You don't hear that as much as you used to. So more people are on the same page more than they once were."

Cohen is right that there were many people in favor of single-payer 15 years ago; as Extra! pointed out back then (7-8/93), polls consistently found majorities supporting tax-financed national health insurance. And the numbers today? A January New York Times/ CBS poll (1/11-15/09) found 59 percent in favor of government-provided national health insurance. In other words, contrary to Cohen's claim, people are on pretty much the same page today as they were 15 years ago.

Her suggestion that it was those loud single-payer voices that stymied "reform" is likewise unfounded; as Extra! reported in 1993, corporate media were then solidly behind the Clinton administration's big insurer-friendly "managed competition" plan-single-payer was hardly discussed in the press. ("The debate over healthcare reform is over. Managed competition has won," the New York Times had already editorialized on October 10, 1992. "The outcome is as wondrous as it is surprising.")

And just as big media silenced single-payer back then, Cohen and her colleagues continue the tradition today. In the week leading up to Obama's March 5 healthcare summit, hundreds of stories in major newspapers and on NBC News, ABC News, CBS News, Fox News, CNN, MSNBC, NPR and PBS's NewsHour mentioned healthcare reform, according to a recent FAIR study (3/6/09). But the idea of single-payer was mentioned only 18 times-and only five of those included the views of single-payer advocates. 

On March 31, PBS's Frontline took an in-depth look at the U.S. healthcare system in Sick Around America, offering a prime opportunity to explore single-payer-or so thought the correspondent originally slated to do the show, T.R. Reid. In Frontline's 2008 special Sick Around the World, Reid examined healthcare systems in other developed countries, concluding that in nations where there is some private-sector role in health financing, one of the central lessons is that they "all impose limits"-including that insurance companies "can't make a profit on basic care." The show discussed single-payer alternatives, including Taiwan's healthcare system.

But in Sick Around America, the only alternative to the current U.S. healthcare system that was examined in any depth was Massachusetts' system of mandating that people buy insurance from for-profit health insurance companies. Reid, who was contracted to be the correspondent for the new documentary, quit over concerns that it contradicted his earlier research (Corporate Crime Reporter, 4/2/09): I said to them, mandating for-profit insurance is not the lesson from other countries in the world.... I said, I'm not going to be in a film that contradicts my previous film and my book. They said I had to be in the film because I was under contract. I insisted that I couldn't be. And we parted ways.

After FAIR criticized the film (4/7/09),  Frontline pointed out that the show's narrator mentions that "other developed countries bar health insurance companies from making profits on basic care and cap their administrative costs." Of course, one brief mention in an hour-long show hardly constitutes a fair hearing.

As FAIR's study found, most mentions of single-payer tend to come from its critics, who bring it up in order to shoot it down-such as when Fox's Sean Hannity argued (2/19/09), "If we look at England, if we look at France, if we look at Canada, the single-payer, the worst thing we can do if we really care about kids is let the government run the healthcare system."

Single-payer did recently get a new proponent in corporate media with MSNBC's hiring of populist radio host Ed Schultz to fill its 6 p.m. slot. Since going on the air April 6, Schultz has questioned guests about single-payer multiple times, as when he asked why the Democrats won't put such a plan on the table (4/27/09): "The majority of the health providers, the majority of Americans want single-payer. You've got a president with a 69 percent approval rating. What are they waiting for?"

Schultz ought to ask the question not just of Democrats, but of his corporate media colleagues as well.


© 2009 Extra! Magazine (FAIR) Julie Hollar is the managing editor of FAIR's magazine, Extra!. Isabel Macdonald is the communications director at FAIR. 

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The Single-Payer Taboo

by Ralph Nader. Posted May 11 at Counterpunch.

Among the giant taboos afflicting Congress these days is the proposal to create a single payer health insurance system (often called full Medicare for everyone).

How can this be? Don’t the elected politicians represent the people? Don't they always have their finger to the wind?

Well, single payer is only supported by a majority of the American people, physicians and nurses. They like the idea of public funding and private delivery. They like the free choice of doctors and hospitals that many are now denied by the HMOs.

There are also great administrative efficiencies when single payer displaces the health insurance industry and its claims--denying, benefit--restricting, bureaucratically-heavy profiteering. According to leading researchers in this area, Dr. David Himmelstein and Dr. Stephanie Woolhandler, single payer will save $350 billion annually.

Yet, on Capitol Hill and at the White House there are no meetings, briefings, hearings, and consultations about kinds of health care reforms that reform the basic price inflation, indifference to prevention, and discrimination by health insurers.

There is no place at the table for single payer advocates in the view of the Congressional leaders who set the agenda and muzzle dissenters.

Last month at a breakfast meeting with reporters, House Speaker Nancy Pelosi (D-CA) responded to a question about health care with these revealing and exasperating words: "Over and over again, we hear single payer, single payer, single payer. Well, it's not going to be a single payer."

Thus spake Speaker Pelosi, the Representative from Aetna? Never mind that 75 members of her party have signed onto H.R. 676-the Conyers single payer legislation. Never mind that in her San Francisco district, probably three out of four people want single payer. And never mind that over 20,000 people die every year, according to the Institute of Medicine, because they cannot afford health insurance.

What is more remarkable is that many more than the 75 members of the House privately believe single payer is the best option. Hillary Clinton, Barack Obama, Ted Kennedy, and Nancy Pelosi are among them. But they all say, single payer "is not practical" so it's off the table.

What gives here? The Democrats have the numbers and procedures to pass any kind of health reform this year, including single payer. President Obama could sign it into law.

But "it's not practical" because these politicians fear the insurance and pharmaceutical industries--and seek their campaign contributions--more than they fear the American people. It comes down to the corporations, who have no votes, are organized to the teeth and the people are not.

So, when Senator Baucus, chairman of the Senate Finance Committee and a large recipient of health insurance and drug company donations, held a public roundtable discussion on May 5, fifteen witnesses were preparing to deliver their statements. Not one of them was championing single payer.

As Senator Baucus started his introductory remarks, something happened. One by one, eight people in the audience, most of them physicians and lawyers, stood up to politely but insistently protest the absence of a single payer presentation.

One by one, the police came, took them out of the hearing room, arrested and handcuffed them. The charge was "disruption of Congress"--a misdemeanor.

They call themselves the "Baucus Eight". Immediately, over the internet and on C-Span, public radio, and the Associated Press, the news spread around the country. You can see the video on http://singlepayeraction.org.

To the many groups and individuals who have labored for single payer for decades, the Baucus Eight's protest seemed like an epiphany.

Dr. Quentin Young, a veteran leader for single payer and a founder of Physicians for a National Health Program (PNHP) e-mailed his reaction: "For our part, when the history of this period is written, we believe your action may well be noted as the turning point from a painful, defensive position to a more appropriate offensive position vis-à-vis Senator Baucus and his health industry co-conspirators."

Webster's dictionary defines "taboo" as "a prohibition against touching, saying, or doing something for fear of a mysterious superhuman force." For both Democrats and Republicans in Congress it is a fear of a very omnipresent super-corporate force.

However, moral and evidential courage is coming. On May 12, 2009, Senator Baucus is having another roundtable discussion with thirteen more witnesses, including those from the business lobbies and their consultants. Word has it that the Senator is about to invite a leading single payer advocate to sit at the table.

Here come the people! Join this historic drive to have our country join the community of western, and some third-world, nations by adopting a state of the art single payer system.

Visit http://singlepayeraction.org and break the taboo in your Congressional District.

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Budget Deal Includes Fast-Track for Health Reform

by Walter Alarkon. Originally published in The Hill, Friday April 24

Democrats in Congress and the White House have struck a tentative budget deal that includes reconciliation instructions that will make it easier to push through healthcare reform this year.

The deal, which still needs approval from the full House and Senate, would allow Democrats to pass healthcare reform with just a simple majority in the Senate, instead of the 60 votes needed to pass most controversial legislation, according to a congressional aide.

The budget agreement does not include reconciliation instructions for climate change legislation, which both Senate Republicans and Democrats have argued against.

The decision to include reconciliation instructions will likely rile Republicans, who portrayed the use of the maneuver as an attack on Senate rules. But top Democrats have said that they'll resort to reconciliation rules if Republicans remain unwilling to cooperate on long-awaited healthcare legislation.

Senate Budget Committee Chairman Kent Conrad (D-N.D.) stressed that the deal has yet to be finalized. He noted that he and House Budget Committee Chairman John Spratt (D-S.C.), who held talks on the budget Thursday night, still need to present "options" on the budget resolution to their fellow colleagues.

"There is still a fair amount of work to be done and colleagues to check with before we can reach a final agreement," Conrad said. "But we are hopeful we will be able to complete work next week."

Sen. Judd Gregg (N.H.), the top Republican on the Senate Budget Committee, said that using the reconciliation process goes against Democrats' talk of bipartisanship.

"A reform of our health care system – a massive legislative undertaking that will impact every American – should be done through the normal debate and amendment process," Gregg said in a statement. "To circumvent that process in favor of ramming through a partisan plan that needs only a simple majority to pass is a far cry from the bipartisanship that has been promised."

Obama administration officials, including White House Chief of Staff Rahm Emanuel and White House Budget Director Peter Orszag, have been meeting with congressional Democrats this week to hammer out an agreement before President Obama's 100th day in office, which is Wednesday. Senate Majority Leader Harry Reid (D-Nev.) said he hopes to hold a final Senate vote on passing the budget resolution on Wednesday, which is also when Obama will hold a primetime news conference.

If it passes, the president will be able to tout progress toward his goals of energy independence and healthcare and education reform. The budget calls on lawmakers to pass legislation that will reform the healthcare system, reduce the country's dependence on foreign oil and increase access to higher education without adding to the deficit. The budget, however, does not specify how those goals would be reached and how they would be paid for.

The tentative budget deal would set the non-defense discretionary spending in 2010 at levels lower than Obama and the House's requests but greater than the request from the Senate. Obama's budget called for $540 billion in such spending, the House called for $533 billion and the Senate called for $525 billion.

The agreement would also prevent the Alternative Minimum Tax (AMT) from hitting upper-middle-class taxpayers for another three years, which is what Senate Democrats had called for. The House plan wanted an AMT patch that would expire after one year, while the Obama administration had called for indexing the threshold at which taxpayers are hit by the tax to inflation, a proposal that would have generated more revenue but increased the tax burden on above-average earners.

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Labor Leaders Disappointed by Lack of Working People's Voices at Vermont Healthcare Reform Discussion

by the Labor Campaign for Single Payer Healthcare, posted on CommonDreams.org on March 18

Working people's voices were not heard at the Obama Administration's second regional Health Care Summit in Burlington, VT on March 17.

"Despite the fact that several union spokespersons attended the meeting, we were not called upon and unfortunately the voice of workers was shut out of the discussion," said Peter Knowlton, president of the Northeast Region of the United Electrical Workers Union (UE). "When it came to the financial discussion, Gov. Douglas and Gov. Patrick [the two governors moderating the session] only called on wealthy special-interests from the worlds of business and professional circles."

Sandy Eaton, a nurse who attended the forum stated that nurses' voices went unheard as well. "Nurses were well represented, but our voices were not heard -- and the term "nurse" or "hospital worker" was never mentioned in the two hour forum," said Eaton who is a member of the executive board of the Massachusetts Nurses Association.

Outside the auditorium where the summit was held, over 250 labor and community members rallied in support of HR 676 and single payer healthcare. "Our system needs fundamental reform," said Dawn Stanger, President of the Vermont Workers Center-Jobs with Justice. Stanger, a UPS employee and member of Teamsters Local 597, was joined by dozens of unionized nurses who worked next door at Fletcher Allen Health Care, the largest hospital in Vermont.

"We need to build a movement to demand change," Stanger told the crowd. The Vermont Workers Center is coordinating a major statewide "Healthcare Is a Human Right" rally on May 1 at the Vermont Statehouse, which will include U. S. Senator Bernie Sanders. The rally will oppose Vermont Governor Douglas' proposed budget cuts to healthcare programs and support state and national single-payer legislation.

"I was really hopeful that these forums would finally give voice to workers concerns," added UE leader Peter Knowlton. "There were many people there who could have reminded them about the serious problems hourly workers face with skyrocketing premiums and dealing with the horrors of co-pays, deductibles, out-of-pocket expenses and the run around all workers face with managed care. If this forum is any indication of future ones, we will need to be much more aggressive to get our voices heard."

Knowlton, Eaton and Stanger were among the several labor leaders at the forum who support HR 676, the "Expanded and Improved Medicare for All" Act. HR 676 was re-introduced this year by Congressman John Conyers. It currently has 66 congressional co-sponsors. Because it eliminates the private insurance industry from profiting from people's misfortunes and, like Medicare, establishes the federal government as the "single payer" of everyone's medical bills, HR 676 can provide healthcare for all with no co-pays or deductibles in a fiscally prudent manner. HR 676 has the endorsement of hundreds of state and local labor federations and local unions as well as many other civic and religious organizations.

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A Spoiler in the Health Care Debate

by Matthew Murray. Published in Roll Call March 16

By inviting a vast spectrum of stakeholders to collaborate with the White House on its health care reform push, President Barack Obama is trying to pre-empt opponents of his plan from blocking his campaign promise to insure 46 million Americans.

To date, labor unions, seniors advocates, business interests, pharmaceutical companies and insurers are all assured a seat at the table during the ongoing debate - that is, provided they stick to the script and forgo attempts to sabotage the eventual proposal.

With billions of dollars at stake, not everyone is expected to be on board when the legislation is unveiled. But one group will undoubtedly be disappointed: the single-payer lobby, an allegedly 20 million-strong coalition that is pledging no compromise in the upcoming debate and is rallying around a bill recently introduced by House Judiciary Chairman John Conyers (D-Mich.).

"Single payer is the only means that we know to get the ends we seek," said Joe Jurczak, a lobbyist for the California Nurses Association. "We want to see guaranteed health care for everyone."

Jurczak's group is part of the Leadership Conference for Guaranteed Health Care, which is pushing the administration to adopt a universal health care system similar to Medicare, a program for seniors paid for by taxpayers that would use the country's existing private infrastructure of facilities and health care providers.

The California Nurses Association also runs Guaranteedhealthcare.org, which states that "only a single-payer system would assure that everyone is covered with one high standard of benefits and care ... establish effective cost controls, curb administrative waste, and end insurance industry interference with care."

"We don't want doctors to work for the federal government and hospitals to be run by the federal government. We want health care to be a right," Jurczak said. "No co-pays, no deductibles."

The Leadership Conference for Guaranteed Health Care also has written to the White House, explaining its reach. The group wrote to Obama that the coalition includes "thirty organizations representing doctors, nurses, the homeless, faith based organizations, community activists, students, consumers, seniors, women's interests, and organized labor ... organizations [that] represent over 20,000,000 members, many of whom are community and political leaders at the grass roots level."

According to the group's Web site, its membership includes anti-war activists CODEPINK, watchdog Public Citizen and the Ruckus Society, an Oakland, Calif.-based group that recently protested coal use at the Congressional power plant.

Jurczak said single-payer advocates host a monthly call-in for supporters and is planning a lobbying blitz on the Hill in May.
He also said supporters of a single-payer plan - whose biggest celebrity advocate undoubtedly is documentary filmmaker Michael Moore - will be "very visible" at an April 6 White House Forum on Health Reform in Los Angeles.

The California Nurses Association and the National Nurses Organizing Committee are distributing polling that the organizations claim shows public opinion on their side. In one March 2008 survey conducted by Indiana University, 59 percent of those polled supported a single-payer system.

Despite the their apparent support, it appears unlikely their proposals will win out. A White House spokesman said any ultimate health care fix is unlikely to resemble Medicare or any other federally implemented system.

Still, along with major insurance providers, pharmaceutical companies, insurers and other major stakeholders, the White House invited single-payer advocates like Conyers and the Physicians for a National Health Program to the recent White House summit, according to the spokesman.

"We don't expect that the plans they produce will be single-payer plans," the spokesman said. "We are working with partners on the Hill from both parties and they're the ones that ultimately will craft legislation.

"The plan the president laid down during the campaign was not a single-payer proposal," he said.

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Health insurance industry works on an image makeover

by Ricardo Alonso-zaldivar, Associated Press, March 15

WASHINGTON – The health insurance industry is working on a transformation that could come right out of "Extreme Makeover."

Long cast as villains for denying coverage or refusing to pay for treatment, insurers now are representing themselves as indispensable partners in health care overhaul. In their pitch to lawmakers, the companies say they are in a unique position to help improve quality and root out waste, saving money so everyone can be covered.

"They are making inroads," said John Rother, public policy director for AARP. "They are getting past the rhetoric and starting to talk about more concrete ideas for improving quality and getting value."

In a big change from three or four years ago, insurers are writing bigger campaign checks to Democrats, now the party of power in Washington. The insurance industry gave $10.7 million to Democratic candidates for federal office in the 2006 elections, according to OpenSecrets.org. Last year, it was $20.7 million.

The stakes are high.

If the industry's pitch succeeds, insurers will be guaranteed many more customers. The industry wants all people in the United States to be required to carry medical coverage, with government providing financial help for those who cannot afford it.
Even if insurers end up making less per customer because of anticipated consumer safeguards, they still could come out ahead.

But if the overhaul that President Barack Obama has promised goes against them, insurers could find themselves trying to compete against a new government-run health plan offering cut-rate premiums to middle-class families. That's exactly what many liberal Democrats want, and Obama hasn't taken the option off the table.

"No one is naive enough to believe that insurers aren't going to have problems with parts of this," Rother said. "But they are pushing back in a rather quiet way."

Said Karen Ignagni, president of America's Health Insurance Plans and the industry's top strategist in Washington: "We understand we need to come to the table with very specific solutions."

Ignagni is hedging her bets by building ties to groups such as small businesses, whose conservative outlook and grass- roots clout could be crucial.

Yet the industry has won a measure of respect from some longtime adversaries. "I have seen very few groups, including the insurance industry, that are willing to exercise the nuclear option and torpedo reform," said Ron Pollack, executive director of Families USA, a liberal advocacy group. "They have participated in a good faith manner."

Others on the left are not convinced. "Private insurance is the problem," said Carmen Balber of Consumer Watchdog, a California-based group. "Individuals can't afford to be forced into buying private insurance."

If insurers have come to see government as a partner, that's not as strange as it may seem. Employer coverage has dwindled in recent years, but government programs for older people, children and the poor have grown into a vital business. The Medicare prescription drug benefit is delivered by private insurers. Also, about 10 million older people are signed up in Medicare managed care plans. Many states operate their Medicaid programs through private insurers. The same goes for the federally backed State Children's Health Insurance Program.

Government programs "are a significant contributor to growth for us," said Angela Braly, chief executive of Wellpoint, which covers 35 million people in 14 states. "We think we can be a significant part of the solution for the uninsured."

Insurance companies can do more than just pay claims, Braly said. They can use the data in their files to monitor whether doctors and hospitals are providing the right level of care — not too little, not too much.

For example, a soon-to-be released study by Wellpoint looks at treatment of back pain, a condition that costs roughly as much as cancer or diabetes to treat. Most back pain clears up in about six weeks, and national guidelines recommend postponing surgery and sophisticated imaging tests. But the study found that 35,000 patients had imaging tests and an additional 1,000 had surgery before the six weeks were up. Potential savings over a 12-month period: $23.6 million.
In the future, insurers could use such findings to cajole doctors into changing the way they practice.

"We think we can play a central role in delivering value," said Braly.

Wellpoint says such studies don't always endorse the low-tech option. Its research also found that a costly medication for multiple sclerosis was worth the investment, because it helped patients avoid relapses. But there's concern that insurers and government could one day use such studies to deny coverage for expensive new treatments and diagnostic tests.

It's hard to tell whether the industry's makeover will work. So far, the Obama administration doesn't seem to be sold. While Obama invited Ignagni to the White House health care summit, he's also asking Congress to slash payments to private insurance plans in Medicare. Far from being efficient, Obama says the plans get 14 cents more on the dollar than it costs to care for older people in the traditional program.

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The Business Roundtable spotlights a US health care "value gap"

The Business Roundtable does a good job explaining the problem, but falls short on the solution!

by Ricardo Alonso-Zaldivar, Associated Press, published March 12

If the global economy were a 100-yard dash, the U.S. would start 23 yards behind its closest competitors because of health care that costs too much and delivers too little, a business group says in a report to be released Thursday. (note: you can read the report here)

The report from the Business Roundtable, which represents CEOs of major companies, says America's health care system has become a liability in a global economy.

Concern about high U.S. costs has existed for years, and business executives — whose companies provide health coverage for workers — have long called for getting costs under control. Now President Barack Obama says the costs have become unsustainable and the system must be overhauled.

Americans spend $2.4 trillion a year on health care. The Business Roundtable report says Americans in 2006 spent $1,928 per capita on health care, at least two-and-a-half times more per person than any other advanced country.

In a different twist, the report took those costs and factored benefits into the equation. It compares statistics on life expectancy, death rates and even cholesterol readings and blood pressures. The health measures are factored together with costs into a 100-point "value" scale. That hasn't been done before, the authors said.

The results are not encouraging.

The United States is 23 points behind five leading economic competitors: Canada, Japan, Germany, the United Kingdom and France. The five nations cover all their citizens, and though their systems differ, in each country the government plays a much larger role than in the U.S.

The cost-benefit disparity is even wider — 46 points — when the U.S. is compared with emerging competitors: China, Brazil and India.

"What's important is that we measure and compare actual value — not just how much we spend on health care, but the performance we get back in return," said H. Edward Hanway, CEO of the insurance company Cigna. "That's what this study does, and the results are quite eye-opening."

Higher U.S. spending funnels away resources that could be invested elsewhere in the economy, but fails to deliver a healthier work force, the report said.

"Spending more would not be a problem if our health scores were proportionately higher," Dr. Arnold Milstein, one of the authors of the study, said in an interview. "But what this study shows is that the U.S. is not getting higher levels of health and quality of care."

Other countries spend less on health care and their workers are relatively healthier, the report said.

Medical costs have long been a problem for U.S. auto companies. General Motors spends more per car on health care than it does on steel. But as more American companies face global competition, the "value gap" is being felt by more CEOs — and their hard pressed workers.

One thing the report does not do is endorse the same solution that countries like Canada have adopted: a government-run health care system.

The CEOs of the Business Roundtable believe health care for U.S. workers and their families should stay in private hands, with a government-funded safety net for low-income people.

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If Private Insurers Compete with Government, They'll Lose

Should government bolster the public good by instituting universal Medicaid, or protect the profits of insurance companies?

by Dean Baker. Posted Tuesday, March 10 on CommonDreams.org

We all know that people have different ideologies about the proper role of government. Some people, who tend to be left of center, think that the government's role is to try to promote the general good, by providing basic services, protecting the poor and the sick, and ensuring a well-working economy. On the other hand, there are others, who usually place themselves right of center, who believe that the proper role of government is to redistribute as much income as possible to the wealthy.

These competing views of government are coming to a head in the debate over national health care reform. Those who think that the role of government is to serve the public good are likely to favor some form of universal Medicare. Such a system would almost certainly save a huge amount in administrative costs at the level of insurers, providers and government oversight.

Private insurers spend more than 15 percent of the money they collect in premiums on administrative costs. By contrast, Medicare spends about 2 percent. Part of the insurers' administrative expenses go toward marketing - an expense that would be unnecessary in a universal Medicare system.

The other major factor driving administrative costs with private insurers is associated with their efforts to game the system. Gaming is the best way to make profits in the current system. If insurers can find effective mechanisms for either keeping sick people from being insured, or finding ways to deny coverage for expensive care, then they stand to make large profits. Naturally, profit-maximizing
insurers will therefore devote substantial resources to trying to avoid ways to provide health care to people who need it.

At the level of providers, the wide range of divergent forms and policies employs hundreds of thousands of people in administrative positions in hospitals, doctors' offices, nursing homes and other providers. These people are often quite adept at dealing with various insurers, which is an important skill in our current system, but a task that would disappear if we had a universal Medicare system.

Finally, the state and federal governments must devote substantial resources for oversight to police the practice of insurers. Oversight agencies are essential for limiting abuse. This task would be much simpler if there were not corporations that stood to profit by keeping people from getting needed care.

While we could in principle shift to a universal Medicare system immediately, this would be an extremely difficult task politically and would present some serious practical problems as well. During his campaign, President Obama proposed something far more modest: give employers and individuals the choice to buy into a public Medicare-type program. Under this system, if people are happy with their current health care insurance, they would have the option to keep it. However, if they decided that the plan offered by the government was better, they could buy into it.

In this situation, insurers would compete with the government plan in the market. If private insurers could offer health insurance that provided better coverage or charged less, then people would have the option to buy into a private plan. Of course, the government would also regulate the market so that private insurers could not cherry-pick their way to profitability by insuring only healthy people and dumping them when they became sick.

The insurance industry already recognizes that it will lose out in this sort of competition. A government-run plan will be more efficient. We already know this based on the experience with Medicare. When private insurers have competed side by side with the traditional government Medicare plan, in the absence of government subsidies, the overwhelming majority of beneficiaries opted to go with the traditional Medicare plan.

This is why the insurers are yelling that they don't want to face "unfair" competition from a government plan. But, their complaint should be all the endorsement that the public needs to support a public Medicare-type plan. The public
plan will be cheaper and better than what the private insurers have to offer. Why shouldn't the public then have this option?

We all know that the insurance industry executives and the company shareholders want to make lots of money, but maybe they should try to find an industry where they can compete. If the government can provide health insurance better and cheaper, then why do we need private insurers?

Dean Baker is the co-director of the Center for Economic and Policy Research (CEPR). He is the author of The Conservative Nanny State: How the Wealthy Use the Government to Stay Rich and Get Richer (www.conservativenannystate.org) and the more recently published Plunder and Blunder: The Rise and Fall of The Bubble Economy. He also has a blog, "Beat the Press," where he discusses the media's coverage of economic issues. You can find it at the American Prospect's web site.

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Amy Goodman: Put Single-Payer on the Table

Posted Wednesday, March 11, 2009 at TruthDig.com

President Barack Obama promises health-care reform, but he has taken single-payer health care off the table. Single-payer is the system that removes private insurance companies from the picture; the government pays all the bills, but health-care delivery remains private. People still get their choice of what doctor to go to and what hospital to use. Single-payer reduces the administrative costs and removes the profit that insurance companies add to health-care delivery. Single-payer solutions, however, get almost no space in the debate.

A study just released by Fairness and Accuracy in Reporting, a media watchdog group, found that in the week before Obama's health-care summit, of the hundreds of stories that appeared in major newspapers and on the networks, "only five included the views of advocates of single-payer-none of which appeared on television." Most opinion columns that mentioned single-payer were written by opponents.

Congress is considering H.R. 676, "Expanded and Improved Medicare for All," sponsored by John Conyers, D-Mich., with 64 co-sponsors. Yet even when Rep. Conyers directly asked Obama at a Congressional Black Caucus meeting if he could attend the White House health-care summit, he was not immediately invited. Nor was any other advocate for single-payer health care.

Conyers had asked to bring Dr. Marcia Angell, the first woman editor in chief of The New England Journal of Medicine, the most prestigious medical journal in the country, and Dr. Quentin Young. Young is perhaps the most well-known single-payer advocate in America. He was Martin Luther King Jr.'s doctor when King lived in Chicago. "My 15-minute house calls would stretch into three hours," he told me.

But he came to know Barack Obama even better. Though his medical partner was Obama's doctor, Young was his neighbor, friend and ally for decades. "Obama supported single-payer, gave speeches for it," he said.

This past weekend, hundreds turned out to honor the 85-year-old Young, including the Illinois governor and three members of Congress, but the White House's response to Conyers' request that Young be included in the summit? A resounding no. Perhaps because Obama personally knows how persuasive and committed Young is.

After much outcry, Conyers was invited. Activist groups like Physicians for a National Health Program expressed outrage that no other single-payer advocate was to be among the 120 people at the summit. Finally, the White House relented and invited Dr. Oliver Fein, president of PNHP. Two people out of 120.

Locked out of the debate, silenced by the media, single-payer advocates are taking action. Russell Mokhiber, who writes and edits the Corporate Crime Reporter, has decided that the time has come to directly confront the problem of our broken health-care system. He's going to the national meeting of the American Health Insurance Plans and is joining others in burning their health-insurance bills outside in protest. Mokhiber told me, "The insurance companies have no place in the health care of American people. How are we going to beat these people? We have to start the direct confrontation." Launching a new organization, Single Payer Action, Mokhiber and others promise to take the issue to the insurance industry executives, the lobbyists and the members of Congress directly, in Washington, D.C., and their home district offices.

Critical mass is building behind a single-payer system. From Nobel Laureate in Economics Joseph Stiglitz, who told me, "I've reluctantly come to the view that it's the only alternative," to health-care providers themselves, who witness and endure the system's failure firsthand. Geri Jenkins of the newly formed, 150,000-nurses-strong United American Nurses-National Nurses Organizing Committee said: "It is the only health-care-reform proposal that can work. ... We are currently pushing to have a genuine, honest policy debate, because we'll win ... the health insurers will collapse under the weight of their own irrelevance."

Dr. Young has now been invited to a Senate meeting along with the "usual suspects": health-insurance providers, Big Pharma and health-care-reform advocates. I asked Young what he thought of the refrain coming from the White House, as well as from the leading senator on the issue, Max Baucus, that "single-payer is off the table." "It's repulsive," sighed Young. "We are very angry." But not discouraged. I asked him what he thought about Burn Your Health Insurance Bill Day. "Things are heating up." he chuckled. "When things are happening that you have nothing to do with, you know it's a movement."

Denis Moynihan contributed research to this column. © 2009 Amy Goodman

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Nobel support for single payer

Here's an excerpt from Amy Goodman's February interview with Nobel economist Joseph Stiglitz. You can read the transcript online here.

Amy Goodman: He’s [President Obama] called for universal healthcare, but he does not call for single-payer healthcare.

Joseph Stiglitz: I think that there are some fundamental problems in the efficiency of our healthcare system. And what we’ve seen is that the private healthcare insurers do not know how to deliver an efficient way.

Amy Goodman: Do you support single-payer healthcare?

Joseph Stiglitz: I think I’ve reluctantly come to the view that it’s the only alternative. You know, we’ve tried a lot of other things. And we’ve been—you know, I was in the Clinton administration, and we debated a lot of alternatives, and I’ve watched things as they’ve emerged and, you know, evolved over the last twelve, sixteen years, and I think there’s a growing consensus that the private market exclusion is not going to work.

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New York Times: Obama Taps Health Aide With Links to Industry

By Sheryl Gay Stolberg. Published March 2 in the New York Times

WASHINGTON — In picking Nancy-Ann DeParle to champion an overhaul of the nation’s health system, President Obama selected someone with deep roots in the Washington bureaucracy, an intimate familiarity with health policy and respect on both sides of the political aisle — not to mention degrees from Harvard Law School and Oxford University.

But in putting Ms. DeParle in charge of an issue that has bedeviled presidents for decades, Mr. Obama also chose to overlook Ms. DeParle’s business ties to companies that have a direct stake in the health care debate.

In announcing her appointment Monday as the director of the White House Office of Health Reform, Mr. Obama expressed “absolute confidence” in Ms. DeParle, who ran the agency that oversaw Medicare and Medicaid during the Clinton administration. But the White House instantly faced questions about whether her appointment was skirting the spirit, if not the letter, of the president’s tough conflict-of-interest policy.

Since leaving the Clinton administration, Ms. DeParle has been managing director of a private equity firm, CCMP Capital, and a board member of companies like Boston Scientific, Cerner and Medco Health Solutions. White House officials said Ms. DeParle was severing ties with those companies and would recuse herself from participating in any matter that was “directly or substantially” related to former clients or employers.

“It is our view, and the view of counsel here, that the incidence of that will be very low,” an administration official said of the need for Ms. DeParle to recuse herself from decisions. The official, who was not authorized to speak publicly, said Ms. DeParle would be working mostly with federal agencies and lawmakers, and not directly with companies.

Allies of Ms. DeParle described her work in the private sector as a plus, because her familiarity with the industry would enable her to lean on companies to make tradeoffs essential in expanding access to the uninsured.

“She can call their bluff far more credibly and say, ‘Come on, guys, I’ve seen the books, I know you can do this with lower margins and higher market share, and you’ll do quite well,’ ” said Chris Jennings, who was President Bill Clinton’s top health policy adviser. “To me that’s very, very helpful.”

The appointment drew praise from some Republicans, including Bill Thomas and Jim McCrery, both former House members who worked closely with Ms. DeParle on health care. Mr. McCrery described her as “very knowledgeable, and very reasonable.”

At 52, Ms. DeParle, who is married to a New York Times reporter, Jason DeParle, is also no stranger to personal hardship. She grew up in a small town in eastern Tennessee and was raised by a single mother who died of lung cancer when Ms. DeParle was 17.

She went to college on scholarships and loans (she was the first woman president of the student body at the University of Tennessee) and attended Oxford on a Rhodes scholarship. At 29, she was hired by Ned McWherter, then the governor of Tennessee, to run the State Department of Human Services.

After working as a lawyer in Washington, Ms. DeParle joined the Clinton administration in the budget office and later oversaw a vast overhaul of the way Medicare operated.

Donna E. Shalala, a good friend of Ms. DeParle’s who was health secretary to Mr. Clinton, called Ms. DeParle “smart, fair, highly ethical and tough as nails,” and said her appointment, and the nomination of Gov. Kathleen Sebelius of Kansas as health secretary, should erase any concern about the withdrawal of the man Mr. Obama originally wanted for both jobs, Tom Daschle, the former Senate Democratic leader.

“This is a very good one-two punch,” Ms. Shalala said. “This is as good as it gets if you can’t have Daschle.”

This article has been revised to reflect the following correction:

Correction: March 6, 2009
An article on Tuesday about the appointment of Nancy-Ann DeParle to run the White House Office of Health Reform referred incorrectly to the ancestry of Ms. DeParle’s mother. She was a native-born American, not a Chinese immigrant. (Ms. DeParle’s father was from China.)

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Mark Weisbrot: Health Care Reform Is Needed Now More than Ever

Published on Monday, March 2, 2009 by McClatchy Newspapers

With the U.S. economy's downward spiral still accelerating and the federal government looking at its largest budget deficits since World War II, some are saying that this is not the time to expand health care coverage to all Americans.

But this is exactly the time for the Obama administration to move boldly on its campaign promise to implement a universal health care system.

Obama wants spending that stimulates the economy in the short term, but he also wants to reduce the long-term deficit problem after the economy recovers. This is exactly what health care reform will do.

In the short run, health care spending, like other government spending on goods and services, creates jobs and generates income. This will help arrest the economy's downward spiral.

With the collapse of private spending, the federal government must act as the consumer of last resort - hence the vital importance of the $787 billion stimulus package that Congress passed last week. Fortunately this package did contain at least some health care stimulus. In included $87 billion for Medicaid payments to the state governments, $25 billion towards helping unemployed workers extend their employment-based health insurance after being laid off, and $19 billion for health information technology.

But health care reform would do vastly more. President Obama has proposed a reform that would, while keeping the employer-based health insurance that covers most Americans, create a public health insurance system for the 46 million that do not have insurance. Large employers would be required to either pay into this system or provide their employees with insurance that is at least as good as the federal system. Individuals without insurance could buy into the public system, and the federal government would subsidize these payments so that they would be affordable for low-income households and those without ties to the labor force.

The White House estimates that their plan would cost $50-65 billion annually, but it would be better to spend much more than this, with more federal subsidies to employers to cover uninsured workers and improve existing coverage. As big as it may seem, the $787 billion stimulus bill passed by Congress amounts to less than 2.7 percent of GDP. This is not nearly enough to counteract our deep recession: the Congressional Budget Office estimates the output gap (i.e., how much output is below the economy's potential) at $2.9 trillion over the next three years.

Besides saving thousands of lives by providing health care to the uninsured, and supplementing the fiscal stimulus, health care reform has another huge advantage: it can drastically reduce future federal budget deficits. The vast majority of our government's long-term shortfall is due to exploding health care costs in the private sector. These spill over to the public sector, which currently finances about half the nation's health care costs. The United States spends about twice as much per person on health care as other high-income countries, and yet has worse health outcomes, including life expectancy and infant mortality.

The main economic reason for this colossal failure is that our system of private insurance and powerful monopolies is vastly more wasteful and inefficient than the health care systems of other developed countries. Insurance companies spend tens of billions trying to insure the healthy, avoid the sick, and deny payment for claims. Pharmaceutical companies take $350 billion of our health care dollars for drugs that cost a small fraction of that sum to produce.

The Obama health care plan won't eliminate most of these perverse incentives and waste - eventually we will need a truly national, single-payer system like Medicare to accomplish that. But it would be a big step in that direction, creating a nearly universal insurance system and laying the foundation for a sustainable system that can contain costs.

Mark Weisbrot is Co-Director of the Center for Economic and Policy Research (CEPR), in Washington, DC. His column is distributed to newspapers by McClatchy-Tribune Information Services.

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Katrina vanden Heuvel: Revolutionizing Primary Healthcare

originally posted on The Nation's Editor's Cut blog on February 28

“"If you are willing to volunteer in your neighborhood or give back to your community or serve your country, we will make sure that you can afford a higher education.”
-- President Obama, Address to Joint Session of Congress

I’'ve always believed it’s important that we redefine national service so that it isn'’t the exclusive province of the military. That is why this line in President Obama’'s powerful speech on Tuesday night was good to hear. One critical achievement in the Recovery bill was that it tripled funding for the National Health Service Corps (NHSC) to $300 million to provide incentives -- including debt forgiveness and grants -- for physicians and dentists, medical and dental students, to practice in underserved areas.

Thursday, Senator Bernie Sanders and House Majority Whip James Clyburn announced legislation that is very much in sync with the President’s stated priorities. The Access for All Americans Act -- with 21 Senate cosponsors and 72 cosponsors in the House -- would greatly expand the Federally Qualified Health Centers (FQHC) program
that currently provides primary care to 18 million Americans in 1,100 community health centers so that every American in a medically underserved area would have access to care. (Even George Bush supported this program.) It would also increase funding for the NHSC over the next five years to $1.1 billion, providing loan repayment and scholarships to those who pursue primary medical and dental care careers in underserved communities, recruiting 24,000 new healthcare professionals to serve those areas.

“"Insurance coverage is not the only health care crisis that we face,"” Sen. Sanders said Thursday at a press conference at the Capitol. “"Today, over 56 million Americans -- insured and uninsured--are finding it extremely difficult to gain access to a doctor. They'’re looking all over their community, they cannot get into a doctor’'s
office. This means that when [many] Americans get sick... they delay going to a doctor, then they end up getting sicker... and then go into an emergency room or end up in a hospital at great cost to our society and to themselves."” He noted that 18,000 Americans die annually due to their inability to afford insurance or care.

The legislation is timely since President Obama--who Sen. Sanders noted was the first co-sponsor of a similar bill he introduced last session--signaled Tuesday night that he intends to focus on "“preventive care, because that is one of the best ways to keep our people healthy and our costs under control.”" Also, President Obama
announced that his 10-year budget will include a $634 billion reserve fund for health care reform, half of which “"would come from proposed cost savings in Medicare, Medicaid and other health programs,”" according to the New York Times.

Both Sen. Sanders and Rep. Clyburn pointed out that federal community health centers in mostly impoverished areas--providing doctors, dentists, mental health counselors and low-cost prescription drugs on a sliding-scale fee so that no one is turned away--are one of the best ways to achieve those cost savings.

“"The American Academy of Family Physicians found that total medical expenses for health center patients were 41 percent lower compared to patients seen elsewhere, okay?”" Sen. Sanders later told me. “"On average, Medicaid patients seen at health centers have total medical expenses per year that are almost $1,000 less than Medicaid patients who use other providers--due to inappropriate emergency room use and unnecessary hospital admissions.”"

Sen. Sanders said that fully funding the bill would raise fifth-year spending from the current $2 billion for 1100 health centers, to $8.3 billion for 4800 health centers that would provide care to 56 million Americans. It’s estimated that about 17 million Medicaid patients would be among those receiving care. Just through reducing expenses by $1,000 per Medicaid patient, this would save the health care system $17 billion, more than twice the amount Sen. Sanders and Rep. Clyburn propose spending on the health centers.

Rep. Clyburn reflected on the history of the program that was created in 1966 by one of the cosponsors of the current legislation, Senator Edward Kennedy. Sen. Kennedy was inspired by a clinic opened in Boston by two graduates of Tufts Medical School. The Majority Whip said that the centers have become “"pillars in their communities”" throughout South Carolina, "often serving people who are “50 or 60 miles away from an emergency room.”"

In a statement, Sen. Kennedy -- who chairs the Health, Education, Labor and Pensions Committee -- said: “"At a time when the cost of health care and the number of uninsured are rising, community health centers and the National Health Service Corps are more important than ever. From inner city clinics to low-income communities across the country, they make a large difference in the health of millions of our people... I look forward to working with my colleagues to strengthen these two vital programs as part of our commitment to achieve quality, affordable health care for all Americans.”"

Rep. Clyburn said he would be speaking with President Obama about the legislation later in the day at a Congressional Black Caucus meeting at the White House.

“"Through these proven cost-effective programs, we have an opportunity, over the next five years, to provide comprehensive primary medical care, dental care, mental health counseling, and low cost prescription drugs in every medically-underserved region in the country, and remarkably, to actually save money in the process,”" Sen. Sanders later told me. “"In this hour of deepening economic crisis, President Obama has called on us to invest in programs that work and that meet our people’s needs. Community health centers and the National Health Service Corps do both.”"

With reporting from Capitol Hill by Nation Reporter/Researcher Greg Kaufmann.

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