PNHP Logo

| SITE MAP | ABOUT PNHP | CONTACT US | LINKS
NAVIGATION PNHP RESOURCES
Posted on September 16, 2008

PNHP Annual Meeting, Oct 25, San Diego

PRINT PAGE
EN ESPAÑOL

September 16, 2008

Dear PNHP Colleagues,

Our members and friends report a big upsurge in health care discourse in this torrid electoral season. The dramatic plunge in our financial markets only enhances the urgency of our remedy, single-payer national health insurance. Please plan to come to our Annual Meeting in San Diego and do all you can locally.

  • PNHP’s 2008 Annual Meeting is coming up on Saturday, October 25, in San Diego: “Single Payer and the 2008 Elections: Obstacles and Opportunities for Health Reform.” You are cordially invited to attend. All events will be held at the Westin Gaslamp Quarter, San Diego. To reserve a room at the best rate $225 single/double) call at 866-716-8132 before September 26. To RSVP online, click here.
  • The New York Times published an excellent op-ed today by Bob Herbert on the McCain health plan (reprinted below). PNHP Senior Health Policy Fellow Dr. Don McCanne, author of the superb single payer “quote of the day,” was prescient in his critique of the McCain plan in a recent interview (also below).
  • Dr. Claudia Fegan, former PNHP president, gave an inspiring “call to action” to single payer supporters at the Democratic National Convention. Her remarks are online here. Enjoy.
  • Finally the PNHP national office recommends the following new books for single-payer supporters and legislators/candidates everywhere!

“10 Excellent Reasons for National Health Care,” edited by Mary O’Brien, MD, and Martha Livingston, PhD (New Press, 2008, $13.95). Dr. O’Brien is available to speak to PNHP chapters and other groups (see press release below).

“Do Not Resuscitate: Why the Health Insurance Industry is Dying, and How We Must Replace It,” by John Geyman, MD (Common Courage Press, 2008, $12.32).

Thank you for your continued support and especially your priceless efforts for reform.

We hope to see you in San Diego in October!

Cordially,

Quentin Young, M.D.
Volunteer National Coordinator

Ida Hellander, M.D.
Executive Director

P.S. If you can’t join us in San Diego, please consider a donation to PNHP help a medical student attend.

PNHP Annual Meeting Saturday, October 25th, San Diego
Westin Gaslamp Quarter, 9 a.m. - 5 p.m., 7 p.m. - 10 p.m.

The Annual Meeting is PNHP’s most important gathering of the year for forming our health policy and strategy. This year’s meeting is more important than ever as our movement for single-payer national health insurance faces unprecedented opportunities, and challenges, in this electoral season and thereafter in 2009. The keynote speakers will include PNHP leaders in California and nationally as well as international health policy experts (on Taiwan’s successful single-payer program, adopted in 1995) and labor leaders and grassroots activists who are building the movement for single payer.

PNHP’s California chapter, the California Physicians’ Alliance (CaPA), will hold a chapter meeting on-site (Saturday afternoon) and host a reception before the Annual Dinner. The conference will be preceded by PNHP’s popular “Leadership Training” program starting on Friday, October 24, at 1:00 p.m. (space is limited).

Some of the speakers/workshops will include:

*

Drs. David Himmelstein and Steffie Woolhandler on health policy, politics, and the prospects for single-payer reform under an Obama vs. McCain presidency.
*

Dr. Kevin Grumbach on single payer and addressing the crisis in primary care.
*

Princeton economist Tsung-Mei Cheng on the success of the Taiwanese single-payer system.
*

Dr. Jim Kahn on administrative overhead among private insurers and the California movement for single payer, SB 840. Dr. Kahn is the chair of the California Physicians’ Alliance, PNHP’s California chapter.
*

Rose Ann DeMoro of the California Nurses Association on mobilizing AFL-CIO/labor union support for single payer.
*

PNHP President-elect Dr. Oliver Fein on strategy and building local PNHP chapters.
*

Medical student organizing workshop led by student activists from California, Pennsylvania and Massachusetts

To assure that Congress and our next president hear our message about the need for genuine health care reform, we need you. Please come to San Diego!

McCain’s Radical Agenda

By Bob Herbert
New York Times
September 16, 2008

Talk about a shock to the system. Has anyone bothered to notice the radical changes that John McCain and Sarah Palin are planning for the nation’s health insurance system?

These are changes that will set in motion nothing less than the dismantling of the employer-based coverage that protects most American families.

A study coming out Tuesday from scholars at Columbia, Harvard, Purdue and Michigan projects that 20 million Americans who have employment-based health insurance would lose it under the McCain plan.

There is nothing secret about Senator McCain’s far-reaching proposals, but they haven’t gotten much attention because the chatter in this campaign has mostly been about nonsense - lipstick, celebrities and “Drill, baby, drill!”

For starters, the McCain health plan would treat employer-paid health benefits as income that employees would have to pay taxes on.

“It means your employer is going to have to make an estimate on how much the employer is paying for health insurance on your behalf, and you are going to have to pay taxes on that money,” said Sherry Glied, an economist who chairs the Department of Health Policy and Management at Columbia University’s Mailman School of Public Health.

Ms. Glied is one of the four scholars who have just completed an independent joint study of the plan. Their findings are being published on the Web site of the policy journal, Health Affairs.

According to the study: “The McCain plan will force millions of Americans into the weakest segment of the private insurance system - the nongroup market - where cost-sharing is high, covered services are limited and people will lose access to benefits they have now.”

The net effect of the plan, the study said, “almost certainly will be to increase family costs for medical care.”

Under the McCain plan (now the McCain-Palin plan) employees who continue to receive employer-paid health benefits would look at their pay stubs each week or each month and find that additional money had been withheld to cover the taxes on the value of their benefits.

While there might be less money in the paycheck, that would not be anything to worry about, according to Senator McCain. That’s because the government would be offering all taxpayers a refundable tax credit - $2,500 for a single worker and $5,000 per family - to be used “to help pay for your health care.”

You may think this is a good move or a bad one - but it’s a monumental change in the way health coverage would be provided to scores of millions of Americans. Why not more attention?

The whole idea of the McCain plan is to get families out of employer-paid health coverage and into the health insurance marketplace, where naked competition is supposed to take care of all ills. (We’re seeing in the Bear Stearns, Fannie Mae, Freddie Mac, Lehman Brothers and Merrill Lynch fiascos just how well the unfettered marketplace has been working.)

Taxing employer-paid health benefits is the first step in this transition, the equivalent of injecting poison into the system. It’s the beginning of the end.

When younger, healthier workers start seeing additional taxes taken out of their paychecks, some (perhaps many) will opt out of the employer-based plans - either to buy cheaper insurance on their own or to go without coverage.

That will leave employers with a pool of older, less healthy workers to cover. That coverage will necessarily be more expensive, which will encourage more and more employers to give up on the idea of providing coverage at all.

The upshot is that many more Americans - millions more - will find themselves on their own in the bewildering and often treacherous health insurance marketplace. As Senator McCain has said: “I believe the key to real reform is to restore control over our health care system to the patients themselves.”

Yet another radical element of McCain’s plan is his proposal to undermine state health insurance regulations by allowing consumers to buy insurance from sellers anywhere in the country. So a requirement in one state that insurers cover, for example, vaccinations, or annual physicals, or breast examinations, would essentially be meaningless.

In a refrain we’ve heard many times in recent years, Mr. McCain said he is committed to ridding the market of these “needless and costly” insurance regulations.

This entire McCain health insurance transformation is right out of the right-wing Republicans’ ideological playbook: fewer regulations; let the market decide; and send unsophisticated consumers into the crucible alone.

You would think that with some of the most venerable houses on Wall Street crumbling like sand castles right before our eyes, we’d be a little wary about spreading this toxic formula even further into the health care system.

But we’re not even paying much attention.
The Massachusetts Way?

New York Times
Letters
September 6, 2008

To the Editor:

“The Massachusetts Way” (editorial, Aug. 30) says the state’s health insurance program “looks more and more successful.” That is decidedly premature.

The program did not change the structure of health finance in Massachusetts. It simply added government subsidies for the poor and required that anyone else who was uninsured purchase coverage or receive a tax penalty.

The cost of health care in Massachusetts is continuing to rise faster than the cost of living - by 10 percent in just the past year. It will quickly outstrip government subsidies and the willingness of employers to provide decent coverage for their employees.

Leaning on government subsidies that can’t be sustained, and requiring people to buy insurance they can’t afford, is not a solution. Only a real change in the way we pay for health care can truly address our long-term problems.

Using a single public fund, an expanded Medicare for all, would provide the budget and planning tools to contain costs while generating enough savings to cover the uninsured and the underinsured.

Leonard Rodberg

The writer is a professor of urban studies at Queens College, CUNY, and research director of the New York Metro Chapter of Physicians for a National Health Program.

An interview with PNHP Senior Health Policy Fellow Dr. Don McCanne on McCain and Obama’s health care proposals.

Dr. McCanne served as PNHP President in 2003-2004 and writes a daily health policy “quote of the day” for single payer advocates. Subscribe by dropping a note to don@mccanne.org.

PNHP: How would you characterize Sen. McCain’s health care plan?

Dr. Don McCanne: Of the two candidates, McCain would rely more on the private sector and market forces to produce changes in the health care system. He says he would free up the market to allow private insurers to compete with each other to create plans with premiums we could afford.

Compared to Obama’s proposals, McCain’s program represents a much greater change from what we have now. He would shift responsibility for health care from employers to individuals by providing tax incentives for people to move to a deregulated, individual private insurance market.

What would be the impact?

McCain’s plan will likely result in many more people being uninsured and underinsured.

First of all, with workers receiving a government subsidy for health insurance - $2,500 for individuals, $5,000 for a family - employers are going to be motivated to terminate their health insurance programs and turn people over to the individual market.

McCain is basically proposing to change health insurance from a defined benefit to a defined contribution. In today’s market, what kind of family health insurance can be purchased with a $5,000 defined contribution? The average family premium is about $12,000, and that doesn’t include deductibles, co-pays and other out-of-pocket expenses.

I believe the private insurance companies will treat people in the marketplace very shabbily. Many people will be unable to afford any insurance - and it won’t only be those who are older or who have pre-existing conditions, sectors the insurance companies don’t want to cover at all.

Second, his proposal for less regulation of the insurance industry means that industry will be offering grossly inadequate insurance products to people in order to compete on price. The insurers can’t afford to provide real, comprehensive insurance and at the same time make their premiums affordable.

As a result, there will be a huge increase in the underinsured population. People will be losing their employer-based insurance and will be swelling the ranks of the uninsured and underinsured. This will result in a massive, catastrophic failure of the system. It will be horrible.

What about his claim that he’s not turning his back on people who have difficulty getting insurance, e.g. those with pre-existing conditions?

McCain proposes to cover such people through his “guaranteed access plan”, but that’s just a continuation of the state high-risk pools that we already have in place for individuals who typically can’t obtain insurance. These plans don’t work.

States are supposed to do their part in this scenario. But currently only about 190,000 people nationally are in these pools of high-risk individuals. These are very expensive pools. States just don’t have the funds to adequately finance them. So turning to the states - that’s no solution at all. It’s not a serious approach.

Would McCain’s plan give people more choice or control costs?

No.

Most insurance companies have preferred provider lists and most HMOs have closed panels that restrict patients to doctors in the HMO. Although McCain touts the freedom to choose your insurer or HMO, these institutions actually take away your freedom to choose who your doctor is or which hospital you can use - the choice we really want.

McCain’s proposals for containing costs are very weak.

The greatest source of administrative waste in U.S. health care today is our dysfunctional, fragmented private insurance system. That’s where the largest administrative costs are. And the individual insurance market - the market that McCain wants to expand - involves even higher administrative costs. So costs will likely go up.

Cost control is only achieved when you have real control over the health dollars. Only then can you develop incentives, for example, to expand primary care. Only then can you realign financial incentives away from an array of excessive, non-beneficial high-tech services that yield little value, and redirect it to primary care, which delivers greater value at lower cost.

What about Sen. Obama’s proposals?

Obama’s plan emphasizes increased government regulation and oversight of private and public insurance plans, leading to an incremental expansion of the existing system. As part of this, he would introduce a new Medicare-like plan for persons under 65 to serve as an alternative to private health insurance plans.

In terms of universal coverage, Obama’s plan probably will not expand coverage very much, mainly because his plan doesn’t do much to bring down the cost of health care. It continues to use the defective private insurance model.

The problem is that private insurers will not accept everyone in the risk pool, lest their costs go up. Even if regulations require them to do so, they still game the system through measures such as selective marketing. So people who are at higher risk will head for the new public or semi-public plans.

These plans, which under Obama’s proposal would be available through a new National Health Insurance Exchange, would be required to accept people with pre-existing conditions. But they would still involve payment of premiums, co-pays and deductibles.

He says these plans will be as good as what members of Congress get, right?

Obama says they would be patterned after the Federal Employee Health Benefits Program, but that may not be all that great. The plans that are offered to federal employees vary in price and a Senator can afford a plan that has far better benefits that his staffers. The FEHBP plans are not totally stripped down, but they still have deductibles, co-pays and other out-of-pocket expenses, and restrict people to a limited list of providers. In fact, 100,000 federal workers eligible for the FEHBP plans remain uninsured primarily because they cannot afford their share of the costs. Obviously that program wouldn’t work for far too many of us.

Additionally, the program Obama describes will be costly. He says individuals who can’t afford the premiums offered through the health insurance exchange plans will receive subsidies. But I think these subsidies will have to be much larger than estimated and will have to be provided to a much larger number of people than he currently estimates - not only low-income, but middle-income people and even those at the lower end of the high-income group.

So Obama’s stated goal of universal coverage will be foiled by the lack of availability of affordable plans that have adequate benefits. His approach is flawed because the private health plans are not going to be able to have enough benefits if they’re going to have affordable premiums.

Some say Obama’s new public plan could lead to something bigger and better.

The offering of a public plan option, which, incidentally, he shares with Sen. Hillary Clinton and professor Jacob Hacker, is not as simple as it would seem. Depending on the details and amount of funding, it has the potential to be the most important feature of his plan, or it could be a disaster. But even so, it alone won’t lead to anything even close to universal coverage. Obama has stated repeatedly that he knows that single payer is a superior solution for health care reform.

It’s likely that the public plan will be impacted by adverse selection - i.e. that individuals who are sick, or small businesses who have workers with costly disorders such as diabetes or cancer, will tend to seek out the public plans because the private plans would likely withdraw from markets that include high-cost individuals - markets in which they would be losing money. These individuals and small businesses will end up in relatively high-risk pools. It is essential those pools be adequately funded.

To fund the public high risk pools, either the private insurance companies would have to shift some of their funds into the public program through risk adjustment, or, as the public program uses up its funds, the government would have to make a greater contribution. To compete with the private plans, the public program and private plans would have to be funded at the same levels accurately corrected for the level of risk in their pools. That’s not technically feasible. Nobody has a way to do that. So insurers are always able to game the system.

Even if you could get private insurers to compete with the public program on a level playing field, that still leaves a lot of problems. You still don’t get the administrative savings you would under a single-payer system. Providers would still have to deal with multiple insurers. And both the Organization for Economic Cooperation and Development and the World Health Organization say systems that leave private plans in place are more expensive, less efficient and less equitable than a single public system.

What about cost control?

Again, Obama’s proposals, like McCain’s, are weak in this area. The defective private insurance model, to the extent in remains in place, drives up costs and blocks effective group bargaining and health planning.

The private health insurance plans of the 21st century have decided that they should cover only the healthy, putting an end to risk pools that enable a transfer from the many who are healthy to those with sickness or injury. They also realize that they should avoid competing with each other based on lower premiums, but should instead use their oligopolies to push premiums up to the maximum that the market will bear.

Only this month the two largest publicly traded health insurers, WellPoint and UnitedHealth Group, said they would not try to hold down premiums in the name of getting more members. “We will not sacrifice profitability for membership,” said one WellPoint official.

Yet both McCain and Obama propose to leave this industry in charge.

What’s the alternative?

What we really need is a system that removes the financial burden from patients and more effectively pools our funds into a public program that is able to address costs more effectively by introducing greater efficiency and value into our health care system.

Such a system would guarantee comprehensive health care to everyone by replacing the private insurance industry with a tax-supported government agency or agencies that would pay all medical bills, similar to the way Medicare operates today, but even better than Medicare. People would have the freedom to choose their own doctors and hospitals.

That’s a single-payer system. Such a system is embodied in H.R. 676, the “U.S. National Health Insurance Act,” introduced by Rep. John Conyers. It currently has 90 co-sponsors in Congress, more than any other health reform proposal.

How do you reply to those who say single payer is politically infeasible?

There are some in the political arena and health policy field who say the 2008 policy debate is over. They say single payer has lost out, and it’s time to move on.

The only problem is that single payer is the only plan that will work.

Keep in mind that any health care reform will have to be crafted and enacted by Congress. Whatever bill Congress comes up with will most likely not resemble either of the presidential candidates’ proposals very much. Only the general concepts will come into play. Congress will need to enact the specifics.

So it’s important to continue to educate people on basic health policy, contrasting the defective private insurance model with single-payer national health insurance. For members of groups like Physicians for a National Health Program, that means continuing to speak at forums and grand rounds, to write op-eds and letters to the editor, and to attend campaign-related events and raise the issue of why we need single payer.
At a glance
McCain’s proposal

*

Increases number of uninsured and “underinsured”
*

Increases administrative overhead (currently 31 percent of health spending)
*

No effective cost containment
*

Relies on private insurance market to shape system
*

Moves people away from employer-based system to the individual market by offering tax credits ($2,500 individual, $5,000 family) that can be used to buy individual insurance
*

Deregulates insurance markets, e.g. by dropping state-defined standards
*

Encourages Health Savings Accounts
*

Offers vague “Guaranteed Access Program” to address problem of the historically uninsurable - e.g. people with pre-existing conditions - that involves state-based risk pools

Obama’s proposal

*

Partially reduces number of uninsured with $100 billion in new public funding
*

Requires some employers to provide insurance or pay into a public insurance program, i.e. “play or pay”
*

No effective cost-containment
*

Mandates that all children be insured
*

Expands Medicaid and State Children’s Health Insurance Program
*

Sets up public insurance program as alternative to private insurers
*

Sets up “National Health Insurance Exchange” through which insurers could not deny coverage to people with pre-existing conditions with tax subsidies to low-income
*

Provides government reinsurance to employers for handling catastrophic illness or injury

FOR IMMEDIATE RELEASE Contact:
Sept. 16, 2008 Mark Almberg, (312) 782-6006, mark@pnhp.org
Small book on ‘single payer’ packs surprising wallop

10 Excellent Reasons for National Health Care
Edited by Mary E. O‘Brien, M.D., and Martha Livingston, Ph.D.
Foreward by Rep. John Conyers Jr.
The New Press, August 2008
Paperback, 176 pp., $13.95

While the public is accustomed to seeing a fresh crop of books by presidential candidates during each election cycle - autobiographies, collections of platitudes or sometimes more visionary musings - it’s less common for them to come across popular and well-researched policy books on the burning issues of the day.

Even rarer are election-year policy books that are well-written, widely accessible and likely to have staying power long after the last vote is cast.

“10 Excellent Reasons for National Health Care,” however, is just such a book. Edited by Mary O’Brien, M.D., and Martha Livingston, Ph.D. - both health policy experts and leaders of Physicians for a National Health Program (PNHP) - this new offering from The New Press delivers exactly what it promises: 10 persuasive, evidence-based arguments for a single-payer national health insurance program in the United States.

Sixteen contributors, including Rep. John Conyers (D-Mich.), United Methodist Church leader James Winkler, California Nurses Association leader Rose Ann DeMoro and Steelworkers President Leo Gerard, make the case for single payer in a compact, pocket-sized paperback.

National health insurance is good for our health, they say. It’s cost effective and will save money. It will assure high-quality care for all, rich or poor. It’s the moral thing to do. It will let doctors and nurses focus on patients, not paperwork. It will diminish racial disparities. It will reduce medical debt. It will benefit both labor and business.

And, as Joanne Landy and Dr. Oliver Fein of PNHP argue, single payer is what nearly two-thirds of Americans want.

In each case, the argument is fleshed out with facts and statistics, sometimes accompanied by charts and even the occasional cartoon. Several contain dramatic patient stories. Dr. Claudia Fegan, for example, relates her frustration with trying to get an insurance company to approve an urgently needed detox treatment for a patient, ultimately finding herself pleading with an emergency room physician to administer a time-critical injection.

Drs. Olveen Carrasquillo and Jaime Torres vividly describe what they call “medical apartheid” in our present setup, a multi-tiered “system of segregated care and unequal access faced by poor and predominantly minority patients,” including undocumented immigrants.

All of these problems would be effectively resolved under an expanded and improved Medicare for all, the contributors argue. The main obstacle to achieving this goal, however, is the influence of the for-profit, private health insurance industry.

Despite the obstacles to reform, “10 Excellent Reasons” is pervaded by a spirit of confidence that national health insurance can be won, an optimism that most readers will find contagious. It’s a powerful tool for single-payer advocacy. It also includes a valuable list of additional resources at the end.

In his foreword, Rep. Conyers sums it up: “This insightful book will provide you with the information you need to be an informed participant in the public debate about how to achieve health care for all, [and] work toward the only sensible solution to our health care crisis: a single-payer national health insurance program.”

  • * * *

Mary O’Brien, M.D., is a board-certified attending physician at Columbia University Health Services and a faculty member at the Columbia College of Physicians and Surgeons. She is on the board of directors of the New York Metro chapter of Physicians for a National Health Program.

Martha Livingston, Ph.D., is associate professor of health and society at the State University of New York College at Old Westbury. She is vice-chair of the board of directors of the New York Metro chapter of PNHP.

“10 Excellent Reasons for National Health Care” can be ordered from your local bookseller or from Amazon.com, among other places. In searching for the book on Amazon, use the numeric 10 as the first word in the title or search under the names of Mary O’Brien, Martha Livingston or John Conyers.

To inquire about ordering multiple copies, call Physicians for a National Health Program at (312) 782-6006.