Baucus closes door on single-payer in national health care debate
By JOHN S. ADAMS
Great Falls Tribune
May 17, 2009
HELENA — Last week lawmakers on the U.S. Senate Finance Committee wrapped up a series of hearings aimed at laying the groundwork for reforming the nation’s ailing health care system.
That committee will play a crucial role in any health care reform forwarded by Congress, and its chairman, Sen. Max Baucus, D-Mont., could be the most important player of all.
Representatives from the health insurance industry, the business community, retiree groups and others were invited to take part in the May 5 and May 12 roundtable discussions, but missing from the panels were advocates for single-payer health insurance. That fact led to a pair of dramatic protests on the hearing floor that disrupted the proceedings and ended in 13 arrests.
Supporters of single-payer insurance — in which the federal government provides health insurance for all Americans and pays doctor, hospital and other health care bills, replacing the private for-profit insurance industry — say it is the only option for fixing the broken and expensive health care system. They say they repeatedly tried to meet with Baucus to urge him to allow a single-payer advocate to take part in the hearings, but the senator refused.
Baucus, who sets the Finance Committee’s agenda, has consistently stated that single-payer is off the table.
“We’ve got to reform our system fairly quickly, and to be candid with you, very few members of the House and Senate advocate single-pay. The vast, vast majority do not,” Baucus said in an interview Friday. “It tells me that if I go down that road, it’s not going to be successful — it’s not going to pass the Congress.”
Though no single-payer bills have been introduced in the Senate, Rep. John Conyers, D-Michigan, has introduced a universal health care measure in the House, House Resolution 676, entitled “The United States National Health Care Act.” The bill has 75 sponsors in the House and is endorsed by more than 500 unions in 49 states, including the Montana AFL-CIO and the state teacher’s union, MEA-MFT.
“There are 50 million people without insurance in this country. That’s equivalent to 24 state populations. If we had 24 states where nobody had insurance they would be out in the streets raising all kinds of hell,” said Phil Campbell, spokesman for the group Montanans for Single-Payer and the former political director of the Montana Education Association before it merged with the Montana Federation of teachers. “We’re just frustrated with Baucus because all the players are at the table, all the insurance companies and other folks, except advocates for single-payer. We think it’s the solution to the problem. It’s a system that will pay for itself rather than figure out how we’re going to pay for the system.”
With some polls showing approximately 60 percent of Americans in support of single-payer health insurance, advocates say Congress is excluding the majority of Americans from a critical national debate. Single-payer supporters say politicians are unfairly criticizing the idea as politically unfeasible without even having an open and public dialogue on its merits.
“If you have a policy debate on the merits, that’s going to serve the ultimate purpose, which is to come up with the best health care reform plan possible,” said Michael Lighty, director of public policy for the California Nurses Association, one of the groups that staged a protest at Tuesday’s hearing. “If you let political feasibility truncate the policy debate then you haven’t done service to the debate.”
Protesters showed up at the two Senate hearings this month to urge Baucus to give single-payer advocates a seat at the table. In both cases, protesters were escorted out of the room by police and arrested. In all, 13 protesters — dubbed “The Baucus 13” by some — were charged with unlawful conduct for disruption of Congress.
The protests were organized so that as one protester was escorted out of the room, another would stand and demand the panel consider single-payer.
Dr. Judy Dasovich, a volunteer medical director of a free clinic in Springfield, Mo., was arrested at Tuesday’s hearing. As the hearing got under way, Dasovich stood up and said, “We request that single-payer advocates be allowed at the table. Health care should be for patients, not for profit.”
Dasovich said she was promptly escorted out of the Dirksen Senate Office Building by police. She spent the next five hours in jail.
“I don’t understand how a country that is as rich as ours can allow 20,000 of its citizens to die for lack of health care and allow others to be financially ruined by exorbitant costs. Callous neglect is not an American value,” Dasovich said in an interview from her home Friday.
According to federal estimates, 46 million Americans are without health insurance and another 25 million are underinsured, or more than 20 percent of the United States population. Additionally, those numbers are increasing as more workers lose their jobs in the ongoing recession.
Meanwhile, the cost of health care continues to skyrocket, making it more difficult for those who do have insurance to pay for it.
According to the National Coalition on Health Care, in 2008 total national health expenditures rose 6.9 percent from the previous year, or twice the rate of inflation. Meanwhile, health care spending topped $2.4 trillion in 2007, or $7,900 per person. Currently, total health care spending represents about 17 percent of the gross domestic product.
So what would single-payer advocates have told the Senate Finance Committee if given the chance?
“In terms of having a health care system that’s sustainable and we can afford, it is the only realistic option,” said Marcia Angell, a prominent critic of America’s health care system and the former editor of the New England Journal of Medicine. Angell also is a senior lecturer in social medicine at Harvard medical school and author of the book, “The Truth About the Drug Companies: How They Deceive Us and What to Do About It.”
Many single-payer supporters publically urged Baucus to let Angell take part in the hearings.
“What I would have said is that the underlying problem with our health care system, the thing that makes it such a mess, is that it is based on seeking profits and not on providing health care,” Angell said. “It entrusts the financing of health care in the private sector to hundreds of investor-owned insurance companies who maximize profits by avoiding covering high-risk patients, and stinting on the services of people that they do cover.”
Baucus said he believes there is a dire need to reform health care, but that a majority of Americans are mostly happy with their current health insurance coverage.
“I think to be successful here, we have to somewhat work with what we have. Work with changing the system we Americans know and are comfortable with rather than some major change that would disrupt Americans in a way that most Americans don’t want to be disrupted,” Baucus said.
Some conservative critics of single-payer say it is “socialized medicine,” adding that it puts the government in a position of choosing which doctors patients see and imposes a massive bureaucracy on the health care system.
Angell says that’s hogwash.
“The notion that the private sector is efficient is total mythology,” Angell said.
According to Angell, private health insurers take 10 to 20 percent of premiums patients pay just to cover administrative overhead costs. She said some smaller insurance companies take up to 30 to 40 percent of premiums.
“Medicare pays only 3 percent in overhead. Right there you see a much more efficient system,” Angell said.
Baucus favors a program similar to what Massachusetts implemented in 2006, in which everyone is required to be covered by some sort of health insurance, either through their employer or out of their own pocket. If a resident can’t afford to buy his or her own coverage, the state helps that person pay for it. Baucus outlined the main points of his proposals in a report last November.
“Massachusetts is being held up as some sort of a model. I live in Massachusetts, and I can tell you it’s not a model you would want to follow,” Angell said. “Most people in Massachusetts are now insured, but the costs are going up so rapidly that they are having to shrink benefits and increase co-payments, and it cannot last in the form intended. The state is broke.”
Angell said the federal government could face the same fate if it adopts that model of reform.
Though Baucus refuses to include single-payer advocates in the heath care reform hearings, he said he cares about their ideas and is listening.
“In fact, I’m meeting with advocates of the single-pay system. I have in Washington, and I’m in Montana right now (and) will soon be meeting with them in Montana,” Baucus said Friday.
He also is considering the idea of offering a publicly run insurance plan that would compete with private plans.
“We have a public option on the table,” Baucus said. “It’s one of the so-called coverage options, and it’s similar to single-pay and that’s being discussed, that’s being debated.”