Single Payer in Maryland

February 28, 2009

A letter to Senator Thomas McLain (Mac) Middleton

Chairman, Senate Finance Committee

Maryland State Senate       

Thomas Middleton    





Thomas Middleton

In one way or another I have been associated with labor management benefit funds throughout my working career.  For years, the multiemployer funds were my model of how a health care system based on employment could work.

But I have become convinced that the health care system is broken at its core.

I understand that the Maryland State Senate will be considering SB 881 in committee hearings on Wednesday, March 4th.    I am asking you to join the effort to lead Maryland to a single payer solution to health care in Maryland and the nation.

Who should the system serve?

First,  I ask you to pay attention to who is complaining the loudest that the current system is broken.  It is patients and doctors.  If all of the other stakeholders aren’t facilitating patient access to care and physician delivery of care, then their role in the process needs to be reexamined.   A single payer approach begins a fundamental realignment of those roles.  It does not need to eliminate their roles.  It needs to make them secondary.

Broken at the core – let the buck stop here

I believe that the current health system is broken at its core because no entity accepts full responsibility for any portion of the bill.  Listen in on any collective bargaining discussion to begin to appreciate that.  Employers want to shift as much of the cost and responsibility on to employees as possible. 

At the same time, the federal government doesn’t accept full responsibility for Medicare eligible beneficiaries.  They push as much as possible on to private employers as possible. 

And do state governments honestly think that Medicaid payments can sustain a delivery system?  Who makes up the difference?  Health care financing is like the card game, Old Maid.  Who will be the last one holding the poison card? 

A single payer system says “the buck stops here!” and ends the health care financing shell game that so distorts incentives for all stakeholders.

Broken at the core – level the competitive playing field

I believe the current system is broken at its core because it fundamentally distorts our competitive economy.  The inequitable financing of health care distorts competition domestically and internationally. 

You witness how competitive pressures have created a race to the bottom that has eliminated private pensions for many and threatens pensions for many more.  The same is happening in health care.  Look at the auto industry! 

What is the incentive for private employers to take full responsibility for the health of their employees, their retirees, and their families if it puts them at a competitive disadvantage at home with employers who don’t assume the same level of responsibility, and internationally where health care costs are significantly lower?

A single payer system takes health care costs out of competitive considerations and allows companies to focus on their core competencies.

Broken at the core – empower the workforce

I believe the current system is broken at its core because it reflects poorly on the value we place on our citizens and their role in the economy.  You must be familiar with the countless tragic stories of people with inadequate or no health insurance. 

Those are not just stories of physical, financial and emotional stress.  They are stories of people who have been denied the opportunity to become productive members of the economy.

By providing equal access to care, you are allowing equal access to work.  By taking health care out of the cost of employment, you encourage those employment trends that struggle to gain a foothold in the current economy – less overtime, more part time, job sharing, phased retirement.  How many creative ideas never come to market, because a creative individual is afraid to sacrifice his or her health insurance to risk starting a new business?

A single payer health care system is a work force and economic development issue.

We do not need more patches on a leaky and sinking health care boat.  We need a newly designed boat that will steer the Maryland and the US economies and their workforces to less turbulent waters.

I hope you will listen to the many more detailed arguments supporting SB 881 put forward by Health Care NOW Maryland; that you will sign on as a co-sponsor of SB 881 and that you will enlist the support of your colleagues in this effort.


Health Care Reform – the True Test of Equality

February 21, 2009

Opposition to a single payer health care system has absolutely nothing to do with rational argument.  By any rational measure, a single payer system is a superior approach to organizing and financing the delivery of health care services.

Opposition comes primarily from two quarters:

  •        those who already benefit from the current system and don’t want to lose whatever benefits they think they take from the current system.
  •        Those who simply think that some people don’t deserve health insurance.

The first group is somewhat easier to deal with.  They represent interests that are, in some capacity, engaged in the system.  Because of that engagement, they can’t help but see some of the problems facing the most fundamental stakeholders, patients and providers.  In an effort to find solutions, common ground is achievable.  It may be more expensive, but it is achievable.

But there is another group that is threatened in a different way. Read the rest of this entry »

Polls the Pols aren’t watching

February 18, 2009

Two recent polls, barely noticed in the mainstream media, remind us that the public is very much behind a Medicare for All health care reform solution.

The group Consumer Watchdog released the results of a poll that shows that 64% of Americans support expanding Medicare as a choice for everyone as an option to private health insurance.  Even when reminded that this could increase taxes the support for the concept dropped only a few points.

Do you favor a public health plan option?

Do you favor a public health plan option?

Another CBS/New York Times poll released earlier in the month revealed that 59% of Americans believe the government should  provide national health insurance.

This is not a sudden change.  Two years ago, CBS reported that only 8% felt that health care in the US needed only minor changes.  Ninety per cent  said the U.S. health care system needs fundamental change or needs to be completely rebuilt.  I’m not sure even CBS could explain the difference in those two perspectives.

CBS Poll

CBS Poll

This should not be a surprise.  Physicians for a National Health Program have argued that 60% of health care spending is already supported with tax dollars.  I suspect that the American public knows in their gut what the PHNP maintains: that we are paying more in taxes for health care than any other country on the planet and yet too many of us are not getting health care.

Now I don’t maintain that 60% of health care dollars equals 60% of health care patients.  I do think there are a lot of patients who are paying taxes and wondering what their government is doing for them

And too many politicians are doing nothing.

The Stimulus – The Good, the Ugly, and the Bad

February 14, 2009

The Good

It looks like the stimulus package is on its way to becoming law.

The Good news is that health care safety net provision have survived somewhat intact.  The additional support for Medicaid and for COBRA continuation coverage are still in the package.  In addition the features of health care stimulus that encourage the development of the electronic medical record and research on the comparative effectiveness of treatments were only slightly modified.

The Ugly

The way those on the right react to these provisions is ugly.   I commented on this last week.  Not only do they see impending doom with each additional patch on our leaky health survival raft;  they have a way of turning long standing truths on their head and interpret liabilities of the current maze into positives.

Last week I pointed out right wing reactions to “comparative effectiveness research” and the electronic medical record.  Recently the Washington Times outrageously equated comparative effectiveness research with Nazism.  Most people reading or listening to the scares on this topic would assume the Office of the National Coordinator for Health Information Technology is some new and sinister bureaucracy.  In fact, the office was created by executive order of President George W. Bush in 2004.  This was pointed out by Keith Olbermann on MSNBC’s Countdown.   Read the rest of this entry »

Keith Olbermann – The Real McCaughey

February 14, 2009

MSNBC and Keith Olbermann on Betsy McCaughey in the Blumberg Report

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The Stimulus and the right wingers on health care

February 7, 2009

In discussing the nation’s health care system, “broken” is the most common descriptive term.  Almost all stakeholders seem to agree on the adjective.  Not Mr. Tevi Troy, writing recently for the Weekly Standard.

Health Care Reform Can be a Stimulus

I have argued that a major overhaul of health care would be a significant stimulus to the economy by leveling the competitive playing field for both employers and workers – those currently working, those out of work and those working on the margins.  In the long term, it would free up capital, both the monetary kind and the human kind, for more productive investments.

It does not surprise me that Congress might see things differently.  The major health care provisions in the stimulus package that will be approved by the Senate have very little to do with stimulus and everything to do with safety net.  Support for state Medicaid programs and provisions related to COBRA.  There are two small provisions in the package that do attempt to push the reform agenda a tiny fraction of an inch.

There is a provision in both House and Senate versions of the bill for for further development of electronic medical records and there is money for “comparative effectiveness research”.

These are hardly earth shaking provisions, unless you are listening to the likes of Mr. Tevi Troy.  To Mr. Troy and his ilk, these measures are the Ft. Sumter of the liberal war on the US health care system.

What planet to these people live on? Read the rest of this entry »