Single Payer – Gaining Momentum

June 13, 2009

New York Times columnist, Nicholas Kristof, injected some balance into the health care reform discussion on Thursday.  In a forceful counterpunch to conservative criticisms of the Canadian health care system, he reported the “real life story” story of Diane Tucker, an American living in Canada, who has had significant encounters with health care on both sides of the border.  The one in Canada was positive, the one in the US was not.

in his follow on blog, Mr. Kristof writes that

Canada does have health care problems, including waits and escalating costs, but the U.S. has even worse problems – including that we spend twice as much per capita and get significantly worse results.

What is most refreshing is that it quickly became the number one e-mailed article on the New York Times on-line edition.  Comments to both his column and his blog clearly indicate that, at least among Mr.Kristoff’s readers, a Canadian style health care delivery system would be a significant improvement over our current system.

Mr. Kristoff admits that he would prefer a single payer system, but concedes that is unlikely to happen.  A public plan option is an adequate alternative, he argues.

But Mr. Kristoff reflects a creeping awareness among the media establishment that single payer is “on the table.”  This is to the credit of the single payer activists who demanded to be heard beginning with their protest of President Obama’s health care summit and the Senate Finance Committee hearing in May.

Since then single payer voices are being heard on the streets, in the media and in Congress.

On the Streets

In cities across the country, activists have called for a single payer health care system.  There was a rally in San Francisco, Nancy Pelosi’s back yard.  There were rallies in Montana, Sen Baucus’ state.  There was even a rally in my home town, Harrisburg, PA.

In the Media

The main stream media is only slightly less dismissive of single payer than Congress.  Trudy Lieberman, in the Columbia Journalism Review, reminds us just how rare Mr. Krisoff’s voice is.   Ironically the most exposure to single payer seems to be in the home state of Senator Max Baucus.  Bill Moyers, true to form, showed the media how to do it on the Bill Moyers Journal on NPR.  Single payer advocates did appear on the Ed Schultz Show, not main stream yet.  And locally, single payer has had air time on Baltimore public radio and somthing approaching an objective discussion on the Dianne Rehm show on WMAU in Washington DC.  But the media has not shown any great understanding of the issue.

In Congress

Single Payer got a chance to appear before the Senate Health Education and Labor Committee on June 10 and June 11.  Kevin Zeese, an activists with Maryland Health Care Now, reported on the site, Prosperity Agenda.

Yesterday, as Senator Tom Harkin (D-IO) left the health care hearing room he leaned over to me and said:

“I used to sell insurance. The basic rule is the larger the pool the less expensive the health care. Today we have 1,300 separate pools – separate health care plans – and that is why health care is so expensive; 700 pools would be more efficient and less expensive and one pool would be the least expensive. That’s why single payer is the answer.”

Nothing like common sense.

But, common sense was not on display in the Senate yesterday. Instead, the senate is seeking a path to the goal of universal coverage by protecting the least efficient model – the for-profit insurance industry that through waste, fraud, abuse and bureaucracy eats up 31% the cost of health care.

Back to the Streets, the Media and Congress

All of this may come together on Thursday, June 25th when single payer advocates from across the country will converge in Washington DC, 11:30 in Upper Senate Park, to rally and swarm their congressional representatives.

Hopefully the media will notice.


Single Payer Gets a Voice Behind the Table

May 9, 2009

When reason fails shouting prevails.

From Senator Max Baucus, “We need more police.”

Voics from the back of the room

And more voices from behind the table.

Margaret Flowers, MD & Katie Robbins, Healthcare-NOW

Carol Paris, MD, PNHP

Adam Schneider from Health Care for the Homeless

Russell Mokhiber, Single Payer Action

Thanks to the brave organizers of this event!


Healthcare Reform – Why a public plan Option?

April 25, 2009

Some things I don’t understand!

I just don’t quite get the “public plan option” idea.

I read Jacob Hacker’s proposal for a public plan option again.  Professor Hacker is a scholar with his heart in the right place, a rare combination.  He gained my immense respect after I heard him speak about his book, The Great Risk Shift, a couple of years ago.

Professor Hacker makes a compelling case that a public plan is not only administratively more efficient than private plans, but that they have a convincing record of introducing large scale quality initiatives and payment reforms into the marketplace.

He then goes on to describe the dismal record of private insurers in comparison to public plans.

So why are the private plans an option if the public plans are superior?

That’s what I don’t get! Read the rest of this entry »


Docs talk about health care reform – sort of

March 18, 2009

Two weeks ago, The Annals of Internal Medicine posted three articles on health reform and invited readers to comment.  The three articles highlight the perspective of physicians, more specifically internists who generally fit into the category of primary care physicians.  As one commenter notes, the three articles read like committee reports.

There are some pretty heavy hitters among the authors to the three reports so I offer my comments with some trepidation.  Bottom line, they miss the mark.  I have this image of trying to land an airplane when the altimeter is 10,000 feet too high.  The plane just doesn’t seem to touch down.

Except for the details outlined in the EMBRACE program, there is little to disagree with, it is just as if the the wheels just don’t reach the ground.

Read the rest of this entry »


COBRA – Stimulus or Bureaucracy?

March 14, 2009

Does Congress really think they are doing anyone a favor with the new COBRA subsidy provision in the recently enacted stimulus package? capitol_art_160_20080314161058

Why can’t they make it simple?

Conservatives who fear “socialized” medicine because it will make medicine more bureaucratic should acquaint themselves with COBRA regulations. Litigation over COBRA keeps lawyers and judges busy all over the country.  And what does any of it have to do with the delivery of care?

What is COBRA anyway?  The Consolidated Omnibus Budget Reconciliation Act of 1986 was one of those huge (thus the word omnibus) budget bills that included everything from tobacco price supports to fishing fees for foreign fishing vessels.   But it will be remembered because Title X (of XX) included provisions to permit those who lose their health insurance under an employer sponsored health plan to continue their health insurance under certain conditions (called qualifying events) and provided they pay the full cost of the coverage.

Because, the person without coverage is also usually without a job, and because the person must pay the full cost (actually 102%) of the coverage, very few people elect the coverage and those that do are more likely chronically ill individuals.  In insurance parlance, that’s called adverse selection.  The plan sponsor will usually end up paying more than they receive in premiums.

So what did Congress and President Obama do with COBRA? 

The new law makes the cost of COBRA premiums slightly more affordable.  Normally, a 65% discount would seem pretty attractive.  But the average cost of one of our family plans exceeds $1,000.  $350 – 450 per month for a family with one less breadwinner is still a stiff price. images_2 Imagine selling a Lamborghini at 65% off!  $70,000 for a $200,000 car is a huge bargain.  But for someone without a job?

The new law allows those terminated between September 1,2008 and February 17, 2009 and who initially declined their COBRA election, another opportunity to elect the coverage at the reduced rate.  And they can begin their coverage March 1 instead of the date of the qualifying event.

Unlike regular COBRA, the subsidy is limited to those who are “involuntarily” terminated and their family members.  The plan sponsor can rely on the employees’ attestation that they were involuntarily terminated. Read the rest of this entry »


Health Care Reform – Three different themes

January 17, 2009

Three reports this week about the costs of health care and health care reform caught my attention.  One said that health care reform will be a sure fire economic stimulus because it will replace jobs lost from the current recession.   Another suggests that a modest upfront investment will produce $530 billion in savings.  The third moans that without a commitment to hard choices, we are doomed to health care spending profligacy.

John Nichols in The Nation describes a report and follow-on campaign by the National Nurses Organizing Committee/California Nurses Association (NNOC/CAN) that attempts to bolster the argument for a Single Payer health care system by describing its impact on jobs and the economy.

A report in Reuters describes a report by DeLoitte that argues that a $220 billion investment in e-prescribing and electronic medical records will produce $530 billion over ten years.

Lastly, Robert Samuelson in the Washington Post reports on findings of a report by the McKinsey Global Institute that provides valuable insights into why US health care costs so much more than it does elsewhere in the world.  Unfortunately,  it was short on constructive “shovel ready” policies. 

So how does one react to such disparate perspectives.   Read the rest of this entry »


Health Care Reform as Economic Stimulus

January 3, 2009

There is some dicsussion that health care reform should take a back seat in an economic stimulus package. 

I suggest that health care reform can go a long way to jump start the economy by itself.  

I make that argument for three reasons.  First the current system of health care financing distorts the competitiveness of the American economy.  Second, the current system of health care financing distorts the job market.  Third, which is really an extension of the second,  the current system of employment based health care financing inhibits the very creative forces that can energize the economy. Read the rest of this entry »