In a surprise move to appease moderate Democrats, sources say the Obama health reform plan may drop the public option in favor of extending Medicare to the uninsured who are more than 55 years of age, the Associated Press is reporting. Currently, only those over 65 are eligible to receive Medicare.
At a last-minute news conference in the Capitol Tuesday evening, Senate Majority Leader Harry Reid (D-Nev) would say only that a “broad agreement” had been reached between liberals and moderates on the issue. The resulting bill is expected to forbid insurance companies to deny coverage based on pre-existing conditions and to reduce healthcare costs in general.
However, dropping the public option is seen as a great loss by those who wish to see healthcare needs prevail over insurance-industry profits. And it seems less likely costs will be curtailed if a purely private health insurance solution is formulated. Currently, about 20% of every healthcare insurance dollar the public pays out goes to insurance industry profits and overhead. The competition provided by the public option was seen as a way to lower these costs and see that more of the healthcare dollars coming both from taxes and individual expenditures would go toward providing actual health care. Medicare overhead costs are generally considered to be between two and five percent, with four percent the most popular figure.
One undoubted benefit of increasing the Medicare rolls is that it will increase the scrutiny paid to Medicare and its benefits. Currently, Medicare recipients are saddled with recent additions to the plan that operate like private insurance or require recipients to sign up for private insurance if they wish to receive, for example, payment for drugs. Some recipients claim that the copays under these plans exceed the cost of many generic drugs purchased directly from a low-cost pharmacy.
Increasing the number of people dependent on the program may increase political pressure to return Medicare more to its single-payer roots.
Represetative Earl Blumenauer has posted an open letter to his fellow members of Congress over on Huffington Post. For your convenience, we’ve posted the text here:
Senators who are filibustering and throwing sand in the gears to delay health care reform desperately need a reality check. It is ironic to me that members of Congress enjoy some of the best health insurance in the world through our government-administered health care, and yet so many are working overtime to deny quality care to Americans – using scare tactics to claim the “government is going to take over their health care.”
Well, for those Representatives and Senators who are so terrified of a government take-over, I say to them NO access to government run programs for you.
Members of Congress should not have access to taxpayer-funded health care when they are actively denying these very people quality care of their own.
So for the 150 members of Congress who qualify for Medicare, a single-payer government insurance plan, you get no access. For all members who are eligible for the Federal Employee Health Benefits Program, no more. And no more access to the attending physician in the Capitol, either. Not until we pass the health insurance reform that millions of Americans so urgently need.
I share with you my open letter to members of Congress:
Dear Colleague,
I invite you to join me in sponsoring the Health Care Reality-Check Act which I will be introducing next week.
It has become clear that some of our colleagues lack proper perspective on the urgency of health reform because, ironically, as members of Congress we enjoy some of the best health security in the world through our government-administered health care:
All Members of Congress are eligible – and most participate in – the Federal Employee Health Benefits Program, which provides all federal employees with a government-negotiated insurance exchange that is subsidized by their employer: the Federal Government;
Almost 150 Members of Congress qualify for Medicare, a single-payer government insurance plan;
The 121 Senators and Representatives who served in our armed forces are eligible for the “socialized” health care we provide for all veterans; and
Members who aren’t veterans can avail themselves to a similar “socialized” program – the Attending Physician in the U.S. Capitol, for an annual fee of around $500.
These government-run health programs have successfully provided countless Senators and Representatives with life-saving medical treatments, but as we all know, most Americans don’t have this kind of protection.
Members of Congress should not have access to taxpayer-funded healthcare when they are actively denying these very people quality care of their own.
Congress needs a reality check.
In 2007, before the economy collapsed, 42% of all adult Americans under 65 were either uninsured or underinsured. Our dire unemployment rates and escalating health care costs have only made this situation worse. Today half of all American families delay seeking medical treatment because they have such a tenuous health insurance situation. Our colleagues do not fully appreciate the plight of 50% of our population, but we can help them understand.
Until health reform is enacted, Members of Congress should get to experience the tender mercies of our fragmented, complex, and exploitative health care system. My Health Care Reality Check Act terminates all government-administered health benefits for Members of Congress until comprehensive health reform is signed into law: no more Federal Employee Health Benefits Program, no Medicare, no VA, no attending physician in the Capitol.
Instead, Senators and Representatives may self-insure or they can rely on a spouse’s company having employer-provided insurance, thus tying them – like millions of Americans- to the employment of a family member. Some will need to buy health insurance on the private market, exposing them to legal discrimination based on age and gender.
By personally dealing with rescissions, pre-existing condition exclusions, the fine-print of insurance contracts and the gaps in coverage from weak consumer protections maybe our colleagues can better grasp the urgency of our health care crisis.
If our own health security were linked to the success of health reform for all Americans, we [would] have a bill enacted within weeks, guaranteed. I urge you to cosponsor the Health Care Reality Check Act today.
There are three videos here, so be patient. The first is nominally a debate between Betsy McCaughey and Anthony Weiner, but moderator/interviewer Dylan Ratigan gets heavily involved. This debate starts out well enough, but it turns into a bit of a free-for-all when Dylan Ratigan refuses to let Betsy McCaughey ignore his question and go off on a tangent to scare seniors with accusations about health care reform. McCaughey is obviously not used to being called on this tactic and becomes defensive.
Meanwhile, New York Representative Anthony Weiner continues to impress as an articulate spokesman for healthcare reform. This particular video may not provide you with lots of new information about healthcare reform, but it should at least make you aware of the attempts some are making to spread propaganda about some of the current healthcare reform bill’s provisions.
In a separate interview with Jon Stewart (below), McCaughey is credited with raising the issue from which Sarah Palin coined the phrase “death panels.” Stewart attempts to hold McCaughey to her task, though more gracefully than Ratigan. The amazing thing is the way McCaughey consumes the whole interview with evasive tactics, never actually coming to the point of demonstrating where in the bill the text she refers to allegedly exists. (It doesn’t.) The whole interview is a study in evasiveness.
But in Jon Stewart’s gracious and skillful hands, it becomes a hilarious commentary on the current healthcare reform debate. He and McCaughey part on friendly terms.
Below is the unedited Part 1 of the Betsy McCaughey interview with Jon Stewart.
Ready for more? Are you still waiting to hear where the health reform bill proposes to pull the plug on seniors? Below is the rest of the interview, uncut.
By the way, there are certain inaccuracies here that Stewart apparently doesn’t know about. When writing previous articles, we’ve checked on health care statistics from WHO and other sources. The method McCaughey uses here to correct for deaths due to violence and auto accidents, thereby establishing the U.S. as the #1 source of effective health care in the world does not work. In fact, the WHO has already thought of these issues and they are incorporated into the statistics WHO provides. Not only is no correction for violence and auto accidents necessary, attempting to do so results in inaccurate statistics. McCaughey is falsifying her evidence, and probably knows it.
You may recall that approximately a year ago the nation was in the throes of a severe financial collapse and that the government—then the Bush administration—had taken upon itself to dole out billions in taxpayer monies to those deemed deserving: by which we mean giant corporations, not our taxpaying individual citizens. Among those recipients was Goldman Sachs, which was selected as among those “too big to fail” and given, in round figures, approximately $70 billion. Forgive us if we err by a few billion in either direction—we’re using round numbers here as the government or Goldman executives would—as though a few billion either way is, well—chicken feed.
You may or may not be aware that Goldman has since enjoyed its best-ever quarterly profits, after a down quarter that coincided with the payouts and a pretty respectable first quarter this year, which was followed, as we say, by a couple of blowouts. Since words don’t really do it justice, we refer you to the chart below right, which was lifted from no less a source than the Washington Post, though we borrowed it in turn from Glenn Greenwald’s excellent blog.
Goldman has its best-quarter ever
You must understand that the figure depicted for the second quarter was the best quarter everfor Goldman Sachs. A mere $3.4 billion in earnings. (That’s in three months, in case you weren’t paying attention.) And the quarter that just ended—the third quarter—was no slouch either. In fact, it just happened to be Goldman’s second-best quarter ever. How’s that for coming back like bandits after a mere $70 billion loan, which—did we mention?—had no strings attached, so Goldman is not obligated in any way to share its outsized profits with those of us who contributed our share but may have continued to fall upon hard times—losing jobs, businesses, houses and so on—despite Goldman’s rather spectacular windfall. Those profits occurred, we’d be remiss not to add, at the same time the unemployment rate went to 9.8%, the highest in 26 years.
You get the picture.
This is a company, you must remember, that were it not for the American taxpayer, would have gone bankrupt a year ago. We repeat: Goldman Sachs was going out of business before we, the taxpayers, intervened. (Okay, our leaders intervented on our collective behalf—had it been up to many of us, Goldman might well have joined the likes of Lehman Brothers, Merrill Lynch, Bankers Trust, and Salomon Bros as footnotes in history.)
Indeed, as other firms on Wall Street failed, Goldman—as one of the privileged bailed-out bankers—was able to quadruple earnings year over year. No small feat, we can assure you. And the scary part is that since the money they used was essentially free in terms of any moral hazard involved, their bailout acted as an encouragement for further risky behavior. (The worst that could happen was that they would still go bankrupt despite raking in billions in government money. But it was our money—not theirs—so they had nothing to lose.)
Mind you, we don’t think Goldman took on undue risk and just got lucky. As seasoned traders, they had every reason to believe that they were trading at or near the bottom of the market, so the bargains they picked up—knowing full well that hardly anyone else was in a position to do so—were likely to remain great bargains a year or so later.
So after skidding over to the brink and looking down, Goldman has managed to land right back on top. And the employees are anticipating record bonuses. Yes. We’re not kidding. Record bonuses for bonusable Goldman employees. Again.
How could all this happen, you might ask? Well, there are legions of Goldman alumni in the Federal government, which is mostly what Greenwald’s column is about. Indeed, those Goldman alums are particularly concentrated in the Treasury Department (which, to paraphrase Willie Sutton, is where the money is).
Dylan Ratigan has a pretty good explanation of it all in this video.
But what does all this have to do with health care or even just plain health? you should be asking. Glad you got around to it.
The point is, we’re pussyfooting around health care because of the great cost, isn’t that right? The Republicans especially love to point out that all this health care could get terribly expensive.
But look at the difference. We paid out $70 billion so that a few hundred or so Goldman employees could get multimillion-dollar bonuses. We paid out over $700 billion just to bail out Wall Street in general and over $2 trillion as of November, 20081. The CBO puts the cost of the current healthcare bill around $1 trillion. What’s so bad about paying out half what we paid out to mismanaged, failing companies so that every citizen in America gets (and will continue to get) good health care?
“Make the U.S. the envy of several African nations,” he says
Whether you agree with him or not, you have to admit that Bill Maher is the master of acerbic whit and political satire. Here he displays his growing irritation with Obama’s apparent laissez-faire attitude toward right-wing Republicans and the inroads they have made against the Obama administration. He then rips into the healthcare debate in a way that no one we know of can better.
Just a warning: there’s some language partially bleeped out in this one, but you can still tell what Maher is saying.
To counterbalance Maher’s acerbity, we’re following that video with an interview with Bill Moyers, in which Bill Moyers displays the command of language, of history and of the issues that has made him so revered as an observer of the American scene.
If you’re a conservative and not too fond of Bill Maher, we urge you to skip the first video but view the second. Moyers is ever the gentleman. He points out that the big difference between the healthcare fight and the civil rights fight is that the healthcare fight is opposed more strenuously by Big Money. And he points out that the Republicans have every reason to oppose healthcare reform. Not only has there been a conservative revolution in the U.S. in recent decades, but Republicans are reluctant to hand President Obama the biggest political victory since President Johnson established Medicare.
Remember that President Nixon first proposed health care reform in 1974. The Republicans have since lost that initiative. Why should they just hand it to the Democrats and make it easier for the President to seek re-election in 2012?
Below: Bill Moyers speaks to Bill Maher about health care reform and related issues.
This first video, a brief excerpt from a roundtable discussion, focuses on the public option in healthcare. In it, first Robert Reich says a few words, then Nobel prize-winning economist Paul Krugman tells us what’s behind the resistance to the public option in the Senate. Then in the clip below that, Robert Reich, who is a former Secretary of Labor under President Clinton and currently a professor at the University of California at Berkeley, explains what the public option really means.
Krugman is Professor of Economics and International Affairs at the Woodrow Wilson School of Public and International Affairs, Princeton University; Centenary Professor at the London School of Economics; and an op-ed columnist for The New York Times. In 2008, Krugman won the Nobel Memorial Prize in Economics for his contributions to New Trade Theory and New Economic Geography.
Robert Reich (below) is currently Professor of Public Policy at the Goldman School of Public Policy at the University of California, Berkeley.
Bill Maher appears on Jay Leno on September 29, 2009. The conversation starts out with some Maher classic “new rules,” turns to talk of Obama, Sarah Palin and George W. Bush. Then they get “serious” with a discussion of health care, which is actually a good summation of the current dilemma facing us as the nation faces a vote on the current round of health-care legislation.
Because this is an NBC tape, it starts with a 30-second commercial spot, for which we apologize. But we guarantee the segment is worth the wait.
In July, an angry constituent confronted Rep. Bob Inglis (R-SC) at a town hall meeting. “Keep your government hands off my Medicare!” the man demanded. Inglis tried as he could to explain that Medicare was and had been from the beginning a government program, but the voter would have none of it.
That episode illustrates the level of confusion surrounding health care reform in particular and our health insurance system in general. For the record, Medicare is a single-payer system, though in recent years private insurance has made huge inroads in altering the system, aided and abetted by Congress. Since it is not purely single-payer in the broadest sense of “everybody in, nobody out,” it does not achieve the economies of scale a nation-wide all-inclusive single-payer system would. And of course, you have to be 65 to be eligible for Medicare.
Our very own socialized medicine
The Veterans Administration (VA), on the other hand, is an example of socialized medicine, since the providers of the healthcare are government employees and the hospitals are all government facilities. So we do indeed have socialized medicine in this country. It is just (ironically) that it exists where most people least expect it—within and on the periphery of the military.
Neither system is inherently bad, though generally Medicare seems to get higher marks from its constituency. The problem with both systems, contrary to what most people believe, is that they are the poor boys of the healthcare system. Because they cater to two groups that have relatively little power compared, say, to the insurance industry—namely, the elderly and veterans—Medicare and the VA system get relatively little attention from Congress.
… and our single-payer system under attack
Let’s be clear that what makes Medicare single-payer is the formula of a government-sponsored payment plan for privately administered healthcare. To the degree that this model is adhered to, Medicare is popular among those it covers. Most of the problems with the Medicare system stem from its concessions to the prevailing external system of private insurance companies. The best example of this single-payer model gone astray is Medicare Part D, which covers reimbursement for prescription drugs.
This system is so complex even pharmacy professionals were totally confused by it for the first year or so it was in effect. It illustrates the downside of having a health care system dominated by the insurance and pharmaceutical industries.
For one thing, when Medicare Part D was passed in 2003 to become effective January 1, 2006, it required seniors to purchase insurance to cover prescription drugs. In a good single-payer system, pharmaceuticals would be covered the same as laboratory tests or doctor visits. Depending on the system, there might or might not be a small copay. But all these issues should be transparent to the patient.
Part D is completely different. There is none of the beauty and economy (for the consumer) of universal coverage. Instead, we have an enigmatic system that has both reduced coverage and increased costs at the same time—precisely what happens when private insurance gets the upper hand.
What’s more, once Part D went into effect, enrollees had to sign up for these benefits within a short period of time or be penalized. (All this from a group of patients whose predominant source of income was presumably Social Security!) As one of our senior readers pointed out in a private correspondence,
Obama says [he wants to cut spending on] Medicare, but that delivered benefits to patients will not be cut. Apparently, he wants to get back some of the money the insurance companies have been stealing. (For example, when Medicare-D was introduced by the Bush League, the insurance companies slashed benefits, increased premiums, raised copayments, and just kept all the extra money the government was giving them.)
Belatedly, the Democrats figured out what was happening. But Obama doesn’t say how he intends to stop the insurance companies from stealing the money. The insurance oligopoly just does whatever it wants unless there is a single-payer system or at least a government-run competing option. But unless Obama can straighten out Medicare, I have no confidence he will straighten out the larger system. It is about time for him to stop talking bipartisanship and to start exposing all the whores and thieves. Here is a perfect opportunity to show why we need a single-payer system—to prevent the sort of larceny that occurred with Medicare-D.
Indeed, an essential part of that larceny was a provision passed by Congress that forbids Medicare from negotiating drug prices with the pharmaceutical companies. Medicare has to pay whatever price the drug companies ask. Yet, given its large constituency, the Medicare system is in an enviable position to exact savings on the part of the seniors it represents. (The VA, in fact, does do this for veterans.) But for Medicare, that practice is strictly forbidden by law, costing taxpayers billions annually.
Given these shortcomings in our existing single-payer system, it is easy to see why so many citizens throw up their hands and shy away from health care reform altogether, even if they have managed to figure the whole system out. But Medicare could be made much better by keeping it to the pure single-payer model rather than saddling it with all the trappings of our private insurance system.
Private delivery of publicly paid care
What’s good about Medicare is that it leaves the healthcare delivery side of the equation alone. You can go to your existing doctor or find another one if you like. (Not all doctors accept Medicare, but then they aren’t all in the same “networks” of existing private PPOs, either. So for those who think they’ve just found a major shortcoming in the single-payer system, nice try—but it’s a wash.)
Walking away from healthcare reform just leaves the thieves and liars to run the show. Far better to exclude them altogether. A pure single-payer system is the only option that makes total sense, because it stands to save the public $4 trillion over the next 10 years, while simultaneously extending coverage to the 47 million or so Americans who are currently uninsured.
That’s why it becomes the least expensive way to cover everyone. By absorbing the money now taken by the insurance industry for overhead and profits and putting that money towards health care, we can add the uninsured to our rolls without increasing overall costs. Suddenly, you don’t have to worry about losing your insurance should you lose your job or about becoming uninsurable because of a prior illness. The current private healthcare system makes it a practice to remove people from its rolls once they begin to need its services.
Choices aren’t always what they’re cracked up to be
Adding a vague “public option” into the mix of private plans providing meaningless choices such as HMO vs. PPO, deductibles vs. copays, should be considered only as a fall-back position in the event that all else fails. We envision a single-payer system in which you get care from your hospital or doctor and the government pays the bill—a healthcare system that is privately administered but publicly funded.
The halfway measure of adding a government-sponsored insurance alternative to the current bewildering array of private plans is not only unnecessarily complex and inefficient, it will simply cost more compared to straightening out Medicare and extending it to all U.S. citizens.
We suggest you write your Congressman and tell him that.
While writing this editorial, we have noticed a few interesting things happening in the media. One is an exchange between CNBC’s Maria Bartiromo and Rep. Anthony Weiner (D-NY) captured on MSNBC.
We had always respected Bartiromo as a business journalist, though we haven’t watched CNBC in years. So we were surprised when she began spouting shop-worn platitudes in the course of this discussion. The notion, for example, that the availability of Erbitux is the barometer by which we judge a healthcare system is totally bonkers. And how many people in this country have access to it via private insurance anyway? We would like to know. (If you have been given Erbitux and had it paid for by your private insurer, please use our comment form below to let us know about it.)
I was a guest on MSNBC’s “Morning Joe” to talk about health care and Bartiromo, who used to work closely with a relative of mine at CNN, was friendly before the segment started. So I was surprised when the show started and Bartiromo went on the attack, asking me how I could say America didn’t have the best health care in the world. Everyone, she said, would choose to be treated in America if they could.
I was staggered for a moment, I admit it, because I thought she was kidding at first. We were probably a full minute into the debate before I realized it wasn’t a joke. And here’s the really funny part: toward the end of my appearance, I said something about how health care in America is great, if you’re an executive at Goldman, Sachs. Then I left the set and… guess who they brought right afterward on to rip me and praise the American health care system? Bartiromo’s colleague at CNBC, Erin Burnett, a former Goldman, Sachs executive.
Bartiromo, both with me and in this spot with Weiner, has been hammering home the same point, that the proof that a public option won’t work can be found in the fact that the public health care system in England will not pay for the colorectal cancer drug Erbitux. I guess she is trying to say that there is rationing of health care in a single-payer system — that the fact that the government will not pay for the most expensive non-generic cancer drug on the market is proof that we shouldn’t have a public option in the U.S.
It drives me crazy when people make this argument. [A] fancy boutique drug like Erbitux[!] I have a very expensive private plan and I can’t even go to a doctor, not even to ask a simple question, unless it’s an emergency. I can’t get a routine checkup, can’t find out what that weird lump in my left foot is, can’t have the pleasure of a routine proctological exam unless I want to pay cash for it, and, well, forget about getting a filling replaced or seeing a therapist to deal with my incipient nervous collapse/burgeoning mid-life crisis.
Hell, forget about paying for Erbitux, if I wanted to get a colonoscopy to find out if I needed Erbitux, I wouldn’t be able to — I’d probably have to wait until I was a fully symptomatic cancer patient before I could even have that conversation on my insurer’s dime. And I’m one of the lucky ones, I actually have money to pay for care out of pocket, if I had to. No country in the world rations care more than the U.S. There are whole generations of Americans (20-40 year-olds in particular) who don’t know what it is to be able to go to a doctor for preventive care or routine checkups. Erbitux, for Christ’s sake! Give me a break.
To watch this short interview and see what your take on the whole thing is, click here. Don’t forget, then, to tell us all what you think about it by clicking on the red text, “leave a comment” in the grey box that marks the end of this posting. That will open up the comment box (if it isn’t already visible) below the posting itself.
Franken, the senator
Another video that hit the wires recently was of Al Franken calming down constituents at the Minnesota State Fair. This impromptu discussion is well worth watching, because Franken gives a generally good primer on health care reform issues.
We admit we had our doubts about Franken as a serious lawmaker before, but he shows here that he has the “people skills” it takes to show and earn respect in politics. So far as we’re concerned, that and the level of sensitivity and intelligence he demonstrates here is all he needs. We predict good things to come from this senator and wish him well. The exchange is here.
And to show just how ugly things can get (without even going into the incident in which a man had part of his finger bitten off) here’s a tape from the Star Ledger in New Jersey showing the shoddy treatment given a disabled woman in a wheelchair who tried to speak up about her situation in a New Jersey town hall meeting. There’s much more to it than that, but we’ll let you see for yourself here. Excellent work by the Ledger reporter, Brian Donohue.
There’s one misconception in this video that you should be aware of: Medicare is not socialized medicine, though the VA system is. Medicare, as we said before, is primarily a single-payer system, though private insurance, through its agents in Congress, is making inroads into corrupting that system. And while the narrator is certainly entitled to believe in tort reform, in reality that is a side issue completely unrelated to health care reform. As a pseudo issue, it’s been cleverly planted, we believe, by the opponents of health care reform. We agree with him about the importance of disease prevention and health maintenance in general, but again—those issues are not directly related to health care reform, if by that we understand the matter of reforming health care insurance, or in other words, the ways that we pay for and distribute health care.
Maria Bartiromo and Rep. Anthony Weiner (D-NY) mix it up on MSNBC.
Al Franken (D-Minn.) shows his stuff in calming down a potential angry mob.
Wheelchair woman tries to speak at New Jersey town hall meeting, gets heckled by unruly crowd.
There’s so much confusion out there about health care reform, and it’s all to the detriment of consumers. For one thing, the very phrase “health care reform” is a misnomer. What we really mean when we talk about health care reform is “health insurance reform,” because the real problem with our system is how we pay for health care.
You see, it’s just too expensive for the average person to pay health care costs given today’s system. Someone we know recently had to spend the night in the hospital for tests when he thought he might be having a heart attack. At the time, unfortunately, he was uninsured.
When he went in, he was told that he could apply to the hospital for charity forgiveness of a portion of his bill. He filled out the necessary forms to establish that he was uninsured and unable to pay. After he was billed separately by both the hospital and the doctors for each individual test and diagnosis, he received a response to his charity application, which was really a summary bill from the hospital. For his one night stay, he was shown a “charity care amount” of $10,626.00. The hospital said it only expected him to pay $3,542. Keep in mind that this was after he had already been billed almost $2,000 for various tests, services and doctor’s fees.
$3,542 for what?
What did he have done? A test of blood enzymes to determine whether he’d actually had a heart attack, limited additional blood tests (primarily a lipids panel), a chest x-ray and a stress test to determine how strong his heart was.
Had he been insured, however, the insurance company would have put a limit on what it would pay for each of those services, as well as for his bed and so on. We’re certain that same night in the hospital would have cost the insurance company less than half what it cost someone who had just proven he was destitute! An amount on the order of $10,626 would never have been mentioned.
In this case, the issue wasn’t with the health careper se. It was the manner of payment—the same thing we’re proposing to fix when we talk about health care reform.
Ideally, someone thinking he’s having a heart attack in a strange city shouldn’t be faced with a dilemma about how to pay. He shouldn’t have to pay more for being out of state (which was a factor in this case) and he certainly shouldn’t have to pay more for being uninsured when it was not his choice to be so. After all, he’d been dumped by his insurance company.
Choice of hospitals and doctors wasn’t really much of a factor in this case. Our hero went to the closest hospital and was treated by the doctors on duty—absolutely no choosing for him at all. But had this not been an emergency, he would have had the option of shopping around for a doctor under a single-payer system.
Why should there be “out of network”?
By contrast, most private insurance plans expect you to pay more for a doctor who is “out of network” if they will cover such visits at all. And if you belong to an HMO, good luck! Your choices are highly proscribed and you are very likely to be told you can’t have certain treatments, just because giving them to you will have an adverse effect on the HMO’s bottom line. We’ve seen it happen in real life.
Insurance companies tell you they’re giving you choices, such as whether to pay a higher premium and get a lower deductible, or vice versa. But the meaningful choice in health care isn’t getting to choose an insurance plan, which merely determines how you pay. Meaningful choice is about who treats you, where you go for treatment and which treatment you will receive. You want to have control over those things, as well as over what conditions you think merit treatment. Since a single-payer system provides private delivery of health care (just like we have now) it wouldn’t change the meaningful choices. The only part it changes is how the bill gets paid. A single-payer system centralizes payment so that it is done either by the government or by a publicly owned agency. There’s no insurance company middle man.
Australia and Canada, for example, have single-payer health care systems. Those two countries rank 7th and 8th, respectively, in life expectancy among nations, according to CIA figures. The U.S. ranks 50th. In 2003 (the latest year for which we could find the figures, calculated in U.S. dollars) Australia spent $2,886, Canada $2,998 and the U.S. $5,711 per capita on health care.
What choices best serve the consumer?
As we go through the debate about health care reform, one of the issues informed consumers should watch closely is whether or not a single-payer option is put on the table. This is the solution least likely to be offered because it is the most beneficial to the public and therefore the least profitable for industry. In fact, a bill in Congress—H.R. 676—represents just such a single-payer system, based on expanding Medicare coverage to cover all. (The bill, introduced by John Conyers of Michigan, is called “Expanded and Improved Medicare for All,” not so surprisingly.)
You won’t find many in Congress or the Senate standing up to push H.R. 676, though, because it is precisely the bill the health insurance industry does not want to see enacted under any circumstances. If it passes, over $400 billion in annual profits will disappear from the health insurance industry, along with a lot of perks for congressional supporters.
And what’s worse, the CEO of United Health Care will have to give up making $120,000 an hour, or at least find some other industry in which to make it.
We bet you’re going to lie awake nights now, worrying about him.
The U.S. Department of Justice announced today that it had reached the largest settlement ever with a pharmaceutical manufacturer as Pfizer pled guilty to felony charges of fraudulent promotion of pharmaceuticals.
According to a DOJ press release, the company will pay a criminal fine of $1.195 billion, the largest criminal fine ever imposed in the United States for any matter. Pharmacia & Upjohn (subsidiaries of Pfizer) will also forfeit $105 million, for a total criminal resolution of $1.3 billion. The companies were misbranding Bextra with the intent to defraud or mislead. Bextra is an anti-inflammatory drug that Pfizer pulled from the market in 2005.
Misbranding in this case refers to the practice of recommending a drug for a purpose that has not been approved by the Food and Drug Administration (FDA).
The company also settled civil suits with the DOJ for violation of the False Claims Act as a result of illegally promoting four drugs—Bextra; Geodon, an anti-psychotic drug; Zyvox, an antibiotic; and Lyrica, an anti-epileptic drug—and causing false claims to be submitted to government health care programs for uses that were not medically accepted by the FDA and therefore not covered by those programs. The civil settlement also resolves allegations that Pfizer paid kickbacks to health care providers to induce them to prescribe these and other drugs. The federal share of the civil settlement is $668,514,830 and the state Medicaid share of the civil settlement is $331,485,170.
The DOJ further stated that this is the largest civil fraud settlement in history against a pharmaceutical company.
“This historic settlement will return nearly $1 billion to Medicare, Medicaid, and other government insurance programs, securing their future for the Americans who depend on these programs,” said Kathleen Sebelius, Secretary of Department of Health and Human Services. “The Department of Health and Human Services will continue to seek opportunities to work with its government partners to prosecute fraud wherever we can find it. But we will also look for new ways to prevent fraud before it happens. Health care is too important to let a single dollar go to waste.”
“Illegal conduct and fraud by pharmaceutical companies puts the public health at risk, corrupts medical decisions by health care providers, and costs the government billions of dollars,” said Tony West, Assistant Attorney General for the Civil Division. “This civil settlement and plea agreement by Pfizer represent yet another example of what penalties will be faced when a pharmaceutical company puts profits ahead of patient welfare.”
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