Health Spectator

by Lindsay Beyerstein

Big news broke over the weekend: Evidently, the president lit a fire under Max Baucus (D-Mont) and the Senate Finance Committee by unexpectedly announcing last week that he’d be laying out his own vision for health care reform this Wednesday. Just weeks ago, committee member Kent Conrad (D-ND) predicted the Finance Committee wouldn’t have a bill until November. But Baucus circulated a legislative framework over the weekend.

Baucus’s bottom line: There will be no public option. Instead, the government will spend hundreds of billions of dollars to subsidize the same old expensive, inadequate private insurance system that health care reform was supposed to reform. The insurance companies get 46 million new customers, and in return, they will pay higher taxes to offset the cost of the subsidies—a kickback to Uncle Sam.

Last week Brian Beutler of Talking Points Memo and I sat down to discuss some burning questions in health care reform: What’s the president’s thinking on the public option? What leverage does he have over the progressives in the House who demand single payer and/or the Blue Dogs in the senate who reject it? Why is Sen. Olympia Snowe (R-Maine) the last best hope for bipartisanship? (The transcript of our discussion has been edited for brevity and clarity.)

You said the [week of September 1] really stood out from the last month in terms of the health care debate. How so?

Maybe the last two days just stood out from the previous month. … Obama’s approval [rating] slid and popular support for the idea of healthcare reform slid. And August came to an end and the President’s vacation is winding down, and suddenly the administration realizes that Congress is coming back and they are going to have to do something. And so, it seems they start leaking to a bunch of high profile reporters that they are going to perhaps ditch the public option as part of a grander move to regain control of the debate.

Are the anonymous leakers saying in so many words that they want to ditch the public option?

Well, it’s unclear what they are actually going to do. The Public Option would die with dignity. [If] that is accomplished, the President could maybe win over some Republicans, grab the debate and spell out in clearer terms what he wanted [beyond] the public option. He could do this all in a big speech for Congress which is scheduled to happen Wednesday.

Isn’t this just a repeat of what we saw during the week of August 20, when the White House seemed to be doing a good cop/bad cop routine where an anonymous aide would leak “to hell with the liberals and the public option” and then another adviser would say on the record how much the president loves the public option?

It could just be a replay. Once those stories came out, the picture sort of fogged up. [There were] secondary reports that the President was courting Olympia Snowe (R-Maine) again—as if maybe one Senate Republican would vote with him on health care reform. Snowe’s idea [includes a] public option, but you attach it to a trigger mechanism so that it is only enacted if the rest of healthcare reform is unsuccessful at bringing down prices and expanding coverage. And that’s sort of been unacceptable to reformers and progressives, but … that might be the pound of flesh that she yields from the bill. It fits in with the picture that the leakers painted … that the public option was no longer going to be one of the key features of the bill.

You wrote about how budget reconciliation could be used to get around the filibuster. How would that work?

The greater problem is the structure in the Senate, where legislation can pass with a majority vote—but only after Senators have debated the bill for as long as they want. As long as 60 Democrats aren’t there to shut the minority up, debate can go on and on and on. [ED note: AKA filibustering.] And for every major piece of legislation you see. this happens. …

There’s this de facto 60-vote rule on most legislation, at least in this Congress and the previous Congress since the Democrats took it over. It’s extremely difficult to pass a bill through just the regular procedure without either having to concede a bunch of substantive provisions … or just give up on the bill entirely. [There are] 59 members of the Democratic caucus right now, and maybe 10 of them are mushy on the more progressive part of the President’s agenda. Even if all of them are onboard, you’re still one vote short of what you need to end debate. And that is why Olympia Snowe matters right now.

So the House would pass the bill and the Senate would pass a bill with budget reconciliation?

They could in theory. Budget reconciliation is sort of like a magic bullet. Every year, the Congress can pass what is known as a budget reconciliation bill. It sets new taxes, or moves money around within the federal budget to basically do what the Congress’s budget lays out. It … was made exempt from the filibuster because Congress [has to] set a budget. … They need to make sure that money is there and can’t have Senators filibustering it just because they’re in a fit of peak. So that bill can’t be filibustered, but at the same time, the legislation that can be passed in it has to be relevant to the budget, it has to move money around in some way.

So you can pass a lot of elements of healthcare reform in theory—you can pass subsidies to poor people and middle-income people. And you can pass Medicaid expansion, and you might even be able to pass the public option because the public option may need subsidies of its own and could drive down other costs and be a big moneysaver.

How might the president pressure progressives into accepting the bill?

My sense is that the President [will pressure] progressives to back off on the public option. But that could change. Trying to figure out what is going to happen is kind of like trying to move 23,000 moves ahead in a game of 17 dimensional chess. …

[Obama can] say is that what he’s planning will, while not perfect, help a lot of people make the healthcare system more progressive than it was. … But it would really harm the democratic party and his presidency if the whole project failed and nothing passed. Obama doesn’t have a tremendous amount of leverage. [Many] progressive members of Congress are progressive because they don’t have viable challenges. They come from progressive districts, with constituents like them, approval ratings in the 60s, 70s, and they aren’t going to lose to a member of the opposite party. So in that sense, they can do what they want.

How can Blue Dogs say that progressives should suck it up and vote for every bill when they are never prepared to do the same thing?

… It would at least be a good experiment, for the party and the country, for the [Blue Dogs] to be put on the spot. They believe that their jobs are on the line if they vote for controversial legislation. I don’t know how those conversations go when political members of the administration confront these guys and say ‘You got into politics to make the world a better place, not to just have a tenure job on Capital Hill. So you’re going to vote yes on this and if you lose your jobs as a result, then you did the right thing and we’ll make sure that the Democratic party infrastructure is there for you … .’ But that’s not the way the party thinks. [It's a] game of building an unstoppably large coalition, and that becomes the goal in the end. And at some point you lose sight of why you are amassing this giant congressional majority and you’re never willing to say, well we built this 70 whatever majority so that we could sacrifice some of these seats and do something really impressive and progressive for the good of the country.

[Editor's note: This piece by Lindsay Beyerstein was originally published on CARE2 make a difference with the stipulation that it was free to reprint. We thought it did such a good job of presenting the current status of things as of this morning, that we have posted it in its entirety. Thanks to Ms. Beyerstein for capturing the essentials.]

Or, what are our health care options, anyway?

In July 2009, an angry constituent confronted Rep. Bob Inglis (R-S.C.) 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.

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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-N.Y.) 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.)

We thought the best commentary on the Bartiromo incident came from Rolling Stone political commentator Matt Taibbi, who wrote about it on his blog post, Maria Bartiromo shows us how media has helped sandbag health care reform:

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 (D-Minn.) 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-N.Y.) mix it up on MSNBC.

Al Franken (D-Minn.) shows his stuff in calming down a potential angry mob.

Yes, we’re being ironic. There really is no Republican health care reform plan, as you probably already know. Unless, of course, you count the prattle trotted out by McCain and others who talk about needing to enact tort reform whenever they are cornered and forced to say a few words on the subject of health care reform.

We might have voted for McCain in 2000, given the opportunity, but his policies are looking a bit long in the tooth these days. How times have changed!

Unfortunately, rather than doing something constructive such as joining with the Democrats for bipartisan reform, most Republicans in the House and Senate have settled for blowing smoke and repeating platitudes, most of which are not only shop-worn, but inaccurate.

Recently, one of them ran afoul of that process: a freshman senator in the second district of Kansas, Lynn Jenkins. Confronted with a respectful but persistent 27-year-old constituent who is the single mother of a 2 1/2-year-old boy, Jenkins saw the crowd turn against her after she essentially attempted to blow off the waitress’s question, which the crowd happened to think was a reasonable one: what was wrong with a government-run plan for Americans who are currently uninsured?

Having already stated that she was against any “public option,” Jenkins seemed to think answering that question was beneath her. Then she volunteered that a public option wouldn’t cover just Elizabeth Smith, the 27-year-old hard-working waitress, but would cover everyone in the room. That drew howls from much of the rest of the room, which sported quite a few gray heads. Cries of “what’s wrong with that?” rang out.

So, putting down the notion of a public option can backfire even in a conservative state like Kansas. It’s funny how people are beginning to catch on that maybe they do, after all, deserve health care. Watch it here.

Death panels

Meanwhile, over at Huffington Post, Jamie Court has government statistics uncovered by the California Nurses Association showing that Pacificare Health has a procedure kill rate of 40%, while CIGNA’s is 33%. That means, quite simply, that these companies routinely deny 40% and 33%, respectively, of procedures ordered by doctors caring for their patients.

Why should you care?

Well, Natalie Sarkisyan’s parents had CIGNA health care, and Natalie Sarkisyan fell within that 33%. Wendell Potter, the former VP of Communications at CIGNA, was obviously choked up as he recounted in this video the final days of the Sarkisyan family’s campaign to obtain Natalie a liver transplant. Watch it here.

Overall, the California statistics show, one in five requests for treatment is denied by California health insurers regulated by the California Department of Managed Health Care. That’s a 20% denial rate for procedures ordered by private doctors throughout the state. Remember those apocryphal warnings of “faceless bureaucrats” coming between you and your doctor? To us, it looks like all of California is covered by a private insurance death panel.

Sadly, California is not alone. It’s no doubt happening in your state as well.

Finally, we have a video for those who might like help separating myth from fact. Alison in Rome supplies palliative facts in this video. Did you know that over 18,000 die each year in our country because they don’t have medical coverage? That’s six times as many as died in 9/11, or 50 people every day.

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To Representative Lynn Jenkins from Elizabeth Smith: “Why shouldn’t my government guarantee all of its citizens health care?”

Wendell Potter, former CIGNA exec, recounts the story of Natalie Sarkisyan.

AlisoninRome dispels 3 healthcare reform myths. Were you misinformed?

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 care per 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.

It is one of history’s greatest ironies that had Richard Nixon not run afoul of the Watergate scandal, Americans might long ago have obtained universal health care. But thanks to Watergate, Nixon found himself on the path to impeachment and resigned his office. His “sweeping new program” for “comprehsive health insurance” lay dead on the table.

It is another of history’s ironies that Nixon’s successor, President Jimmy Carter, did not have the clout to push through a similar program. We recall sitting with a friend in a bar in New Jersey the same night that John Lennon was shot. A German was expounding on an issue we had never considered before.

“The thing you have to understand about American presidents,” he intoned in his Teutonic accent, “is that they always do the opposite of what you expect them to do. It was Nixon who opened the door to China, and Kennedy and Johnson who got us into the Vietnam war.”

He was claiming, in effect, that a Democrat could get away with sponsoring a program or course of action that, were a Republican to attempt it, would arouse cries of “Nazism.” And a Republican—such as Nixon—is more likely to be successful pushing through a program that, were a Democrat to attempt it, would be called “socialized medicine.”

A tale of two presidents

We happen to think that he was right. And as a consequence, both Jimmy Carter and Hilary Clinton were doomed in their attempts to change our healthcare system. We personally were opposed to Hilary’s attempt and wonder if it is the times that have changed, or have we merely begun to see through the smokescreens that hid the truth from our eyes in former years?

Certainly we have become wiser by experience. We no longer view with suspicion government-sponsored health insurance. In fact, along with a growing majority of healthcare professionals, we have come to see it as the only realistic recourse for a system that is badly broken. Treating health care as a privilege available only to the few who can afford it is simply not a reasonable course of action, in our opinion. We would hope that a humane approach to health care would be an acceptable alternative to a majority of Americans.

We should mention too that we are entirely sympathetic to those who fear that government involvement might bring lowered health care standards. Indeed, we would heartily agree were it not for the fact that private industry has already set the bar so low that even the government can provide better bang for the buck.

Like many conservatives, we wax queasy when others speak of “Medicare for all” as if Medicare were some sort of laudable standard for heath care. Indeed, it is not. There is much to be improved in Medicare, and most of the incursions by Congress into that realm in recent years have been disastrous. (Investigate Medicare Part D if you doubt us.)

Everybody in, nobody out

But getting back to the stated theme of this piece, the essence of a single-payer system is the motto, “everybody in, nobody out.” This is the crux of the matter. When everyone—congressman, senator, doctor, lawyer, president, tax-payer, homeless war veteran—becomes entitled to the same health care, we think government health care standards will markedly improve. Certainly the care meted out by Veterans Administration hospitals is no standard to emulate for the rest of us. But who more deserves the kind of coverage and care afforded to Federal employees and elected officials than those who gave their bodies to defend those same exalted healthcare standards while defending our freedoms? Should we deny any veteran—whether or not she can now afford a home—the very best health care?

We think not. But our system does, daily. And this is unfair.

Health care for patients, not profits

Unfortunately, those who stand to profit from the status quo—mainly health insurance and pharmaceutical companies—have sought to address the discussion of this issue by kicking up dust. They have filled town meetings with loud lackeys who seek to block meaningful discussion.

But this does not mean that the rest of us cannot both study and discuss the issues. The billions of dollars of industry profits are not fiction and they are not funny. If that money were going towards health care in a single-payer system, we would all be receiving better care without higher taxes.

Keep in mind that those industry profits are paid for by those of us who pay out for health care, whether through health insurance premiums for policies we don’t use or through emergency-room visits that we pay for out of our own pockets. If you pay any money at all towards health care, whether you use the healthcare system or not, you are supporting it. Your taxes go towards Medicare and Medicaid, systems for people that private insurers do not cover because it is not in their best economic interest to do so.

Insurance coverage for the rest of us

A government system that cares for everyone, on the other hand, would operate the way insurance companies should in theory, but don’t in practice. That is, the premiums paid by the healthy would go to pay for the needs of those who are sick. Most of us are lucky enough to start out our lives healthy, though most of us gradually develop more need for health care later in life.

Real insurance systems are designed to deal with these disparities among individuals and could do so quite well, we think, were not billions of dollars annually drained from the coffers to pad the pockets of health-insurance CEOs.

A Harris poll taken last fall showed that only 1 in 14 Americans trusts health insurance companies. Yet, Obama and the Democrats in Congress seem to be trying to put together a system that everyone—including Republicans and the insurance companies—will feel good about. We think that goal is as impossible as it is unwarranted. So long as some of those billions in excess profits floating around the health care industry are donated to politicians to get them to support the existing system, there will be those who are not aligned with our common interests. We can’t expect them to be happy about eliminating all that waste when they are the beneficiaries. Obama himself has received massive amounts of money from the healthcare industry, which might explain his recent restraint in pushing for a single-payer program.

Eliminating unnecessary costs

costs
We need a system that provides everyone good and equitable health care. That should be our first priority. Dr. Sidney Wolfe, a physician and acting president of the non-partisan group Public Citizen, has stated repeatedly that eliminating the current healthcare industry would save $4 trillion over the next 10 years. That’s in contrast to offers from the health insurance industry—now faced with possible extinction—to save up to $2 trillion in costs over the same period.

Why would we want to pay an additional $2 trillion to sustain current inequities? What is intrinsically desirable about paying high premiums and high deductibles for health care, much less having a significant portion of our population under- or un-insured? Are we really afraid that going to the doctor will surpass going to the mall as a form of family entertainment in our society?

It is time to set aside emotion in dealing with this issue. Shouting and name-calling are simply not constructive. Now more than ever, Americans need to focus on what is truly desirable in a healthcare system and to stop thinking in terms of what we have done in the past. We have the opportunity to create something new, a system that is designed to serve all our people. We should not waver from that goal just because it will require some politicians to roll up their sleeves and do some work.

Stop the interference

“There’s no way we are ever going to have good health insurance for everyone so long as there’s a health insurance industry in the way, obstructing care,” says Dr. Wolfe.

“In Canada, you can go to any doctor, any hospital you like,” explains Dr. David Himmelstein of Harvard University, founder of Physicians for a National Health Program. “Canadians have better choice than we do,” he adds, while “[they] spend half as much per person as we do on health care.” Himmelstein admits that if we wanted to cut our healthcare expenditures in half to match the Canadians, we would have to put up with longer waits than we do now. But, he says, if we are willing to maintain our current per capita level of spending on health care, “we could cover everybody with terrific access to care” and still not have to pay copays, deductibles, or insurance premiums. (In other words, our health care would be covered by our current level of taxes and would be better care than most of us receive now.)

His statements have been confirmed by the Congressional Budget Office (CBO) and the Government Accountability Office (GAO). These are solid figures, not empty promises.

Keep your doctor, keep your hospital

And note that there is nothing here about having to give up your favorite doctor or be refused procedures your doctor legitimately thinks you need. That is one of the primary reasons distinguished physicians such as Drs. Wolfe and Himmelstein are behind single-payer. It simply promises us a better system of healthcare for a given amount of money.

Perhaps the best part is that we can eliminate thereby interference in healthcare decisions by non-doctors who are simply trying to amass profits. Insurance companies currently hire hundreds of individuals whose job it is to say “no” to legitimate healthcare decisions made by doctors simply because the insurance company would have to pay to cover those benefits. In a healthcare system in which doctors have the final say on medical decisions, patients are better served. In such a system, doctors are not trying to set aside money to be paid out as profits to CEOs and shareholders, they are simply trying to provide healthcare to their patients.

And isn’t that the point, after all?

Remote Area Medical (RAM), founded by Stan Brock, is a foundation that provides free medical care to remote parts of the world—including the United States. For 20 years now, RAM has provided free medical service to people in Wise County, VA via an annual “health fair” set up at the Wise County Fairgrounds. RAM also operates a similar program in Los Angeles.

This is the very same fair that converted insurance industry executive Wendell Potter—at the time, an employee of CIGNA—to a believer in healthcare reform.

Watch this video to find out what United States health care has in common with the Third World.

People speaking out can make a difference

If you were upset by the $22 billion earmarked to bail out the insurance industry this spring, this video may give you pause.

Do taxpayers really need to keep shelling out for higher health insurance premiums while their taxes are footing the bill for industry profits?

Some say, “no!”

Watch the video and decide for yourself. Then click on the red “leave a comment” in the gray box below to let us and your fellow readers know what you think.

Click on the image above to watch the video.

Our series of interviews on the healthcare debate seems to be popular with readers, so we plan to keep giving you more. Since it has largely been ignored by the major media and most of the politicians haven’t been saying much about it, we’ve concentrated on presenting information on what we consider to be the very best option: a single-payer system.

We were not always in favor of such a route. Indeed, not that many years ago we feared all the rumored drawbacks of anything that hinted of “socialized medicine”—long lines, healthcare rationing, shortages of drugs and equipment. Gradually we came to realize that these nightmares were being manufacturered by the companies that stood to gain the most by perpetuating the current inequties: the pharmaceutical and insurance companies.

Once we began to examine the alternatives in an open-minded fashion, we found they weren’t so bad. In fact, now we are convinced that instead of paying almost twice as much per capital as the country with the second-highest healthcare costs for healthcare that is ranked 38th in the world by the World Health Organization (WHO) we might actually save money as a nation while vastly improving healthcare for all.

Your comments welcome

If you disagree with us, please post your comments accordingly. For that matter, feel free to post your comments if you agree. We welcome discussion on these issues. The only way we are going to get the best possible outcome is to decide for ourselves what is right and then tell the politicians responsible what they must do.

Unfortunately, the President has been backing away from the best solution. The Democratic Party is in its usual state of disarray, though there are a few who seem to see clearly what is the best option. And in what has been described by the Huffington Post as “an exquisite political irony,” 13 Republicans on the House Education and Labor Committee offered their support last week for an amendment that would allow states to set up single-payer health care systems. But don’t expect to see widespread Republican support for a single-payer system any time soon, despite the potential savings for our nation as a whole.

To see another of Bill Moyers’s excellent interviews on the subject of healthcare—in this case, an interview with Dr. David Himmelstein of Harvard and Dr. Sidney Wolfe of Case Western Reserve—just click the image above. Then please come back and post your comments.

Your doctor may or may not be in it for the money, but you know down deep in your heart that your nurse is in your corner if anyone is.

When a friend was in the hospital to assess whether or not he had had a heart attack, and a doctor too busy worrying about his golf game had him on a medication that could soon have killed him, the night nurse came on duty and challenged the doctor’s judgment. She probably saved his life.

These nurses just might save yours. Hear what they have to say about financing healthcare. It may give you a whole new outlook on the subject.

This is another brilliant Bill Moyers segment from May 2008 about the California Nurses Assciation and its members’s views on healthcare insurance and similar issues healthcare-related. Here you will find out about CheneyCare. Have you had any of that lately?

Aside from the fact that the administration in power has since changed, you’ll find it’s just as timely and informative as if it had been filmed today.

If you would prefer to download the video to Winamp or another flash video player rather than using the embedded player, click here.

Otherwise, click the image below to watch the video.

For more on the subject, including a Harvard doctor’s viewpoint, click here.

And if you’re in the mood for a good read on the subject of healthcare, this August 29, 2005 New Yorker piece by Malcolm Gladwell (The Moral-Hazard Myth) seems uncannily timely. It explains why there’s so much resistance to concepts such as single-payer healthcare in this country, how insurance theory influences our thinking and why healthcare isn’t just another commodity. Read it here.

Hear how Big Pharma spent $40 million just in April, May and June of this year to influence Congress against single-payer plans and to ensure that pharmaceutical companies will come out on top in whatever healthcare plan results. This report will tell you why you don’t find discussion of certain issues during the healthcare debate.

Andrea Seabrook and Peter Overby explain that one of the most powerful players in health care is a group called the Pharmaceutical Research and Manufacturers of America, or PhRMA. It represents just 32 brand-name drug companies, but it has so much influence that when Congress passes a bill, PhRMA almost always gets its way. One big reason why: PhRMA and its members have spent millions of dollars lobbying Congress as lawmakers work to overhaul health care.

You can read their story here.

Also—don’t miss our views and four videos on the healthcare reform debate.