[Peace-discuss] Surprise! BHO on side of the rich

[C. G. Estabrook]

	February 25, 2009
	THE DEMOCRATS' LOUSY HEALTHCARE BILL
	& WHY SINGLE PAYER IS BETTER

*Physicians for a National Healthcare Plan - Sen. Max Baucus (D-Mont.), chair of 
the powerful Senate Finance Committee, will not allow consideration of single 
payer as an option for reform, and Sen. Kennedy (D-Mass.) is, by all 
indications, poised to promote the flawed Massachusetts health plan at the 
national level after months of secret meetings with insurance, business, and 
pharmaceutical company lobbyists.

While President Obama has acknowledged that single payer is the best option for 
reform, and while he opposed a mandate requiring all individuals to purchase 
private insurance during his campaign, it would appear he is poised to embrace 
the piecemeal, incremental approach that keeps the private insurance industry in 
place.

*John Geyman, MD, Tikkun - The inefficiency and bureaucracy of our 1,300 private 
insurers are not sustainable. According to the Blue Cross Blue Shield 
Association, there are 17,000 different hea1th plans in Chicago.

Private insurers offer much less choice than traditional Medicare; there are 
near-monopolies in 95 percent of HMO/PPO metropolitan markets, enough to trigger 
anti-trust concerns by the United States Department of Justice.

Because of costs, about 75 million Americans are either uninsured of 
underinsured, with large segments of the population forgoing necessary care and 
having worse health care outcomes; the United States now ranks nineteenth among 
nineteen industrialized countries in reducing preventable deaths from amenable 
causes. . .

What is neglected by almost all economists, "experts" and pundits is that there 
is already plenty of money in the system, that we waste about one-third of our 
health care dollar on our inefficient multi-payer financing system and on 
unnecessary care, and that NHI will save money, not cost more. NHI is the most 
fiscally responsible thing we can do now about health care.

The Conyers bill in the House (H.R. 676) will be financed by payroll and 
progressive income taxes that will be less than what individuals and employers 
now pay. The health insurance industry is being propped up by government 
subsidies to the employer-based system and to privatized public programs. NHI 
can save some $350 billion through administrative simplification, while offering 
coverage for all necessary care, full choice of provider and hospital, and 
mechanisms for cost containment through bulk purchasing, negotiated fees, and 
global budgets.

NHI by itself will not solve all of our health care problems, but it will 
provide a structure (as no incremental approach can) to enable other necessary 
steps. These include acceptance of health care as a right, transition to a 
not-for-profit system, reimbursement reform, rebuilding of primary care, 
evidence-based technology assessment, and quality improvement. None of this will 
be possible by using reforms that leave an obsolete private insurance industry 
in place. . .

FDR almost went for NHI in the mid-1930s, but he backed off, mainly due to the 
AMA's opposition. Today, the AMA is marginalized with a membership of no more 
than 30 percent of physicians, and a majority of American physicians now support 
NHI. . . It has become an economic, moral, and social imperative.

*Laura S. Boylan, MD, letter to New Yorker - In "Getting there from here" (Jan. 
26), Atul Gawande suggests that the Massachusetts 2006 mandate plan is a model 
for national health care reform. He sees his stance as pragmatic, politically 
feasible, rooted in the particular history of American health care and gifted 
with the commonsense wisdom that we must start from where we are. Advocates of 
national health insurance (single payer) are characterized as ideologically 
driven extremists with "contempt" for pragmatists. I respectfully disagree.

Most Americans, including most physicians, supported national health insurance 
even before the recent economic collapse, polls show. Endorsers of the single 
payer bill H.R. 676 include 93 co-sponsors in the House of Representatives, 450 
union organizations in 45 states, and countless others representing a wide range 
of constituencies. This is not a fringe movement.

High costs are the root cause of Americans' health insecurity. Gawande's 
analysis is flawed by use of a framework centered on insurance coverage rather 
than the more fundamental issue of health care value. Gawande sees 
employer-based coverage as the "path-defining" element of our current system 
because most people are covered by it. Well, it's all in how you look at it. We 
need to keep our eyes on the prize, the health care dollar, and follow the 
money. Government already dominates: tax dollars fund most health care 
expenditures in the U.S. This is because government covers the sickest and 
poorest people, tax-favors employer-based private insurance, and covers its own 
employees. To use Gawande's metaphor, the lifeboat is already bigger than the 
"main boat" of American health care. This is where we start.

Gawande asserts that Massachusetts "recently became the first state to adopt a 
system of universal health coverage for its residents." . . . A nearly identical 
assertion was made twenty years ago by then Gov. Dukakis about Massachusetts' 
1988 reforms. More breathless proclamations heralded reforms in Oregon (1988), 
Minnesota (1992), Tennessee (1992), Vermont (1992), Washington (1993) and Maine 
(2003). These plans all had common themes: public spending initiatives, new 
regulations and mandates, and continued dominance of private insurance in 
covering low risk populations. None achieved universal coverage. The common 
denominator of the ultimate failure of all these plans was the absence of 
effective cost control. Two weeks ago Gov. Deval Patrick of Massachusetts warned 
that rising costs, "threaten to crush families and businesses and doom 
Massachusetts groundbreaking experiment with universal insurance.". . .

The repetition of failed experiments is not pragmatic, it is part tragedy and 
part farce. Electronic medical records, chronic disease management and more 
emphasis on prevention are all important for many reasons but we must admit that 
short and long-term cost implications are unknown. Some of these measures may 
actually increase costs. Medicare is not perfect, but it is demonstrably more 
cost effective than private insurance and beloved by most Americans. It is 
shovel ready. Single-payer supporters say: everybody in, nobody out.

*Dr. Oliver Fein, Atlanta Journal-Constitution - However well-intentioned, the 
Obama/Baucus/Kennedy approaches share a fatal flaw: they preserve a central role 
for the private health insurance industry.

To varying degrees, they would mandate that everyone buy private health 
insurance - the private insurance that is failing us today. Some of these plans 
offer a Medicare-like, public option that people could buy into, but experience 
with Medicare shows that the private plans refuse to compete on a level playing 
field. They cherry-pick healthier patients and insist on more than their share 
of payment. . .

As long as we rely on private health insurers, universal coverage will be 
unaffordable. These companies generate immense overhead costs and force doctors 
and hospitals to spend heavily on billing and paperwork.

Administration consumes about one-third of every health care dollar in the U.S. 
By contrast, in countries with nonprofit national health insurance, 
administrative costs consume only half that amount. . .

Eliminating the private insurance industry would save $400 billion annually in 
administrative costs, enough to ensure that everyone is covered and to eliminate 
all co-pays and deductibles.

At this critical juncture, a single-payer plan is the only medically, morally 
and fiscally responsible path to take.

We already have an example of an American single-payer system that works - 
traditional Medicare. It's not perfect, but people with Medicare are far happier 
than those with private insurance. Doctors face fewer hassles in getting paid, 
and Medicare has been a leader in keeping costs down, at least until Washington 
politicians decided to pay private insurance plans to enroll seniors at a cost 
12- to 19-percent higher than traditional Medicare.

Single-payer systems give patients complete freedom to choose their doctor and 
hospital. They also enhance cost containment through global budgeting, the 
bargaining power of being the sole buyer, and an emphasis on primary care and 
prevention. . .

Opponents of single payer often admit it's the best, most efficient and 
equitable way to provide quality care, but say it's not politically feasible and 
is therefore off the table in this round of the debate. How so? A solid majority 
of physicians, 59 percent, and an even higher percentage of the public, 62 
percent or more, support national health insurance, recent surveys show. Single 
payer should be front and center.

Medicare for All is within reach, but only if we are prepared to take on the 
private health insurance industry.

http://prorev.com/2009/02/democrats-lousy-healthcare-bill-why.html