• Article by Kevin Zeese, 3/30/10
• Healthcare-NOW! statement
• PNHP (Physicians for a National Health Program) statement
• PNHP summary chart of reconciliation bill (PDF file)
• Firedoglake's Myths and Truths chart of main bill

Talking Points:

Followup Q&A with Dr. Margaret Flowers and Kevin Zeese, Esq.

What about the Grayson "Medicare Buy In" legislation?

There is a lot of discussion about the Medicare buy in. Since the federal legislation does not include a public option and the single payer movement talks about expanding Medicare, people wonder if the Grayson bill is a step forward. The answer, however, is no. Unfortunately, the Grayson proposal does not advance us towards single payer and serves as a distraction, much like the public option was, that takes energy away from working for single payer at a time when we need focus and a clear demand.

When single payer advocates talk about "Improved Medicare for All," we are not actually saying that we would simply expand the current Medicare to everybody. We are talking about creating a national health program that is similar to Medicare in that it is publicly funded and accountable, guaranteed, provides choice of provider and removes the insurance middlemen from making decisions about treatment. The system would be universal, have proven cost controls such as global budgeting, simplified administration and negotiation for pharmaceutical and drug device prices and would create a framework for a health system so that we can address the many other areas that need to be addressed such as having enough providers, getting resources more evenly distributed, looking at how we deliver care and improve the health of our population. Simply allowing people to buy into Medicare will not place us on the path to creating this system.

The biggest obstacle to the success of a Medicare buy-in is that it keeps the private insurance companies, and so the fragmentation of our risk pools, in place. The only way that we as a nation can afford to pay for the health needs of everybody is by creating a single risk pool. It is by doing this that we eliminate the waste of the hundreds of millions of dollars that are required to market and administer these hundreds of different plans. Not only are these dollars required by the insurers to process their claims, but they are spent by[businesses, individuals, doctors, hospitals and health providers to submit and track claims to the many insurers. It is the expense of dealing with the many different insurers that is driving some medical practices, especially primary care, out of business. This would not change with a Medicare buy-in.

Most likely all that a Medicare buy-in would accomplish is attracting the sickest patients as usually happens in this situation in this country. The reason this happens is that the majority of people who are healthy are able to work and so get their insurance through their employer. Those who are not able to work or who do not have insurance offered at work must buy through the individual market. Health insurers don't really want to insure those that have health needs because they are too expensive to treat, so they offer policies with high premiums to those who need care. This forces that part of the population to look elsewhere, which means they would probably be the ones buying Medicare. This would relieve the private insurers of having to cover the sicker population (which they would like) and would place further financial strain on Medicare (caring for the sickest without the healthy contributing). And a simple Medicare buy-in would not create the improved Medicare that we need which would cover all medically necessary care including dental, mental, vision and prescriptions without co-pays.

It is possible to get a national improved Medicare for All health system, but the first and smallest increment of change that we must have in order to do this is to create a single public health fund. There is much more to do after that but this will be the step that will provide sufficient funds and a framework in which to take the next steps.

There will be many distractions and temptations to look for an easier way to get to single payer, but each of these takes us off the path to single payer. It is important that we stay together and focused on our goal. To paraphrase Gandhi, "you cannot compromise on fundamentals" and single payer is the fundamental step that will end health care as a commodity and place us on the path of health care as a human right.

What about the difference between what Dr. Atul Gawande says about the Massachusetts plan, upon which the federal bill was based, and what single payer advocates say about Massachusetts?

"And I've been living through it. The Massachusetts plan has -- we had 12 percent uninsured two-and-a-half years ago. We adopted a bipartisan plan that allows people to get a choice of private insurers, and it actually doesn't look that different from the reform plans going through now. That choice of insurers, you can go online and pick up coverage that's subsidized, so that nobody pays more than eight percent of income, and if you're poor, it's free.

"That provision of insurance has changed things dramatically in the last two years. We have only two percent uninsured. It's like many European countries now. The people in the state haven't really noticed it. And the claim that this is going to bust the budget of the state just hasn't come to fruition, no matter how much the blogs say one way or the other. The data are that health costs in the state have risen at the same rate as in other states. And in this recession, we didn't have the bottom fall out from our families under it. The cancer patients I had to take care of, where we spent half our time trying to figure out how to get them coverage, I haven't had that happen in two years."
~Dr. Atul Gawande, Democracy Now!, January 05, 2010,
www.democracynow.org/2010/1/5/dr_atul_gawande_on_real_health

The two main areas where PNHP and Dr. Gawande differ is in the decline of the number of uninsured in Massachusetts following the passage of the reform and the effect on health care costs. What Dr. Gawande does not address in his comments is access to care, other than for his cancer patients. We consider access to care to be a key feature that defines success of a reform, not access to insurance which does not guarantee access to care.

Dr. Gawande states that the number of uninsured has fallen to 2.5% from 12% before the reform. This number, used commonly in mainstream media, was taken from a phone survey that was done with support from the Massachusetts Blue Cross Blue Shield Foundation (http://bluecrossfoundation.org/foundationroot/en_US/documents/MassHealthReform_Charts_071008.pdf). A study done using census bureau numbers (door to door) as well as data from tax returns shows the uninsured somewhere around 5.5%.

Dr. Gawande states that the health reform has not upset the state budget; however, the state has had to cut back on safety net services and has cut people from the state program in order to control costs and is still over budget.

But the greatest concern regards whether patients have been able to receive needed care. And for those in MA who are on Medicaid and used to receive care free of charge, they must now pay co-pays and so are foregoing needed tests and treatments due to cost. And for families who struggle to afford private insurance premiums, they have had to purchase policies with co-pays, deductibles and skimpy coverage so that cost remains a factor when they need medical treatment. Of course when a patient suspects or becomes ill enough to seek treatment and is diagnosed with cancer, they are going to do what they can to pay for treatment and having Medicaid or private insurance helps. But too many people forego screening tests and checkups that can catch illnesses, such as cancer, in the early stages and too many people skip on prescriptions for conditions like high blood pressure and asthma when they have to pay out of pocket due to deductibles and co-pays.

For more information on the effects of the reform in Massachusetts, check out the article and materials at: www.pnhp.org/news/2009/february/massachusetts_is_no_.php

How will we ever pass single payer in this country when we see the extent of influence that powerful profit-driven health industries have over the media and both the White House and Congress?

Single payer, Improved Medicare for All, is the only workable solution to America's health care crisis. This will become even clearer as the new health law takes effect. The U.S. will continue to see millions without health insurance, bankruptcy from health problems, tens of thousands of preventable deaths and uncontrollable costs. The new law will put greater financial stress on the states and federal government because of the expansion of Medicaid and the subsidies for private insurance. Health care coverage will be reduced while prices continue to rise forcing more and more Americans to go without health care or pay more than they can afford. The United States will quickly find out that the federal health law is financially unsustainable.

And, Americans will also learn that the insurance industry is not one that can be regulated. Already we have seen rapid rate increases in the last weeks before the new law took effect and no price controls under the new law. And, since the law took effect, insurance companies have designated administrative costs as medical care costs in order to meet the requirement that more be spent on health care and less on administration. We have also seen the CEO of United Health, Stephen Hemsley receive $102 million in 2009 as income. The problems of the insurance industry will continue under the new law.

The health care debate over the last year was a conflict between what can be accomplished politically and what is needed to actually solve America's health problems. If there is one thing we saw during the health reform process this past fifteen months it is the extent of influence of the health industries that are currently profiting from the status quo. We have seen this repeatedly at the state level in attempts to pass comprehensive health reform. It is because of the powerful influence of the industries that over and over there have been only compromises and patches passed at the state level (and now federal too). And the end result has been that we are no closer to universal, guaranteed or affordable care. In fact, there are more uninsured people, a growing number of preventable deaths and bankruptcies and health care costs are rising out of control.

No matter how strong the influence of the health industries is, it is imperative that we take on this work to create a national health system that is truly universal (everybody in, nobody out), that ends health disparities (a medical apartheid) and provides the same level of health security that is experienced in all of the other advanced nations. We cannot wait for single payer to be invited to the table. The American people must put it on the table.

There are simultaneous tracks to get us to national single payer. We suggest you choose which one you can work on.

1. State single payer -- many states have single payer legislation. Groups in these states are working together to share strategies, resources and information. There is a concern that states cannot enact single payer because they need certain federal waivers. Members of congress are willing to submit legislation that would grant these waivers. They believe that it will be easier to pass the federal legislation once a state has passed single payer and it has been signed by a governor.
2. Federal single payer -- passing single payer at the state level will not guarantee that it will translate to a national bill. We must work with members of congress to strengthen federal single payer legislation, provide reputable data to support national single payer, educate members of congress and their staff about single payer and find co-sponsors/elect supporters of single payer.
3. Building an educated, large and diverse grassroots base -- just having legislation and sympathetic legislators is not sufficient. They need a visible grassroots movement to back them up. We must grow this movement by organizing more single payer chapters and forming coalitions with other groups. Information and materials for doing this can be obtained through www.healthcare-now.org.
4. We must weaken the health insurance industries in any way possible by continuing to expose and highlight their unfair practices through personal stories and protests, using legislation at the state and federal levels to stop their practices of denial of care and profiteering and by encouraging institutions to divest of their stock.

We made great strides towards single payer over this past year and a half and through our increasing and energetic movement for single payer, we will succeed. It will become more and more evident that the United States will have to adopt single payer because the current situation is unsustainable. Our work can make this happen sooner rather than later and so save thousands of lives.

Action Contacts:

Websites of Organizations Discussed in Conversation

Healthcare-NOW!

Physicians for a National Health Program

Progressive Democrats of America

ProsperityAgenda.US

National Nurses United

Labor Campaign for Single Payer Organizing Committee

Unions for Single Payer Health Care

Single Payer Action

Mobilization for Health Care for All

Mad As Hell Doctors

Health Care for All - Washington (State)

Health Care for All Pennsylvania

Single Payer Now! (California)

Single Payer New York

Physicians for a National Health Program - Maryland Chapter

Healthcare-Now of Maryland

Coalition for the Uninsured and Underinsured for Single Payer (Washington, D.C.)

Chesapeake Citizens (Maryland and Washington, D.C.)

Transcript:
Chat transcript for 2010-04-12 -- "Real Talk about Real Health Care Reform"