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How Can a $124.8 Million a Year CEO Make Health Care More Affordable?

An op-ed piece in the Providence Journal about huge pay packages for corporate CEOs mentioned the breath-taking $124.8 million total compensation of United Health Group (parent of United Healthcare) CEO William McGuire. This figure can also be found in the Forbes Special Report on CEO compensation. Here one can find that other managed care CEOs got less fabulous, but still formidable compensation, e.g., Howard Phanstiel, PacifiCare, 3.38 million; Edward Hanway, Cigna, $13.3 million; John Rowe, Aetna, $22.2 million; and Larry Glassrock, Wellpoint, $25.0 million.
 
McGuire's compensation was so large as to take a measurable part of this large company's net income (5%). Or to look at it from a stock-holder's (and hence, an company owner's) viewpoint, had McGuire, who is an employee, been only paid a cool million, and this money had been distributed as a dividend, it would amount to about a $0.20 per share dividend. (The current dividend is $0.03 per share.) (See company data available from Forbes as well.)

To look at it from a United employee's viewpoint, had McGuire, who is an employee, been only paid a cool million, and this money had been distributed to employees, each of the 40,000 employees could have received a bonus larger than $3000.

To look at it from the viewpoint of the health care system, the $124.8 million total compensation of a single United employee could pay the salaries of 833 general internists at current typical salaries. Or the $124.8 million could run one reasonable size community hospital for a year.

United Health Group's mission statement is "the company directs its resources into designing products, providing services and applying technologies that improve access to health and well-being services; simply the health care experience; promote quality; and make health care more affordable." (See this fact sheet.) Rather, it seems to be directing a good chunk of its resources into salaries of top management employees. How a $124.8 million CEO salary can be reconciled with a mission to "make health care more affordable" is completely beyond me.

United Health Group's mission statement is "the company directs its resources into designing products, providing services and applying technologies that improve access to health and well-being services; simply the health care experience; promote quality; and make health care more affordable." (See this fact sheet.) Rather, it seems to be directing a good chunk of its resources into salaries of top management employees. How a $124.8 million CEO salary can be reconciled with a mission to "make health care more affordable" is completely beyond me.

I Am Not a Health Reform

December 15, 2007
Op-Ed Contributors
New York Times

By DAVID U. HIMMELSTEIN and STEFFIE WOOLHANDLER

IN 1971, President Nixon sought to forestall single-payer national health insurance by proposing an alternative. He wanted to combine a mandate, which would require that employers cover their workers, with a Medicaid-like program for poor families, which all Americans would be able to join by paying sliding-scale premiums based on their income.Nixon’s plan, though never passed, refuses to stay dead. Now Hillary Clinton, John Edwards and Barack Obama all propose Nixon-like reforms. Their plans resemble measures that were passed and then failed in several states over the past two decades.
 
In 1988, Massachusetts became the first state to pass a version of Nixon’s employer mandate — and it added an individual mandate for students and the self-employed, much as Mrs. Clinton and Mr. Edwards (but not Mr. Obama) would do today. Michael Dukakis, then the state’s governor, announced that “Massachusetts will be the first state in the country to enact universal health insurance.” But the mandate was never fully put into effect. In 1988, 494,000 people were uninsured in Massachusetts. The number had increased to 657,000 by 2006.
 
Oregon, in 1989, combined an employer mandate with an expansion of Medicaid and the rationing of expensive care. When the federal government granted the waivers needed to carry out the program, Gov. Barbara Roberts said, “Today our dreams of providing effective and affordable health care to all Oregonians have come true.” The number of uninsured Oregonians did not budge.
 
In 1992 and ’93, similar bills passed in Minnesota, Tennessee and Vermont. Minnesota’s plan called for universal coverage by July 1, 1997. Instead, by then the number of uninsured people in the state had increased by 88,000.
 
Tennessee’s Democratic governor, Ned McWherter, declared that “Tennessee will cover at least 95 percent of its citizens.” Yet the number of uninsured Tennesseans dipped for only two years before rising higher than ever.
 
Vermont’s plan, passed under Gov. Howard Dean, called for universal health care by 1995. But the number of uninsured people in the state has grown modestly since then.
 
The State of Washington’s 1993 law included the major planks of recent Nixon-like plans: an employer mandate, an individual mandate for the self-employed and expanded public coverage for the poor. Over the next six years, the number of uninsured people in the state rose about 35 percent, from 661,000 to 898,000.
 
As governor, Mitt Romney tweaked the Nixon formula in 2006 when he helped devise a second round of Massachusetts health care reform: employers in the state that do not offer health coverage face only paltry fines, but fines on uninsured individuals will escalate to about $2,000 in 2008. On signing the bill, Mr. Romney declared, “Every uninsured citizen in Massachusetts will soon have affordable health insurance.” Yet even under threat of fines, only 7 percent of the 244,000 uninsured people in the state who are required to buy unsubsidized coverage had signed up by Dec. 1. Few can afford the sky-high premiums.
 
Each of these reform efforts promised cost savings, but none included real cost controls. As the cost of health care soared, legislators backed off from enforcing the mandates or from financing new coverage for the poor. Just last month, Massachusetts projected that its costs for subsidized coverage may run $147 million over budget.
 
The “mandate model” for reform rests on impeccable political logic: avoid challenging insurance firms’ stranglehold on health care. But it is economic nonsense. The reliance on private insurers makes universal coverage unaffordable.
 
With the exception of Dennis Kucinich, the Democratic presidential hopefuls sidestep an inconvenient truth: only a single-payer system of national health care can save what we estimate is the $350 billion wasted annually on medical bureaucracy and redirect those funds to expanded coverage. Mrs. Clinton, Mr. Edwards and Mr. Obama tout cost savings through computerization and improved care management, but Congressional Budget Office studies have found no evidence for these claims.
 
In 1971, New Brunswick became the last Canadian province to institute that nation’s single-payer plan. Back then, the relative merits of single-payer versus Nixon’s mandate were debatable. Almost four decades later, the debate should be over. How sad that the leading Democrats are still kicking around Nixon’s discredited ideas for health reform.
 
David U. Himmelstein and Steffie Woolhandler are professors of medicine at Harvard and the co-founders of Physicians for a National Health Program

Sicko? The truth about the US healthcare system

Michael Moore's new film is a damning indictment of the way the world's richest country looks after those who fall ill. Andrew Gumbel finds out whether his accusations are justified
 
The Independent
June 4th, 2007
 
Cynthia Kline knew exactly what was happening to her when she suffered a heart attack at her home in Cambridge, Massachusetts. She took the time to call an ambulance, popped some nitroglycerin tablets she had been prescribed in anticipation of just such an emergency, and waited for help to arrive.
 
On paper, everything should have gone fine. Unlike tens of millions of Americans, she had health insurance coverage. The ambulance team arrived promptly. The hospital where she had been receiving treatment for her cardiac problems, a private teaching facility affiliated with the Harvard Medical School, was just a few minutes away.
 
The problem was, the casualty department at the hospital, Mount Auburn, was full to overflowing. And it turned her away. The ambulance took her to another nearby hospital but the treatment she needed, an emergency catheterization, was not available there. A flurry of phone calls to other medical facilities in the Boston area came up empty. With a few hours, Cynthia Kline was dead.
 
She died in an American city with one of the highest concentration of top-flight medical specialists in the world. And it happened largely because of America's broken health care system - one where 50 million people are entirely without insurance coverage and tens of millions more struggle to have the treatment they need approved. As a result, medical problems go unattended until they reach crisis point. Patients then rush to hospital casualty departments, where by law they cannot be turned away, overwhelming the system entirely. Everyone - doctors and patients, politicians on both the left and the right - agrees this is an insane way to run a health system.
 
When Elizabeth Hilsabeck gave birth to premature twins in Austin, Texas, she encountered another kind of insanity. Again, she was insured -- through her husband, who had a good job in banking. But the twins were born when she was barely six months pregnant, and the boy, Parker, developed cerebral palsy. The doctors recommended physical therapy to build up muscle strength and give the boy a fighting chance of learning to walk, but her managed health provider refused to cover it.
 
The crazy bureaucratic logic was that the policy covered only "rehabilitative" therapy - in other words, teaching a patient a physical skill that has been lost. Since Parker had never walked, the therapy was in essence teaching him a new skill and therefore did not qualify. The Hilsabecks railed, protested, won some small reprieves, but ended up selling their home and moving into a trailer to cover their costs. Elizabeth's husband, Steven, considered taking a new, better-paying job, but chose not to after making careful inquiries about the health insurance coverage. "When is he getting over the cerebral palsy?" a prospective new insurance company representative breezily asked the Hilsabecks. When Elizabeth explained he would never get over it, she was told she was on her own.
 
Everyone in America has a health-care horror story or knows someone who does. Mostly they are stories of grinding bureaucratic frustration, of phone calls and officials letters and problems with their credit rating, or of people ignoring a slowly deteriorating medical condition because they are afraid that an expensive battery of tests will lead to a course of treatment that could quickly become unaffordable.
 
Even when things don't go horribly wrong, it is a matter of surviving by the skin of one's teeth.
 
In Montana, Melissa Anderson can't find affordable insurance because she is self-employed - an increasingly common affliction. When her son Kasey came down with epilepsy two years ago, she was saved only by a recently introduced child health insurance programme specifically tailored to people who aren't poor but can't afford to pay monster medical bills. She herself remains uninsured for anything short of major care needs.
 
Over the past 15 years, the stories have become less about poor people without the economic means to access the system - although that remains a vast, unsolved problem - and more about the kind of people who have every expectation they will be taken care of. Middle-class people, people with jobs that carry health benefits or - as the problem worsens - people with the sorts of jobs that used to carry robust health benefits which are now more rudimentary and risk their being cut off for a variety of reasons.
 
This is the morass that Michael Moore has chosen to explore in his latest documentary, Sicko, which goes on release later this month. Moore spends much of the film demonstrating that there is nothing inevitable or necessary about a system that enriches insurance companies and drug manufacturers but shortchanges absolutely everyone else. His searching documentary looks at health care in France, Britain, Canada, and even Cuba - still regarded as a model system for the Third World.
 
Moore has his share of ghoulishly awful stories. The film kicks off with an uninsured carpenter who has to decide whether to spend $12,000 (£6,000) reattaching his severed ring finger or $60,000 to reattach his severed middle finger. Later on, Moore focuses on a hospital worker whose husband needed a bone marrow transplant to save him from a rare disease. The couple's insurance company refused to cover the transplant because it regarded the treatment as "experimental". The husband died.
 
Many more stories are collected in a newly published book called Sick: The Untold Story of America's Health Care Crisis, by Jonathan Cohn. A woman in California called Nelene Fox died of breast cancer after she, too, was turned down for a bone marrow transplant by her insurance company. In Georgia, a family whose infant son went into cardiac arrest were forced to take him to a hospital 45 miles away on their insurance carrier's orders. He survived, but suffered permanent disabilities that more prompt treatment might have averted. In New York, an infant called Bryan Jones - whose case was trumpeted all over the local media at the time - died of a heart defect that went undetected because his insurance company kicked him and his mother out of hospital 24 hours after his birth, too soon to carry out the tests that might have spotted the problem.
 
America's health system offers a tremendous paradox. In medical technology and in the scientific understanding of disease, it is second-to-none. Since doctors are better paid than anywhere else in the world, the country attracts the best of the best. And yet many, if not most, Americans are unable to reap the advantages of this. In fact, as The New York Times columnist Paul Krugman has argued, the very proliferation of research and high-tech equipment is part of the reason for the imbalance in coverage between the privileged few and the increasingly underserved masses. "[The system] compensates for higher spending on insiders, in part, by consigning more people to outsider status --robbing Peter of basic care in order to pay for Paul's state-of-the-art treatment," Krugman wrote recently. "Thus we have the cruel paradox that medical progress is bad for many Americans' health."
 
Having the system run by for-profit insurance companies turns out to be inefficient and expensive as well as dehumanizing. America spends more than twice as much per capita on health care as France, and almost two and a half times as much as Britain. And yet it falls down in almost every key indicator of public health, starting, perhaps, most shockingly, with infant mortality, which is 36 per cent higher than in Britain.
 
A recent survey by the management consulting company McKinsey estimated the excess bureaucratic costs of managing private insurance policies - scouting for business, processing claims, and hiring "denial management specialists" to tell people why their ailment is not covered by their policy - at about $98bn a year. That, on its own, is significantly more than the $77bn McKinsey calculates it would cost to cover every uninsured American. If the government negotiated bulk purchasing rates for drugs, rather than allowing the pharmaceutical companies to set their own extortionate rates, that would save another $66bn.
 
Astonishingly, there hasn't been a serious debate about health care in the United States since Bill Clinton, with considerable input from his wife Hillary, tried and failed to overhaul the system in 1994. That, though, may be about to change as the 2008 presidential race heats up. Everyone acknowledges the system is broken. Everyone recognizes that 50 million uninsured - including almost 10 million children - is unacceptable in a civilized society.
 
Even the old, classically American free-market argument - that "socialized" medicine is somehow the first step on a slippery slope towards godless communism - doesn't hold water, because in the absence of a functioning private insurance regime the government ends up picking up about 50 per cent of the overall costs for treatment anyway. The indigent rely on a government program called Medicaid. The elderly have a government program called Medicare. And perhaps the most efficient part of the whole system is the Veterans' Administration, a sort of NHS for former servicemen.
 
Rather like London and Paris in the 19th century, where the authorities belatedly paid attention to outbreaks of cholera once the disease started affecting the rich and middle classes, so the American health crisis may be coming to a head because of the kinds of people who are suffering from its injustices.
 
Corporate chief executives, for a start, are gagging under the ever-increasing costs of providing coverage to their employees. Starbucks now spends more on health care than it does on coffee beans. Company health costs, as a whole, are at about the same level as corporate profits. In a globalized world where US businesses are competing with low-wage countries such as India and China, that is rapidly becoming unacceptable.
 
That explains, perhaps, why the chief executive of Wal-Mart, Lee Scott, has made common cause with America's leading service sector union - more commonly a bitter critic of Wal-Mart's labor practices - in calling for a government-run universal health care system by 2012. It's going to be a tough battle. The insurance and pharmaceutical industries bankroll the campaigns of dozens of congressmen and have so far been brutally efficient in protecting their own interests. The Clintons were defeated in 1994 in part because of the power of the industry lobbies. Doing better this time will take singular political courage.
 
In the meantime, we will hear ever more crazy stories like the one told by Marijon Binder, a former nun in Chicago who ended up being sued by a Catholic hospital for $11,000 because her two-night stay for a heart scare was not considered a worthy charity case. Binder, who works as a live-in companion to a disabled old woman, wrote on all her admission forms that she had no insurance and, in her telling at least, was reassured the hospital would take care of her anyway.
 
After a year and a monstrous bureaucratic fight that went nowhere, a civil judge promptly absolved her of responsibility for her bill - a lucky outcome, for sure. Binder said: "The whole experience was very demeaning. It made me feel very guilty; it made me feel like a criminal." She is, though, alive and solvent. Not everyone in this system catches the same break.

Canada's Health Care Lauded by One Who Knows

by Sol Littman

Ever since my wife and I chose to leave Canada and settle in Tucson, we have been amazed and angered by the distortions and misrepresentations in the American media of Canada's government-funded, one-payer medical system. Among them is the recent op-ed article in the Arizona Daily Star by Dr. Jane M. Orient.
For most of my adult life, I worked as a journalist in Canada and took full advantage of Canada's health-care system. My wife, daughter and grandchildren were free to choose their own primary doctors and specialists. Service was consistently kindly, prompt and concerned. If something serious was suspected, we were tested, X-rayed and examined in a matter of days. Our physicians were highly trained and the hospital facilities modem and pleasant.
 
Thirty years ago, I had my gall bladder removed and had to spend three or four days in hospital. When I was discharged, I was presented with the bill — a total of $5.50 for the use of the television set in my semi-private room. The Ontario Hospital Insurance Plan paid the rest.
 
It is important for Americans to know that people in Canada tend to live a couple of years longer than their U.S. counterparts and that Canada's infant mortality rate is lower. This is attributed to the fact that everyone — young, old, working or unemployed — is covered for basic hospital and medical care in Canada without co-insurance or deductibles. This is in contrast to the United States, where there are more uninsured people (over 40 million) than Canadian inhabitants.
 
American critics of Canada's health care are quick to cite the fact that there are lengthy waiting lists for non-emergency medical procedures. It is also true that there is considerable overcrowding in some hospitals, but this is due to the fact that emergencies are treated immediately even if it means a lineup of gurneys in the hospital corridor — a situation I have found exists in American emergency wards as well.
 
The Canadian system does not rely on private insurance companies. The system is run by 10 provinces and two territories. They pay the bills and set the rules.
Medicare, which services the American elderly, is the closest approximation to the Canadian one-payer system, but there are important differences.
 
In the United States, the government pays the bills but private insurance companies that are more wasteful than the government run the system. In addition, some of our American health-care dollars go to make the insurance companies rich and play no role in actual health care.
 
The waiting times for some procedures are longer in Canada than in the United States, but this problem is being actively tackled by the government in the wake of a Canada Supreme Court decision that "access to a waiting list is not access to health care." However, the decision did not abolish the one-payer system — in fact, it reinforced it by giving the Quebec government, which was the chief object of the lawsuit, 12 months to remedy the situation.
 
As a result, Quebec is working hard to catch up with the rest of Canada. The average wait for a hip replacement has been reduced to four to five weeks, and knee replacements usually take six to seven weeks. This may still be too long, but if you happen to be one of the 40 million uninsured Americans, you might have to wait forever.
 
Why have my wife and I chosen to spend our retirement years in Tucson? We did, in fact, worry about leaving behind our Canadian health care, but climate, the availability of year-round golf and relatively good health persuaded us to take the chance.
 
We have found medical services in Tucson excellent, but expensive and complicated. We don't like being at the mercy of an HMO and have yet to decipher the ins and outs of the new drug plan. We continue to long for the simplicity and efficiency of Canada's single-payer system.
 
Sol Littman is a former Canadian journalist living in Tucson with his wife, Mildred.
Copyright © 1999-2006 AzStarNet, Arizona Daily Star and its wire services and suppliers

Hope and Sense

 

By Robin Podolsky | bio

Again, thanks to Jon for bringing us together into this conversation and for laying out the contours of the problem so succinctly. It’s sobering, isn’t it, to realize how well his description of early 20th Century conditions corresponds to our own situation?

 
As a staff member for a state senator who is both the author of SB 840, California’s pending single payer legislation, and the Chair of the State Senate Health Committee and, therefore, obligated to work with all due speed for whatever useful reforms can be crafted, I appreciate Jon’s call for healthcare advocates to work in several time frames at once. But I would invert his concerns. While we don’t want to make the perfect the enemy of the good, neither do we want the incremental to be the strangling death of the remedial.

It’s almost once a week that I hear some variation of the ‘single payer won’t pass so why bother’ argument—and the assumptions behind it are more than a little disquieting.

From all sides of the debate, I hear the following question: “What makes you think we can achieve single payer when Big Insurance opposes it?” After all these years, I’m hardly naïve about the role of money and lobbying in the legislative process. Law, sausages, yada. But are we actually willing to concede the boundaries of healthcare policy to a business interest that currently guards its profit margin by seeking to strip health coverage from sick people? (Lisa Girion; Los Angeles Times: Sep 17, 2006; February 16, 2007; March 22, 2007)


First of all, Jon’s right—-single payer makes sense. If we look at a study by the Lewin Group, an independent medical cost/benefit analysis firm (numbers available at www.sen.ca.gov/kuehl), we see that, if we remove the artificial middle-man (private insurance) and marshal California’s purchasing power to negotiate bulk rates for prescription drugs and durable medical equipment, we really can insure every Californian with comprehensive coverage, save some money in the short run and control costs in the long run.

So the question becomes, “Just because this is supposed to be a representative democracy, what makes you think we can achieve a common sense solution if a powerful interest opposes it?” If the answer is, ‘we can’t,’ then why are we even torturing ourselves with this dialogue?

In fact, in large part because of the grass roots support it continues to gain (as well as Senator Kuehl’s acumen in moving it through), SB 840 has emerged as the bill that wouldn’t die. This is the third two-year version that the Senator has introduced, and each year, as the bill stays in front of the llegislature and its varied constituencies, it garners more legislative co-authors and a diverse range of endorsers who run from labor to business to nurses and doctors, along with local governments. As other options are raised and defeated (a pay-or-play employer mandate, for instance, was rejected at the polls), and the discussion of concrete solutions continues, single payer is beginning to stand out, in the Capitol building and among advocates, as the Gold Standard to which we are advancing.

Also, as Joe Paduda argues, this isn’t exactly a case of Big Business vs. the Little Guy. This is Big Insurance vs. everybody else. Single payer would save money for almost all businesses that now pay for health coverage benefits, and it would level the playing field for everybody else. As one of our main advocates, John Hughes, President of Rhythm and Hues, points out, California’s entertainment industry is having a hard time competing with those of other industrialized nations (that offer universal coverage)for many reasons, not the least of which is the cost of insuring top level employees. Small business owners, for their part, are healthcare consumers too, with families and health problems of their own. They don’t appreciate being forced to go without insurance or pay whatever a monopolized industry can extract for substandard plans.

To make a more general point: automatic cynicism is as idealistic as reflexive optimism. Batting away any hope for positive change is like refusing to hear bad news—-both reflexes demand a rejection of factual evidence. In truth, change is protracted, difficult and imperfect; and it is possible. Or we wouldn’t have Social Security at all, or, for that matter, universal suffrage.

Last year, California history was made when both houses of the legislature passed this bill. The Governor vetoed it, but he too has acknowledged the need to make healthcare reform a key priority. While, as of this writing, the Governor has not found a sponsor for his own ideas for reform, which combine old ideas, such as individual mandate and pay-or-play for businesses, his own stated goals only make SB 840 look more attractive: affordability, shared responsibility and preventive care/wellness. Single payer answers those needs and realizes two more principles: a mandate for quality care and genuine consumer choice.

Which brings me to my final point of the day. I don’t agree, Jon, that single payer would wipe out “American-style competition” or freedom of choice. If we were all insured, all healthcare providers would be competing for our business. And we would have more personal freedom to make decisions about whether to start businesses, go to school, get pregnant or change neighborhoods, because our insurance would follow us.

Which brings me to my final point of the day. I don’t agree, Jon, that single payer would wipe out “American-style competition” or freedom of choice. If we were all insured, all healthcare providers would be competing for our business. And we would have more personal freedom to make decisions about whether to start businesses, go to school, get pregnant or change neighborhoods, because our insurance would follow us.

Mandated private insurance just helps insurers

By Milton Fisk
The Journal Gazette
03/26/2007

 

Suddenly, the most unlikely bunch has turned altruistic. Conservative businesses and politicians want health coverage for the uninsured. Schemes are multiplying about how to do it. Why the change of heart? Beware of those bearing gifts — this altruism is but poorly disguised self-interest.

Look at some apostles of this new altruism. Wal-Mart is an easy case; it hopes to use it to avoid paying any more for health benefits. Why Gov. Arnold Schwarzenegger? He hopes to garner more dollars for powerful private insurers he needs.

 

What are these schemes?

 

Common to all of them is the use of public subsidies so the uninsured can buy private insurance. However, spreading private insurance worsens the problems it creates.

 

The idea came from President Bush’s 2003 Medicare Plan D drug program, by which private insurers get public subsidies. It’s unadulterated corporate welfare. The drug companies get $40 billion a year more because Medicare can’t bargain over what it charges. The insurers’ ads and profits cost the government $5 billion a year.

 

With Medicare Plan D as inspiration, don’t expect much from our new altruists. Covering more people is an admirable goal. Getting it through private insurance will push inflation in health care through the roof. To modulate this inflation, we’d need public insurance — Medicare (A and B) is an example — extended to all.

 

In 2005, CEOs at five big insurers received together a total of $14 million plus stock options and grants for over 2 million shares. The aggregate profits in 2006 of these insurers were $12 billion. Still, their premiums have nearly doubled in the past decade. A public insurer seeks no profits, and its chieftains don’t become plutocrats.

 

Don’t stop here — there’s more to being an expensive parasite. Premiums for private insurance go to marketing as well as health care: the TV ads, junk mail, public relations accounts to burnish a bad image and hucksters signing on employers and hospitals. There’s little of this waste with public insurance.

 

Then there’s the cost of underwriting — trying to find whose poor health warrants a bigger premium, whose pre-existing conditions will deny them coverage and who to dump from the rolls. This cherry-picking is absent with public insurance; there’s no extra charge or denial for bad luck or poor genes.

 

Schwarzenegger wants insurers in his state to devote at least 85 percent of premiums to health care. WellPoint says it devotes only 81 percent; as a California giant, its screams will get Arnold back on track. This bickering is juvenile when Medicare has overhead of 3 percent.

 

Hang on for more — add to private insurers’ overhead a ripple effect on providers. Doctors and hospitals must send bills to multiple insurers. With a single public payer, this inefficiency disappears. Hospitals won’t have to bill insurers; they will operate under annual budgets negotiated with that single payer.

 

Shouldn’t the competition between multiple insurers save money?

Free enterprise versus big government? That’s not the fight. It’s rather: Pay more or pay less?

 

When a new altruist says he or she wants more people covered, ask, “Do you want to expand business for private insurers or do you want to reduce inflation in health care costs by having a single public insurer?”

 

Milton Fisk, a Bloomington resident, is a member of Hoosiers for a Commonsense Health Plan. He wrote this for Indiana newspapers.

The Corporate Crime of Selling Private Health Insurance

Counter Punch

March 27, 2007

Political Players and Single Payer

By CORPORATE CRIME REPORTER

In most of the world, it is a corporate crime to sell private health insurance.

 

That's because most countries insure their citizens as a matter of right.

Private insurers dilute the public pool.

One nation, one payer.

Medicare for all.

Everybody in, nobody out.

No bills from the doctor.

No bills from the hospital.

No deductibles.

No co-pays.

No in network.

No out of network.

No corporate profits.

No threat of bankruptcy from health bills.

Health insurance will be the number one domestic political issue in the USA in 2008.

Polls indicate that the majority of the American people want single payer.

But who will deliver?

On Saturday, the Center for American Progress Action Fund and Service Employees International Union (SEIU) sponsored a forum in Las Vegas for presidential candidates to discuss health care.

No Republicans accepted.

Seven Democrats accepted.

All the candidates at the forum agreed that universal health care was the goal. (Even the Business Roundtable and the insurance industry now say they want "universal health care.")

But only one--Congressman Dennis Kucinich (D-Ohio)--accepts the only answer that will work--single payer.

Medicare for all.

The rest--including Barack Obama, Hillary Clinton, Chris Dodd, Bill Richardson, Mike Gravel, and John Edwards--want some mixture of public and private health insurance.

They know this public/private mix won't work--the healthy wealthy will buy private insurance, the sick poor will sign on with the government--and the government program will be crippled.

But they don't have the guts to stand up to the private insurance industry and say--get out.

Kucinich has introduced single payer legislation (HR 676) in Congress that would make it unlawful to sell private health insurance for benefits that are medically necessary.

Last week, we entered the belly of the beast--the American Health Insurance Plans (AHIP) 2007 National Policy Forum at the Capital Hilton in Washington, D.C.

AHIP is the trade association for the companies that will be sacked if single payer becomes law.

We walked into a session titled--Coverage for All Americans: Putting Access at the Top of the National Agenda.

The session was moderated by AHIP President Karen Ignagni.

Not once during the 90-minute session was single payer mentioned.

Universal coverage, yes.

Single payer, no.

But during the discussion, the geography of nowhere was laid out.

On one side, Ron Pollack, executive director of Families USA had teamed up with AHIP's Ignagni.

On the other, Bill Novelli, CEO of AARP and John Catsellani, president of the Business Roundtable.

AARP and the Business Roundtable have joined with SEIU to form something called Divided We Fail.

Divided We Fail is a corporate liberal answer to single payer.

All Americans should have access to affordable quality health care.

All Americans should have peace of mind about their future long-term financial security.

Families USA and AHIP do a separate dance but mouth similar platitudes.

But both Divided We Fail and Families USA/AHIP dismiss single payer as unworkable.

On the single payer side is Kucinich, about 60 members of the House of Representatives, the California Nurses Association, Physicians for a National Health Program, and Health Care Now.

Kucinich is now the single payer champion.

The problem with Kucinich, of course, is that if he doesn't get the nomination, he will take the stage at the Democratic Convention in 2008 in Denver--as he did in 2004 in Boston--raise the hand of the corporate nominee and endorse the corporate platform.

Then where will we be?

Nowhere.

Again.

Corporate Crime Reporter is located in Washington, DC. They can be reached through their
website.

Time to Fix Healthcare

[Editorial from the March 26, 2007 issue of The Nation]

 

The need to expand access to affordable healthcare is rapidly emerging as the top domestic policy issue in the 2008 presidential race. And no wonder: With the number of uninsured now up to nearly 47 million, and more than one-third of that total consisting of households with family incomes of $40,000 or more, lack of health insurance has become a concern not just of the poor but also of the middle class. Moreover, soaring medical costs--increasing in large part because at least one of every five healthcare dollars goes to administrative costs and insurance company profits--are a worry even to those who have some form of insurance. More than half of personal bankruptcies today are caused by illness or medical debts.

 

There's no mystery about the fix Americans want: Nearly two-thirds of those surveyed in a recent New York Times/CBS poll say the government should guarantee health coverage for all Americans. Half said they'd willingly pay as much as $500 a year more in taxes to pay for universal coverage. To do that, this country needs to establish a single-payer system--one inspired by Canada and other developed countries but distinctly American in approach. There's already legislation, with seventy-eight co-sponsors--the United States National Health Insurance Act (HR 676)--that would accomplish this by expanding and improving the existing Medicare system. The popularity of such an approach, endorsed March 6 by the AFL-CIO executive council, is illustrated by the ease with which California legislators passed a single-payer plan last year--only to have Governor Schwarzenegger veto it. In late February, the plan was introduced again, as part of a reform-from-below push that is seeing states tackle the healthcare crisis.

 

Ultimately, however, America needs a national fix.

 

Americans have lost hope that the Bush Administration will do anything to address the national healthcare crisis. Only 24 percent of those in the New York Times/CBS poll said they were satisfied with Bush's handling of the issue. And that number will surely shrink with recent revelations about the deplorable conditions at the Army's Walter Reed Hospital--another reminder of this Administration's incompetence. But so far most of the major presidential candidates have failed to take advantage of Bush's low standing to advance bold proposals.

 

Among the candidates, Congressman Dennis Kucinich has a long record of embracing single-payer proposals. Unfortunately, he is a lonely leader. The front-running Democratic contenders remain vague and cautious. Senator Barack Obama says, "I am absolutely determined that by the end of the first term of the next President, we should have universal healthcare in this country." Senator Hillary Clinton says she would enact "health insurance for every child and universal healthcare for every American"--with specifics "yet to come." Former Senator John Edwards moves beyond rhetoric to a plan: He would require everyone to have insurance and require employers either to provide coverage or pay into a fund to provide it. But although he reaches out to labor on other issues, Edwards is unwilling to embrace HR 676, which has earned support from nine international unions, seventeen state federations and sixty-three central labor councils.

 

Voters have to demand more if they want more. Obama at least recognizes the frustration of Americans for whom meaningful healthcare reform has been a dream deferred at least since the collapse of the Clinton Administration's bureaucratic proposals of the mid-1990s. The Clinton plan rejected single-payer and embraced a complicated hybrid that relied too heavily on the same insurance companies that had failed to make healthcare affordable and accessible. "We can't afford another disappointing charade in 2008, 2009 and 2010," says Obama. He's right. But he and his fellow front-runners should recognize that as long as they avoid talking about single-payer and continue to tinker around the edges of the current system, they are players in the charade.

What we need: single payer, a single plan

When it comes to genuine reform of the health care system, a band-aid solution won't do.
 
StarTribune / Minneapolis-St.Paul, Minnesota
March 14, 2007
Lisa Nilles
 
The universal health insurance plan introduced last week by Healthy Minnesota (a coalition of providers, legislators and insurers) is nothing more than a band-aid on a system in need of a much bigger fix.
It promises universal access to health care by requiring all Minnesotans to "own" health insurance (called individual mandate).
 
On the surface, it may look good, momentarily, to claim that Minnesota has a universal health care plan, but without underlying repair of our overly complex and outrageously expensive health care system, the satisfaction won't last long.
 
Healthy Minnesota's proposal is similar to the universal-health-care-by-individual-mandate plan passed in Massachusetts last year. This is somewhat surprising, since the Massachusetts plan is already failing in its promise to make "affordable" health insurance available to all.

We need repair of the broken system to achieve universal health care. It's that simple, and it's that hard. Band-aid solutions are "politically possible." Genuine reform, which replaces our fragmented, failed system of multiple private insurers with a single payer and one single plan for all, is considered "politically impossible." But it is what we need to do.

It is not un-American to suggest that we work together to solve the health care crisis. It is a huge social and economic problem that affects each and every one of us. Eighty-six percent of Minnesota physicians believe "it is the responsibility of society, through the government, to ensure that everyone has access to good medical care."
 
We can't expect the private market to solve this problem: Entrusting it to manage health care just fractures the system and drives up cost. We need to work together on this one, and the only institution that represents all of us is government.

We don't want to waste any more time or money on band-aid solutions. We are ready for real reform: single-payer with universal coverage.
 
Lisa Nilles, M.D., of Minneapolis, is a graduate student in theology and a member of Physicians for a National Health Program.
 
©2007 Star Tribune. All rights reserved.

`Single-Payer' Idea Stays Afloat

Legislative Committee Clears Two Differing Approaches To Health Care Reform

By DIANE LEVICK
Courant Staff Writer

March 14 2007

A bill to create a single health insurer in Connecticut - an anathema to the industry - won half-hearted approval Tuesday from a legislative panel, which also passed a reform bill the industry favors.

The Insurance and Real Estate Committee, in a 12-7 vote, approved a bill aimed at creating a "single-payer" system to ensure coverage for all Connecticut residents not on Medicare.

Several Democrats on the committee, including committee Co-chairman Brian J. O'Connor, said they were voting for the Connecticut Saves Health Care bill simply to keep reform debate going despite misgivings about potential job loss in the insurance industry.

State Rep. Christopher R. Stone, D-East Hartford, who voted yes Tuesday, said he wouldn't support the bill on the House floor.

The bill's proponents, though, scored the vote a victory because it showed a major shift in the climate for universal health care and keeps the single-payer idea afloat.

The Connecticut Saves Health Care program would replace the current system of employer-based and individually purchased policies, taking away much of the role of private health insurers. However, they wouldn't be prevented from selling supplemental coverage.

The insurance committee is known for preserving the role of insurance companies in health care, but "what they've said today with their vote is the system is broken and we need to change it," said Phil Sherwood, legislative director of the Connecticut Citizen Action Group. "I think that rang loud and clear."

Legislators of both parties, however, voiced worries about insurance industry jobs in Connecticut, should there be a switch to a single-payer system.

State Sen. Louis C. Deluca, R-Woodbury, the committee's ranking member, said Iowa has become as big or bigger a mecca for insurers than Connecticut because of legislators' actions here over the years.

"We continually give them reasons not to be here," he said. "I believe this would be another one."

Keith Stover, a lobbyist for the Connecticut Association of Health Plans, warned that "If Connecticut wants to maintain its pre-eminence as an insurance state, I would think that passage of single-payer would be about the worst possible message you could send to the industry.

"It's a lot of families that are supported by the insurance industry, a lot of mouths are fed, a lot of children put through college, and the idea that people are willing to just chuck that is extremely disturbing."

But state Rep. John C. Geragosian, D-New Britain, praised the single-payer concept, saying, "Insurance companies don't add any value in this [current] system" and that "it's time to take some bold action" to solve the health care crisis.

Stover blanched at that, saying after the meeting that "essentially every innovation in health insurance, from chronic disease management to consumer-driven health plans, etc., all come from the minds here in Hartford, in Connecticut."

Tuesday's vote was a "victorious first step toward comprehensive change," said Juan A. Figueroa, president of the Universal Health Care Foundation of Connecticut, which had pushed the single-payer bill.

The vote, he said, "acknowledges that incremental steps are not the way to fix our state's broken health care system."

The vote for a single-payer system also drew praise from Council 4 of the American Federation of State, County and Municipal Employees, the largest AFL-CIO union in the state, and from Citizens for Economic Opportunity, a labor-community coalition.

But a single-payer system is "potentially unsustainable" from a funding standpoint, said Eric George, associate counsel at the Connecticut Business and Industry Association, which has "grave concerns" about the idea.

The state already under-funds Medicaid payments to hospitals, driving hospitals to make up a part of the shortfall through reimbursements from private insurers, George said. In a single-payer system, health care providers wouldn't have private insurers to fall back on, he said.

The insurance committee removed funding provisions from the bill because there was no consensus, measures that would have levied a 50 percent surcharge on the state income tax and an 8 percent payroll tax on employers of a certain size. The bill now goes to the Senate.

The committee also passed a revised version of the Healthy Steps bill, which Stover said "provides the most rational framework for ongoing discussion" and relies on a market-based system.

The bill, which now heads to the House, would create a new Health Care Reform Commission to develop a more affordable health plan for small employers of 50 or fewer employees.

The state would contract with a private nonprofit organization that would serve as an insurance purchasing pool for previously uninsured individuals and small employers to buy coverage.

The Connecticut Connector program would offer three kinds of health plans, including a high-deductible plan linked with a health savings account.

Legislators removed from the bill a proposed 3 percent tax on revenue of health care providers in Connecticut that would have helped to fund some of the provisions. Doctors protested the tax at a committee hearing last week.

The bill would provide tax credits at varying levels to small employers that provide health insurance that meets or exceeds the standards set for the affordable plan to be developed.

The measure also calls for expansion of the state's Husky insurance program, and increased reimbursement to doctors, dentists and hospitals from insurers serving Medicaid members.

Contact Diane Levick at This email address is being protected from spambots. You need JavaScript enabled to view it. .
Copyright 2007, Hartford Courant

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