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Why we say that single-payer is good for business as well as the rest of us

Honeywell locks out USW Local in Illinois over health care — sister Local in Canada wins contract with no problem; everyone there Is covered under Canada’s single-payer plan

On June 28, 2010, Honeywell locked out the 230 union workers at its uranium hexafluoride plant in Metropolis, an Ohio River town of 6,500 at the tip of southern Illinois 400 miles south of Chicago. A working class town nestled amidst the corn, soybean and wheat fields, Metropolis is known for its Superman statue on the court house square where most Illinois candidates, including Barack Obama, have stopped by for a photo op.

Honeywell didn’t care if the workers liked their health care plan. This corporation said it was not going to let them keep it. The members of United Steelworkers (USW) Local 7-669 refused to accept the company proposal to increase workers’ out of pocket health care maximum to $8,500 a year and to end retiree health coverage. The union proposed to continue working as they bargained. Honeywell said no and locked the doors.

USW 7-669’s sister local in Canada signed their current contract in July 2010, and health care coverage did not present a problem. “Bargaining was not particularly difficult this time around,” said Chris Leavitt, President of USW Local 13173 in Port Hope, Ontario, Canada, home of the Cameco plant, the only other one in North America to make the uranium hexafluoride used to produce nuclear energy. Canadian USW Local 13173 is about the same size as the Metropolis local and was a part of District 50 of the United Mine Workers which affiliated with the USW.

Everyone is covered under the Ontario Health Insurance Plan—automatically–as a part of Canada’s Medicare, a single payer plan, explains Leavitt. Members of Local 13173 and their families pay nothing—no premium, no co-pay, no co-insurance, no deductible–for hospital care plus medication, out patient services, doctor’s visits, and other doctors’ services such as surgery. Health care is publicly funded for everyone so unions can use their bargaining power to negotiate for wages and other benefits. Read full article.

Democrats Block California Single-Payer Bill

September 1, 2010

By Don McCanne

Speaker John Perez of the California State Assembly, on the very last day of the legislative session, pulled SB 810, the single payer bill, from the Assembly floor.

This highly unusual move of pulling a bill that had cleared all legislative hurdles except for the final Assembly floor vote was to protect Democrats from having to cast a health care reform vote in a difficult political environment three months before the next election.

Democrats feared a backlash from those who are opposed to the recently enacted federal health care legislation should they vote for the bill, and they feared offending their progressive base should they vote against the bill. Since a veto by Gov. Schwarzenegger was a given, it was decided that it would be safer to avoid the political risks by simply pulling the bill.

But did they really avoid that risk? Are the single payer advocates expendable? Don't think so.

Fortunately, Senator Mark Leno is not to be deterred. He has vowed to reintroduce the bill in the next legislative session which begins in January.

The Democrats are worried about their political base, but maybe that's not the framing we should be looking at. Perhaps the single payer advocates should be reassessing their own base instead.

Not all Democrats have been supportive of single payer, and several Republicans who are not part of the prevailing lock-step bloc do understand the benefits of the single payer model. The Patient Protection and Affordable Care Act is proof that we can't rely on the Democrats to do the right thing. Most importantly, everyone understands the benefits of Medicare as a social insurance program (even if there is a fringe reactionary element that would emasculate it).

The Tea Party is proving that passionate voices can be heard. Maybe we can learn from them, though our message should contain more than simple platitudes. Our message needs to convey the principled substance of health care justice, and it needs to be loud, clear and highly infectious.

Right-Wing "Think" Tanks and Health Policy

"You can always tell if you're succeeding by the viciousness of the opposition." — Dr. Quentin Young, PNHP National Coordinator

 

By Nicholas Skala. Updated by Chris Gray, July, 2010

As the movement for single payer expands, attacks on single payer in the media by the far right have increased. In addition to misleading articles and op-eds, several books attacking single payer by conservative pundits were published in recent years, including one endorsed by former GOP Speaker of the House Newt Gingrich.

The PNHP National Office has identified 20 right-wing think tanks that employ full-time health policy "scholars" to oppose national health insurance and advocate for health care privatization, deregulation and market-based reforms. These groups are funded with millions of dollars from wealthy far-right foundations such as the Lynde & Harry Bradley Foundation, the Charles Koch Foundation, the John Olin Foundation, the Adolph Coors family’s Castle Rock Foundation and the Scaife Family Foundations, which share an ultra-conservative social agenda.

The Right-Wing "Echo Chamber": Although they masquerade as legitimate research institutions, most of these policy think tanks are little more than PR firms for those who want to obscure the facts about health care in America. Many, such as the Fraser Institute, produce bogus research and purposely avoid peer review. Instead, they provide "experts" with fancy titles to write editorials and appear on TV news programs to spread misinformation. Each of these institutions is funded by the same small group of ideological foundations, and it is extremely common for these "experts" to cite each other's bogus research in their commentaries, giving the impression of wide scientific credibility for their views. Twenty of the top "think" tanks are detailed below. Members are encouraged to take the lead on behalf of PNHP in responding to misinformation spread by these and other groups.

Tennessee Ernie Ford and the Company Store

 

 

 

Circleville Herald
Thursday, September 30, 2010 9:54 AM EDT

You load sixteen tons, what do you get?
Another day older and deeper in debt.
Saint Peter, don’t you call me ’cause I can’t go
I owe my soul to the company store

Senate Republicans last week protected the Company Store again by blocking the DISCLOSE ( Democracy Is Served by Casting Light on Spending in Elections) act for the second time. The DISCLOSE act would have required corporate CEO’s to appear on the television attack ads they bought. We have no way of knowing till months after the fact, and then only if we are relentless in seeking the information, what corporation sponsored the mendacious propaganda on our screen. The Bush appointed Roberts/Alito Supreme Court damaged free and fair elections this January by ruling that corporations ( aka the Company Store) have the right to dump unlimited, unidentifiable cesspools of bucks directly into any election they choose. We perhaps should require that candidates dress like NASCAR drivers, with the corporations that bought them printed in large letters all over their jumpsuit.

Want to run for office in West Virginia on a platform requiring compliance with mine safety? You lose. CEO Don Blankenship of Massey Energy, owner of the mine that killed 29 miners this past May after hundreds of safety violations, can buy up all the air time, newsprint space with gazillions of profits made from endangering his workers. No one will hear you. Used to be government was the referee, us looking out for each other. Decades of social legislation from 1900 on had made for a large, stable middle class. Since the Reagan revolution, the Company owns the referee.  The anger of the Tea Party is understandable, but they have it wrong, it isn’t the government that is hurting us, in fact taxes are lower than they have been in 60 years. It is the unregulated corporation that crashed Wall Street, took your job and home, profits from your healthcare and owns the store.

Before the Citizens United Supreme Court ruling Cincinnati billionaire and principal shareholder of American Financial Group Carl Lindner could contribute only a maximum of $4,800 to Republican Senate candidate Rob Portman. On August 2nd American Financial Group donated 83 times that amount, $400,000 to American Crossroads. In mid-August American Crossroads spent $454,000 on a statewide television ad backing Portman. American Crossroads was founded by former Bush operative Karl Rove as one of hundreds of front groups taking in billions of corporate dollars for Company Store friendly candidates. American Crossroads’ take in August alone was $2.6 million, $7.9 million from January up to August. $2 million of the August booty for American Crossroads came from two Texas businessmen.

“This is perhaps the best example to date of a big dollar impact in Ohio stemming from the high court’s Citizens United campaign finance decision..” (quotation, figures from “Court ruling boon to Ohio campaign”, Columbus Dispatch 22 September 2010 p. B1). Democratic Party Senate candidate Lee Fisher notes “This is an election, not an auction. Our democracy is about one person one vote… and should not be subverted by corporate spending without transparency.” Ohio Democratic Senator Sherrod Brown adds “It’s especially essential that the public knows who these people are giving this money.” Brown further noted that many outside groups, including an arm of American Crossroads aren’t required to ever disclose their donors. (“Brown: TV ad donors should be revealed” Columbus Dispatch 23 September 2010 p. A8)

A new Associated Press poll found that Americans who think the Patient Protection and Affordable Care Act of 2010 (PPACA) does not do enough to make healthcare more available outnumber 2:1 those who oppose the law believing that government should not be involved in healthcare. Four out of ten Americans believe the new law does not go far enough, one in five oppose the PPACA citing opposition to government involvement. (Washington Post 26 September 2010) One would think the nation was overrun with Tea Partiers screaming and packing firearms to health reform town halls based on FOX news reports. The fact is, Americans wanting further reaching reform outnumbered those fearing government two to one.

How then did we end up the health insurance industry/pharmaceutical company friendly PPACA? Part of the answer is Rick Scott, former CEO of Columbia/Hospital Corporation of America who was forced to resign after his company was fined $1.7 billion for fraud, kickbacks and understaffing of hospitals to cut costs. Scott founded “Conservatives for Patient’s Rights” to fight healthcare reform. Scott’s group spent $20 million, just a fraction of the $1 million industry spent every day of 2009 to insure Company Store friendly reform. (Geyman, J., MD; Hijacked; The Road to Single Payer in the Aftermath of Stolen Health Care Reform, p.79) As former CEO of a criminal healthcare corporation, I question Scott’s concern for patient rights.

This November, before you vote, consider that much of what you see and hear about candidates was financed by the Company Store. Consider which candidate and which political party has consistently stood up for the middle and working class.

Dr. Cotton is a member of Physicians for a National Health Program while working full-time in the emergency department, one of the few places in America that treats everyone based solely on need.

Brown, Wyden offering health-care revision

POLITICO

By: Sarah Kliff
November 17, 2010 07:54 PM EST

Sens. Scott Brown (R-Mass.) and Ron Wyden (D-Ore.) will introduce legislation Thursday allowing states to opt out of the controversial individual-mandate requirement of the health care reform law far sooner than they would under the law passed by Democrats earlier this year.

"States shouldn't be forced by the federal government to adopt a one-size-fits all health care plan. Each state's health care needs are different," Brown saysin a statement accompanying the legislation. "Our bill provides flexibility, and allows states like Massachusetts to opt out of portions of the health care law."

The bill is a significant step on both sides of the aisle. It's an effort by a Senate Democrat to ease one of the law's requirements. And it's the first Republican-sponsored effort to modify - rather than repeal - a provision in the law.

The Affordable Care Act allows states to set up health care systems without a mandated purchase of health insurance, as long as they meet minimal requirements established by the Department of Health and Human Services. States can begin applying for mandate waivers in 2017, three years after the individual mandate is set to take effect.

But Wyden, who co-authored health reform's waiver provision with Sen. Bernie Sanders (I-Vt.), has previously spoken out against the 2017 start date as problematic: States would have to go through the motions of setting up a mandate-centered system only to dismantle it a few years later.

This new legislation would roll the waiver date back to 2014, when the individual mandate comes into effect.
In an interview with POLITICO, Wyden described the legislation as a natural fit for Oregon and Massachusetts, two states that have experimented significantly with their health care systems. 

"Oregon and Massachusetts are ideal bookends on this," he said. "Oregon was one of the first to start using institutional dollars on home care, essentially giving seniors more of what they wanted. Sen. Brown obviously has an interest in Massachusetts, where Mitt Romney and Ted Kennedy have come from.

"He was easy to work with in a divisive political climate. We kept the focus on state innovation and the opportunity to get away from one-size-fits-all, federal, cookie-cutter reform. "

Wyden pushed back against those who might interpret his legislation as a form of resistance to health reform.
"Clearly by HHS putting in place the coverage framework, you make it clear a state can't go off and do nothing," he said. "They have to have all kinds of services that are more in line with the spirit of coverage. The state will obviously work with the federal government, which will be looking on."

Wyden pressed CMS administrator Don Berwick on the issue at a Senate Finance Committee hearing Wednesday morning, asking him for his views on how much flexibility states will receive. He got a positive reaction.

"The cliché about states as laboratories of democracy is not just a cliché, it's true," Berwick said at the hearing. "The diversity of approaches that we're seeing emerge state by state has been there for a long time. I think we should be doing everything we can to encourage it."

Wyden has also pursued Oregon's Health Authority Office on the issue, indicating his intentions to introduce legislation rolling back the waiver date and encouraging the state to apply.

"Section 1332 is scheduled to go into effect in 2017. I intend to introduce legislation shortly to accelerate that date to 2014," Wyden wrote in a letter in September. "Moreover, if the bipartisan legislative leadership and the executive branch were in support, I would like to explore the possibility of Oregon moving forward with a federal waiver even earlier."

In Vermont, single-payer health care in a single state

Tuesday, December 14, 2010

By Josh Goodman, Stateline Staff Writer

Congress never really considered a single-payer health plan run by the government. Vermont is planning for one. This isn’t some liberal fantasy. Vermont lawmakers are serious. To understand how serious, you only have to look at the resumes of William Hsiao and Jonathan Gruber.

Hsiao, a Harvard economist, is credited with designing Taiwan’s single-payer system. Gruber, an M.I.T. economist, helped design Massachusetts’ near-universal health care system and the federal health care reform law itself. They’re on the team that the Vermont legislature contracted with this year to explain how single-payer would work there. In other words, the nation’s 49th most populous state is deploying some of the world’s leading experts to redesign its health care system. Their report is due early next year, after which Vermont will decide whether to become America’s first single-payer state.

If Vermont decides on that course of action, the experiment will serve as a test of whether more aggressive government intervention can improve health care and reduce costs. Long before the results of that experiment would be known, Vermont’s project could serve as a test of something that even the state’s conservative counterparts elsewhere are interested in finding out: just how much power states have over their own health care systems.

Containing costs

Vermont is perhaps an unlikely place to try something dramatically new in health care. That’s because by most standards, Vermont’s health care system already is one of the nation’s best. The United Health Foundation has ranked Vermont the healthiest state in the country four years in a row. Fewer than 10 percent of Vermonters lack health insurance, one of the lowest rates in the country.

If the state’s only concern were getting insurance to the comparatively few people who lack it, Vermont could sit back and wait for the new federal law, with its promise of near-universal coverage, to kick in. But expanded access is only part of what the state wants — and it isn’t the part that officials tend to mention first.

“For Vermont, it’s all about containing costs,” Peter Shumlin, the governor-elect, told Stateline. He points out that the annual cost of health care in Vermont — for individuals, businesses and government — has doubled to roughly $5 billion a year over the past 8 years. “It’s killing small businesses,” Shumlin says, “kicking the middle class in the teeth.”

Vermont’s problems paying for health care aren’t much different than the problems other states face. What makes Vermont different is that many of its top officials believe the solution is to have only one entity providing health insurance. In their boldest schemes, they’re hoping to drive private health insurance providers out of existence and to free employers from the responsibility of providing health insurance to their employees.

That includes Shumlin, who led the state Senate when it approved the legislation approving the study that Hsiao is leading. The five-way Democratic primary for governor had other single-payer supporters, but none was more forceful than Shumlin. He won the primary by 203 votes, then won the general election by 2 percent.

Providing health insurance to everyone is, of course, a very costly endeavor. But Shumlin and many of the Democrats who run the legislature think single-payer can save money in a couple of ways. For one, they note that hospitals and doctors’ offices spend a lot of money filling out paperwork and coding claims for insurers. These administrative costs aren’t especially high in Vermont compared to many other states, but supporters of the single-payer plan believe that if health care providers could deal with one insurer, they’d be able to focus more on providing care and less on processing claims.

Supporters also see single-payer as an antidote to the fragmentation of Vermont’s health care system. For example, state Representative Mark Larson, who’s expected to chair the House Health Committee next year, laments that his local hospital, Fletcher Allen Health Care in Burlington, is planning to sell off its outpatient dialysis units.

Fletcher Allen made the move because it was losing money on dialysis. The reimbursements it was receiving from all of Vermont’s various public and private health insurance providers weren’t enough to pay for the costs. In the current system, even if it were clear that the cheapest and best way to care for dialysis patients was for Fletcher Allen to own the units, the state’s power to do anything is limited. The structure of health care is subject to the vagaries of Medicare and private insurers, not coherent planning.

Under single-payer, that would change. “It’s very hard to direct a strategy for accomplishing long-term savings in health care — to manage care better, to minimize unnecessary procedures, to invest in strategies that have demonstrated savings in quality and cost — without some system of financing and payments to direct those efforts,” Larson says.

One-state experiment

There remains one huge question: Can wholesale reform work in a single small state? State Representative George Till, a member of the legislature’s Health Care Reform Commission, is skeptical of single-payer. 

Till points out all the different entities that provide health insurance to Vermont patients. There are the state’s private insurers. There’s the state itself, through Medicaid and through its coverage of state employees. There’s the federal government, separately through Medicare and the Veterans Health Administration. There are some larger companies, such as IBM, that self-insure. And there are many people whose health insurance isn’t even based in Vermont. “At the hospital that I work for, we deal with 14 different insurers from New York,” says Till, who is a doctor.

Due to those complications, what Vermont is trying to do is, at its heart, a test of the power of state government. Can a state wrest total control of health insurance from the federal government and private companies? 

The simple answer is that it can’t without federal permission. Companies that insure their own employees at their own expense are exempted from state health care regulation under the federal Employee Retirement Income Security Act, known as ERISA. Medicare and the VA, of course, fall under federal purview. The new federal health care law forbids states from receiving waivers from its provisions until 2017, although some senators are working to change that date to 2014, when the law’s most consequential provisions kick in. 

If those efforts succeed, states would gain a lot more freedom to do what they please. For now, though, the definition of single-payer is in doubt, even among the people who are designing Vermont’s programs. “The last thing we want to do is create the perfect policy that can’t be implemented,” says Steven Kappel, a Vermont-based health care researcher who is part of the Hsiao-Gruber team.

The question is whether single-payer without Medicare patients or without VA patients or any other piece of the pie would really be single-payer at all — and whether leaving a piece out would undermine the advantages of the change that Vermont expects. The researchers are charged with developing other plans beyond single-payer: One is a government plan open to all Vermonters with conventional private insurance as an alternative. Despite Shumlin’s commitment to single-payer, it’s possible another option might look more appealing in the end.

Chance to lead

For now, though, those obstacles haven’t compromised the incoming governor’s commitment to the single-payer concept. In fact, he doesn’t think he has much of a choice.

Shumlin’s view is that health care interests are powerful enough in Washington that aggressive cost containment isn’t really possible there. “I believe that the states will have to lead true, meaningful health care reform,” he says. “We have a real opportunity to lead the country in health care if we have the courage.” But Shumlin and others also argue that, despite some of the difficulties, Vermont is the perfect place to try.

The biggest advantage Vermont has is the political environment in the state. Blue Cross Blue Shield Vermont, the state’s largest private insurer, has stayed neutral on single-payer. “We don’t think it’s our role,” says Kevin Goddard, the company’s vice president of external affairs. Even the state chamber of commerce, while somewhat dubious of the concept in its purest form, isn’t actively opposed yet.

What everyone agrees upon is that some very smart people are thinking about the best way to structure Vermont’s health insurance system. The initial report is due next month. Even critic Till says, “I think people will listen very carefully to what Dr. Hsiao comes back with.” 

— Contact Josh Goodman at jgoodman@pewtrusts.org

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