Critique of Medical Reform Bills by Single Payer Advocates

This article shows the way in which both Reform bills actually help out insurance companies and dump high risk more expensive patients onto Medicare thus increasing the cost to the taxpayer. No doubt these increasing expensives will eventually result in a reaction that will cut services to the elderly. From this site.


An Unworkable Mess
Steffie Woolhandler is a professor of medicine and David Himmelstein is an associate professor of medicine, both at Harvard Medical School. They are co-founders of Physicians for a National Health Program.

Milk and lemon both taste good in tea. But mix them together and it’s a curdled mess. Similarly, the latest Senate health reform compromise combines two appetizing elements — a Medicare expansion and tighter insurance regulations –- to create a noxious brew.

We need Medicare for all, not a plan that takes only the high-cost patients off private insurers’ books and makes them Medicare’s problem.
Both the House and Senate versions of reform would turn over hundreds of billions of tax dollars to the same private insurers who’ve proven incapable of controlling costs or giving American families the coverage they need. And these bills would make failure to buy insurers’ defective products a federal offense. Together these measures greatly augment insurers’ financial and, hence, political muscle.

The only concessions wrung out of the insurers for this windfall are modest new regulations on the policies they sell to individuals: insurers will have to accept every applicant; they won’t be allowed charge the sick higher premiums; and they’ll be able to charge older people only two to three times more than the young.



Most of these regulations won’t change things for people who get their coverage through an employer, but they’re helpful for the many of the roughly 7 percent of the population who buy their own private insurance.

For insurers, the regulations make the near-elderly who don’t get employer-sponsored coverage into pariahs. On average, they cost insurers far more than twice as much as the near-teens, but they can’t be charged premiums to match their costs.

Now the Senate plans to take some of these high-cost patients off private insurers’ books, and make them Medicare’s problem. Consequently, the costs of this Medicare buy-in will be high — both for patients and for the taxpayers who will subsidize the near-poor starting in 2014.

Meanwhile, younger, healthier and hence more profitable patients will be forced into private insurance. There’s no public option for them, nor for anyone offered employer-sponsored coverage. If you have private insurance and you like it, you can keep it; if you have private insurance and you don’t like it, you still have to keep it.

But even though it’s bad health policy, this new compromise is brilliant politics. For insurers, it offers a hidden subsidy. Meanwhile, it gives the appearance of responding to the vocal and growing legion of single payer supporters who want Medicare for All.

In the end, the Senate compromise, like its House counterpart, will do little to salvage the sinking U.S. health system. Costs will continue to skyrocket, putting coverage more and more out of reach for middle class Americans, and driving the costs of taxpayer-funded subsidies through the roof.

In contrast, a single payer system could save nearly $400 billion annually on health insurers’ overhead and the paperwork they inflict on doctors and hospitals -– savings that would make universal coverage affordable. Medicare for All won’t grow from the Senate compromise, but from its ashes.

Matt Taibbi on the sad state of US health reform..

At least this is a fitting counterpoint to those US commentators who get up and say that in spite of its shortcomings the US has the best health care system in the world. Actually that might be close to the truth for those who are very well off. But the WHO ranked the US as 37th of 190 countries so Taibbi is perhaps being a bit harsh to say it is the worst though perhaps he is right about its being the dumbest! This is just a small part of the article from the Rolling Stone.



Watch Matt Taibbi break down his report on the sad state of health care reform in his blog, Taibblog.
Let's start with the obvious: America has not only the worst but the dumbest health care system in the developed world. It's become a black leprosy eating away at the American experiment — a bureaucracy so insipid and mean and illogical that even our darkest criminal minds wouldn't be equal to dreaming it up on purpose.
The system doesn't work for anyone. It cheats patients and leaves them to die, denies insurance to 47 million Americans, forces hospitals to spend billions haggling over claims, and systematically bleeds and harasses doctors with the specter of catastrophic litigation. Even as a mechanism for delivering bonuses to insurance-company fat cats, it's a miserable failure: Greedy insurance bosses who spent a generation denying preventive care to patients now see their profits sapped by millions of customers who enter the system only when they're sick with incurably expensive illnesses.
The cost of all of this to society, in illness and death and lost productivity and a soaring federal deficit and plain old anxiety and anger, is incalculable — and that's the good news. The bad news is our failed health care system won't get fixed, because it exists entirely within the confines of yet another failed system: the political entity known as the United States of America.
Just as we have a medical system that is not really designed to care for the sick, we have a government that is not equipped to fix actual crises. What our government is good at is something else entirely: effecting the appearance of action, while leaving the actual reform behind in a diabolical labyrinth of ingenious legislative maneuvers.

House party on US Health Care.

This is from NY Times.
The existing health care system has so many powerful players that it is very difficult to reform. It is doubtful that Obama is willing to really cut out the big players and opt for a single payer system.



At House Party on Health Care, the Diagnosis Is It’s Broken
By ROBERT PEAR
VIENNA, Va. — When a dozen consumers gathered over the weekend to discuss health care at the behest of President-elect Barack Obama, they quickly agreed on one point: they despise health insurance companies.
They also agreed that health care was a right; that insurance should cover “everything,” not just some services; and that coverage should be readily available from the government, as well as from employers.
Those were the conclusions of a house party held here in Northern Virginia at the home of Karima Hijane and Theodore A. Kolovos, information technology consultants who have been married for seven years. It was one of more than 4,200 such events being held around the country from Dec. 15 to 31, as part of an experiment in grass-roots politics and policy-making, to provide recommendations to the president-elect.
“We have to keep the momentum going,” said Ms. Hijane, 34, who was a volunteer in the Obama campaign and is active in women’s health advocacy. “We are not lobbyists. We are simple citizens. We want to make sure that our voices are heard and that health care is reformed.”
One of the people seated around Ms. Hijane’s dining room table, Bruce D. Chatman, worked for I.B.M. for 29 years. Corporations, he said, have too much influence in the legislative process and the health care system. He wants to counterbalance their power with the energy and passion of citizens lobbying for themselves.
Mr. Chatman, a Chicago native who lives in Fort Washington, Md., said he had been inspired by Mr. Obama’s book “The Audacity of Hope” and started working for his campaign as a volunteer in April 2007.
“I don’t believe health care should depend on people making money,” Mr. Chatman said. “The profit motive has to be tempered, especially on the administrative side of the health care business.”
Shiva S. Makki, an economist, complained that in many cases, insurers did not cover the costs of screening procedures and preventive care.
Dr. Lawrence M. Nelson, a scientist at the National Institutes of Health who emphasized that he was speaking as a private citizen, said: “The incentives in the current health insurance system are upside down. The less care you provide, the bigger your profits.”
Dr. Nelson said he liked Mr. Obama’s proposal to create a new public plan, similar to Medicare, that would compete with private insurance companies.
Alex R. Lawson, a volunteer in the Obama campaign now trying to build public support for Mr. Obama’s agenda, said a public plan would give people a choice they do not have.
“A public insurance plan would not take anything away,” Mr. Lawson said. “It just adds another option.”
After one speaker expressed a mild concern about too much involvement by the government, Mr. Kolovos said: “Everyone is afraid of government bureaucracy. But what we have now, with the filing and adjudication of insurance claims, is also bureaucratic.”
Several people at the health care forum said they were frustrated by the current arrangement under which health insurance is tied closely to the workplace.
Hamudi Almasri, a 35-year-old information technology consultant at a small company that does work for the Labor Department, said that when he changed jobs, he had to change health plans and doctors.
“If I change employers, why should it be such a hassle?” Mr. Almasri asked.
His wife, Li Yang, said: “When I move from one doctor to another, my information is lost. In many cases, the doctors don’t talk to each other. In a country where information technology is so advanced, there’s no system linking all these doctors together. It’s a hindrance to treatment.”
Ms. Li said she and her husband “had a few surprises” when they started shopping for a better health insurance policy on their own.
“If we wanted a baby,” Ms. Li said, “insurers would not cover the maternity care if conception occurred within six months after we purchased the insurance. We were shocked.”
In many cases, the standard individual insurance policy does not cover maternity care, though such coverage can be bought for an additional premium. Even then, some insurers stipulate that maternity benefits will be available only if a woman waits for a certain amount of time before becoming pregnant.
The Obama transition team asked for “particularly poignant stories to highlight the need for health care reform,” and such stories were abundant at the round table here.
Mr. Almasri said that when his infant daughter had severe eczema, she had to wait several months to see a dermatologist in their H.M.O. network. By then, he said, “the symptoms were all cleared up.”
Ms. Hijane said she had gone from doctor to doctor for more than a year before she got correct diagnoses for premature ovarian failure and celiac disease, a digestive disorder.
“Instead of being able to focus on my health,” Ms. Hijane said, “I focused on insurance to cover the tests and treatments. Everything we did was designed to find a job with good health insurance.”
The Obama transition team did not ask people how a new health care system should be financed, but several people here said that individuals and businesses should have to pay a small health care tax — some preferred to call it a “contribution” — so that everyone could be covered.
Mr. Chatman said he expected insurance companies and others in the health care industry to resist many of Mr. Obama’s proposals.
“This is warfare for the health care of our country,” Mr. Chatman said. “The question is, Will money win, or will the people win? If we lose, we’ll be a second-class country.”

US health reform by Himmelstein and Woolhandler

New York Times - December 15, 2007
The attempts by US states to attempt to find some alternative to a truly universal system has not had very positive results and has still left many uninsured.
The stranglehold that private insurers have on the system prevents any radical reforms.

I Am Not a Health Reform
By DAVID U. HIMMELSTEIN and STEFFIE WOOLHANDLER

Cambridge, Mass.

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.


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