Colorado & healthcare reform

Colorado has an unreasonable number of healthcare activists with national prominence.

I'll begin with T.R. Reid, although he's a journalist, not an activist. His Frontline film and upcoming book are and will be important in the debate.

There's Nathan Wilkes, a young father and member of the board of Health Care for All Colorado who speaks nationally on the need for universal, effective, quality healthcare.

There's Donna Smith - who's now in Chicago, but has deep roots in Colorado. She appeared in Michael Moore's Sicko.

David Sirota, the pundit, is here. He's not exclusively about healthcare, but he speaks on the issue, and how it's central to a movement to strengthen the middle class.

Glen Pearson, MD, is former president of Physicians for a National Health Plan.

Rocky White, MD, also on HCAC's board, is running for the State House of Representatives, and is the editor of the reprint of Healthcare Meltdown, a book to read if you're wanting to learn more about the need for healthcare reform.

Elinor Christiansen, MD, was one of the original authors of the first draft of HR676, the single-payer legislation sponsored by Rep. John Conyers (D-MI) and Rep. Dennis Kucinich (D-OH).

In the center there's the 208 Commission, with many of its members being nationally known leaders in healthcare policy, Barb Yondorf in particular, who has co-authored several papers.

On the right, there are Paul Hsieh, MD, and Lin Zinser. The two have an article on "Moral Health Care vs. 'Universal Health Care'" at something called The Objective Standard.

There are a number of single-payer advocates who ignore stuff like this on the grounds that it's mean-spirited. Other activists love to get exercised over this kind of argument, ignoring the fact that most Americans see Zinser and Hsieh's position for what it is - not only mean-spirited but also extremist.

I guess I think it's good to understand where people are coming from, even if you know beforehand that you won't agree. To be a Social Darwinist and still feel good about yourself must require an extreme ability to think in the abstract. For instance, Z&h's first step in fixing what they now acknowledge to be an American healthcare crisis is to repeal EMTALA, the law that requires hospitals to treat people who show up injured or sick at their doors. They'd also eliminate Medicare, Medicaid, and all insurance regulations.

About EMTALA - While the need for the EMTALA law is new, brought about by the distortions of profit in what used to be religious institutions' mission of caring, the underlying value is centuries old - at least as old as Christianity and Judaism.

Z&H give a history of our current crisis, beginning with how Blue Cross/Blue Shield became non-profits, and thereby began to compete with other insurance companies on what Z&H consider an unfair playing field. They believe it became even more distorted after the WWII wage freezes took place, with their concurrent tax breaks for employers offering health insurance.

Z&H compare health insurance to homeowners' insurance, arguing that if homeowners' insurance covered lawn work, painting and remodeling, our homeowners' insurance rates would skyrocket. Especially if the government forced homeowners' insurance to cover poor homeowners...

The problem with that analogy is that homeownership is completely optional - as is, to a lesser extent, upkeep. Health isn't optional. A good portion of what happens to our health isn't choice-driven either. No one chooses their father's stroke proclivity, their mother's and sisters' breast cancer. No one chooses to grow up down river from a chemical plant, or for their mother's crappy prenatal care.

Z&H see Medicare as worse than charity, worse because, they write, people don't realize it's charity. We fools think we've been paying for it via our own taxes.

I'll stop. It's tedious reading someone else's rebuttals to something, and more instructive to do it yourself. The Libertarian notion is that if the healthcare market were simply freed from government meddling it would thrive. It's not a bad intellectual exercise to actually think through what the evidence is against that being true. May even come in handy one day - especially here in Colorado.

Even some of the up-and-coming Colorado politicians are taking notice.

It's too bad the newspapers are out of the loop. Katy Human at the Denver Post does a good job of covering health issues and stories, but the opinion pages have pretty much taken a pass. It would be a public service if they did a better job of covering the issue - with an emphasis on single-payer and modified single-payer, since it is the funding mechanism by which the rest of the world keeps their costs down and provides universal coverage - despite Z&H's ongoing success in ignoring that.

Consumer Reports becomes activist!

There's a great new website and initiative up from, of all organizations, Consumer Reports. It shouldn't really be a surprise - they did some great work earlier this year on the failure of the American health insurance industry.

The Cover America Tour begins with a bus with speakers that's traveling around to bring focus on this issue. Shades of Healthcare Now! That's exactly what Donna and Larry Smith did last autumn.

They're not single-payer, but it looks to me like most of their information points in that direction. Take a look at their media page - one of the choices there is a piece on "Six Prescriptions for Change," which reports the results of a survey of what Americans want (on a page titled: "Health-care security: Losing confidence in the health-care system." Their findings:

• Coverage for all uninsured children.
• Protection against financial ruin due to a major illness or accident.
• The ability to obtain coverage regardless of a pre-existing condition.
• Coverage that continues even when people are laid off, changing jobs, or starting their own business.
• Premiums, deductibles, and out-of- pocket expenses that are affordable relative to family income.
• The ability of people to keep their current health insurance if they choose.

It's too bad that folks don't get it - that last item effectively trumps all that came before.

Cost doesn't equal quality

The renowned education author Jonathan Kozol tells a story about money and education.

The inner boroughs of New York City spent $8,000 or so per student (more now). The outer boroughs about $12,000. The really tony enclaves spent $24,000 per student. At Andover, where Bush went to school, it's $40,000.

When Kozol's conservative friends told him that the answer to our education crisis wasn't to simply throw money at the problem, he liked to reply, "Why not? It works for your kids..."

(I think we can all imagine where Bush might be today - also a federal facility - if he'd gone to an underfunded school in New Orleans or D.C.)

The impact of cost on health care outcomes is different. The rigorous Dartmouth Atlas of Health Care has shown that spending doesn't necessarily correlate with outcome. Now a survey of Medicare beneficiaries released this week in JAMA "suggests that more regional spending on medical care does not improve patients' perception of the medical care they receive..."

The researchers found that per capita expenditures were highly related to receiving more medical care, such as average number of ambulatory visits to physicians in the past year and more cardiac tests (respondents reporting receiving tests in past year, 40.1 percent [lowest average expenditures quintile] to 63.5 percent [highest average expenditures quintile]). However, 7 of the 10 measures of perceived quality, including perceived unmet needs for tests and treatment (respondents reporting unmet needs, 3.9 percent to 5.0 percent) and spending enough time with physicians (respondents reporting adequate time, 88.7 percent to 87.0 percent), were unrelated to expenditures, while the overall rating of perceived quality of care was higher in the lower-expenditure areas (respondents reporting overall care rating of 9 or 10, 63.3 percent to 55.4 percent).

Coincidence? I think not...

There's an unintentionally funny post at a blog I stumbled over this a.m. regarding Scott McClellan's new book, What Happened. The guy saw a correlation between Bush's falling approval ratings and Scott McClellan's competence as a press secretary. (As if the Bush administration would put an incompetent in a position of importance because of cronyism....) "Even Tony Snow couldn’t reverse the trend," this person wrote.

Somehow I think White House won't go with that. Looks like they've settled on disgruntled former employee sells out for book advance - same as McClellan himself used on Richard Clarke.

A bit of basic logic at Wikpedia gives some other examples of "Correlation does not imply causation":

The more firemen fighting a fire, the more damage there is going to be.
Therefore firemen cause damage.


With a decrease in the number of pirates we have seen an increase in global warming over the same time period.
Therefore, global warming is caused by a lack of pirates.


Since the 1950s, both the atmospheric CO2 level and crime levels have increased sharply.
Hence, atmospheric CO2 causes crime.

Put a Doctor in the House!

Rocky White, M.D., has a website up regarding his run for Colorado House District 62. Rocky's website looks great - single-payer-financed healthcare is front and center. He writes:

I believe in a single risk pool for everyone in Colorado so that everyone shares in the expense of our health care system according to their ability to pay. I believe that every resident should have equal access to a defined benefits package that ensures a minimum standard of health and welfare for all. I believe that everyone should have a certain degree of personal responsibility for their own health care and that the burden of health care financing should not rest exclusively on the back of business.

The transcript from Amy Goodman's show with Rocky is at Alternet, titled, "Evangelical Doctor Touts Better Health Care Plan Than Clinton, Obama."

Rocky got a brief mention in the Denver Post article on the Democratic State Convention:

One of the few surprises of the weekend was the upset of Rep. Rafael Gallegos, D-Antonito, who was seeking a third term in the House.

Gallegos' own District 62 assembly swept him out, picking Rocky White, a doctor from Alamosa, to be on the ballot. The district covers eight counties in south-central Colorado in an area that includes the San Luis Valley.

White attributed his victory to being well-known in the valley and "just campaigning like crazy."

Gallegos, who received 14 votes, and Ed Vigil, another candidate seeking the seat who received 12 votes, can still petition to get on the ballot.

What ever happened to states' rights?

The Republicans have been so amazingly nimble politically from - what would you say? - 1995 to 2005? - that books will be written a hundred years from now on what they wrought during this crucial time. If, of course, their anti-family-planning, anti-environmental, pro-sprawl, pro-greed, you're-on-your-own polarizing policies haven't precluded publishing.

A NYT opinion piece on states rights offers a chapter of examples on how the right wing, that mighty protector of states rights, has been studiously and quietly stripping the states of their right to protect their citizens.

In February, the day after his infamous encounter at Washington’s Mayflower Hotel, Eliot Spitzer, then the governor of New York, published a remarkable opinion piece in The Washington Post.

He wrote that several years earlier, state attorneys general noticed a spike in predatory lending that the federal government was doing nothing about. When the states tried to rein in abusive mortgage lenders, the Bush administration finally did something. The Office of the Comptroller of the Currency issued rules nullifying state predatory lending laws over the objection of all 50 state banking superintendents.

The clampdown, which paved the way for the subprime mortgage crisis, was done by “pre-emption,” a little-understood doctrine that allows the federal government to wipe away state laws. The Constitution’s supremacy clause says federal law can trump state law. But the federal rule should be a floor, not a ceiling. It should set a minimum level of rights, not stop states from doing more to protect their citizens.

That's just one of 50 examples in an Associated Press report that also includes safety rules for chemical plants, head restraints in autos, abusive Medicare marketing, and curbing greenhouse gases.

One would assume the current makeup of the Supreme Court backs these new rules. That's a Supreme Court John McCain has said he'd strengthen.

Time predicts healthcare reform

Last week's Time Magazine's cover story was on the economic mess that the next president will need to clean up. The piece ends with a couple paragraphs on healthcare:

Then there's health care, which has become perhaps the biggest source of financial worry and occasional disaster among middle-class Americans. A 2005 study found that half of all personal bankruptcies in the U.S. were attributable at least in part to medical costs.

But there's real hope on this front. It is possible to conceive of a system that brings the 47 million uninsured into the fold, improves medical outcomes and costs less than what we've got now. It's possible to conceive of because many other wealthy countries already have such systems. Figuring out exactly how to make universal health care work in the U.S. is a matter better left to its own lengthy magazine article. But if you're looking for big economic change from the next Administration, this is the form it's most likely to take.

I find that comforting. It means that mainstream journalists, who aren't likely to be single-payer advocates but who are likely to be better read than the average American (not all, but it is part of the job) now get it. This writer, in any case, knows that the data is there. Other countries have shown that healthcare investment can be managed far better than we've accomplished.

There is a real chance that we'll see change in the next five years - perhaps not true universal healthcare via single-payer, but surely steps in that direction.

McCain's startling proposal

Some overworked and underpaid editor at something called "Newsoxy.com" managed to get nearly everything wrong in providing a synopsis of a well-written piece there. He or she wrote:

John McCain wants to bring healthcare costs under control by actively allowing companies to compete around the world.

While I wouldn't put it past McCain to suggest that U.S. companies be "actively allowed" to compete around the world (huh?), a read of the story reveals that this poor editor garbled the last paragraph here:

Other rich similar industrial nations that offer universal care spend only 11 to 12 percent of their gross domestic product on healthcare. Canada spends even less, a bit more than 9 percent of GDP, on a single-payer government insurance system for all its people.

Healthcare advocates say an ambitious change in the United States healthcare system has become an economic necessity, not just a social desire to offer the service to all Americans.

Regina Herzlinger, an expert at the Harvard Business School in Cambridge, Mass. says that the business community bears for 55 percent of the nation's total health costs, the government just 45 percent. Moreover, many businesses eventually want to get rid of their health costs altogether.

"Bringing costs under control is the only way," Sen. John Mccain said on his website, "allow our companies to effectively compete around the world."

Unfortunately, McCain thinks the way to get costs under control is via insurance companies competing with less regulation and more tax breaks. That's worked so well already, after all.

State-Based Health Care Reform Act

Talk about a buried lede. Or the mainstream media not paying attention to an important story. The Milwaukee Small Business Times reports that a bipartisan proposal would let states reform health care - "States could use single-payer systems, expansion of current programs, market-based reforms or adopt completely new ideas in their efforts to cover the uninsured."

U.S. Sen. Russ Feingold (D-Wis.) and Sen. Lindsey Graham (R-S.C.) are authors of the State-Based Health Care Reform Act. Sen. Susan Collins (R-Maine) signed on today.

You can read the bill at the Library of Congress's Thomas.

There's a longer article on the bill at Psychiatry Online from October 2007.

S 1169... would establish the Health Care Coverage Task Force to approve grants to states whose proposals mandate minimum requirements in coverage and quality measures and meet cost guidelines. The bill would provide about $40 billion for state matching grants to expand health care coverage, while mandating certain "cost-sharing" limits to keep the coverage affordable for beneficiaries...

Another state-based approach would authorize grants for states to create universal health care pilot programs that could become models for other states and the country. The legislation, sponsored by Sen. Bernie Sanders (I-Vt.) and known as the States' Right to Innovate in Health Care Act of 2007 (S 2031), would authorize five, five-year grants to states committed to developing plans for universal, comprehensive, cost-effective health care. The states would have to provide comprehensive benefits, including coverage for long-term care, diagnostic services, preventive care, prescription drugs, dental and vision services, and mental health treatment including that for substance abuse.

What's PNHP's position on these bills?

Howard Dean on single-payer

Time Magazine offers up 10 Questions for Howard Dean, DNC chair:

As a former physician, what are your thoughts on the Democratic candidates' health-care plans vs. a single-payer system? Megan Prouty CARROLLTON, TEXAS

I think while someday we may end up with a single-payer system, it's clear that we're not going to do it all at once, so I think both candidates' health-care plans are a big step forward. Certainly compared to Senator [John] McCain, who represents a big step backward.