30 May 2007

Obama plays it safe

Obama came out with his healthcare plan yesterday — and it wasn't single-payer.

Counterpunch's Corporate Crime Reporter explained why back in February:
The majority of the American people want a single-payer health care system ­ Medicare for all.

The majority of doctors want it. A good chunk of hospital CEOs want it. But what they want doesn't appear to matter.


Because a single-payer health care plan would mean the death of the private health insurance industry and reduced profits for the pharmaceutical industry.

Presidential candidates John Edwards, Barack Obama, Hillary Clinton, and Mitt Romney and California Governor Arnold Schwarzenegger talk a lot about universal health care.

But not one of them advocates for single-payer ­ because single-payer too directly confronts the big corporate interests profiting off the miserable health care system we are currently saddled with.
Take a look at that entire Counterpunch article, which interviews Dr. Steffie Woolhandler of PNHP.

Back to the present, Edwards estimates his plan would cost $90 billion to $120 billion; Obama figures $50-$65 billion for his. (A nice chunk of protection cash either way for the various powerful insurance families. The Gambinos themselves couldn't have done better.) Obama's plan, like Edwards, includes unspecified employer contributions, cost-saving measures, and specifically coverage for all children. Edwards' plan mandates that individuals have insurance; Obama's doesn't.

Speaking of the families, in particular the bosses, this wouldn't be a complete win. Both Edwards and Obama would pay the insurance families in part by getting rid of some of Bush's tax cuts for the wealthy.

As for the other candidates, Senator Christopher Dodd, who sold out to the insurance industry back in the 1990s, and Governor Bill Richardson also like mandates. Alaska Mike Gravel likes vouchers — which could be single-payer. Sen. Joseph Biden is the most timid. He'd insure children — an increasing number of them orphans and paupers as parents have a harder and harder time covering themselves. Sen. Hillary Clinton also talks a lot about children. She hasn't shown us her cards yet, but she has promised to reduce the power of insurance companies and to computerize medical records — a good start.

Rep. Dennis Kucinich is of course unabashedly for single-payer. He'd pay for it with income and payroll taxes, and a tax on stock and bond transactions.

Kevin Drum doesn't think much of Obama's plan. "Obama's voting record shows him to be, possibly, the most liberal of the three main Democratic candidates. But his record also shows him to be a very cautious liberal. This is not necessarily a bad thing: the time he's spent in the trenches doing community organizing and then as a state legislator seems to have taught him that there are no easy answers; that political coalitions are hard to build; and that real progress often requires a slow but steady approach. He may even be right about that. Certainly I'm no revolutionary myself. Still, sometimes audacity requires audacity. Hope isn't always enough."

Ezra Klein explains the plan, which includes a new regulatory agency called the National health Insurance Exchange — which would both regulate the insurance industry and administer a new public insurance program:
...That's a big deal — one of the real tests of seriousness for the new plans is whether they create a public insurance program, and Obama's does. Unlike Edwards' and Jacob Hacker's plans, he doesn't use Medicare as the basis for the program, but instead creates an entirely new public insurer.

Here's the catch: The Obama plan does not set the public and private plans in competition with each other, as the Edwards plan does. Rather, the best way to think of it is as a two-track plan. The first track extends the new public program to the self-employed, small businesses, and the uninsured. In other words, the public plan is open to those who are currently disadvantaged in the insurance market — it is not a new insurance market unto itself. That said, if it proves popular and effective, it would be trivial to expand it in the future, letting all businesses, or all individuals, buy in.

The second track is a restructured insurance market. Participating insurers ... will have to offer minimum benefits, spend a certain portion of their budget on patient care (rather than profits and advertising), be barred from discriminating on health history, and be forced to justify large premium increases. Employers will have to either pay into this market, or pay into the national plan.

...The Obama campaign's decision to omit a mandate is a puzzling one, both from a policy perspective -- you want the largest possible risk pool -- and a political one. His plan, unlike others, is not truly universal, it's simply possibly universal.
RJ Eskow predictably puts down criticism of incremental plans that funnel tax money to the private insurance market:
Rose Ann De Moro, for example, has done terrific work as leader of the California Nurses Association. But she drips with contempt for anything less than immediate single-payer reform. Barack Obama is "rearranging deck chairs on the Titanic," she writes. Really? Someone who receives coverage for the first time under the Obama plan, or who gets better care, might feel more like they'd been rescued from a shipwreck. The John Edwards plan, which forces private insurers to compete with a public program, would lead inevitably to single payer unless private insurers could offer something else that some part of the public might want. Nevertheless, to Ms. De Moro the Edwards plan is a "soggy mix and match."

"Edwards does deserve some credit for proposing that at least one plan in each health market be a public program based on Medicare," she writes. "But, if a public program, as he implies, is more likely to assure affordable alternatives to the private insurance model, why get off in Chicago when your plane is going to New York?" Here's why: If the plane doesn't have enough fuel to get to New York, you stop off in Chicago. If some passengers want to get off there, that's fine too. But Ms. De Moro, like other single-payer absolutists, gives this aspect of the Edwards plan only a passing glance before dismissing him by saying he "should go back to being a populist."
Eskow claims he'd switch our system in a heartbeat for Britain's — but, since that won't work, he's for the incremental steps. Which is a bit of a self-fulfilling prophesy...

MSNBC rounds up of mainstream coverage of Obama's announcement. Here is the quote there from the LAT: "Like the other top Democratic presidential contenders, he rejects the left's growing support for a government-run, single-payer healthcare system. Instead, he proposes to reinforce the existing system, under which the vast majority of Americans receive coverage either through their employers or through government programs such as Medicare and Medicaid."

24 May 2007

Rationing care

I heard a story yesterday that renews my belief that so many Americans have been affected by the slow-motion disaster of our current healthcare system that we will be able to change it.

I was at the Denver Conference on Homelessness, handing out brochures and talking with people about single-payer financed healthcare. I was with a sharp, intelligent and lively Health Care for All Colorado volunteer, Ruth Gilbert. It was Ruth's 84th birthday.

We heard about homelessness from the people with whom we shared a lunch table, and we told them about the need for universal healthcare. As if they didn't know.

One of the women at the table had lived in Britain for a time. She spoke with awe and respect for their system.

Another women at the table then spoke up. She said her 30-year-old daughter had been diagnosed with Hodgkins Disease — cancer that starts in the lymphatic tissue. The ill daughter missed a lot of work during the course of her treatment and lost her job.

When the daughter lost her job, she lost her insurance. And here her mother stumbled a bit in the telling — her family had been under a lot of stress with the illness, and they hadn't managed to do what, perhaps, might have been done so that the ill woman's coverage could have continued. Perhaps.

So should that be a death sentence? Add into your consideration the fact that the daughter has three children. She completed her chemo, but not her radiation.

We are the wealthiest country in the world. Should this woman's children be motherless because their mother cannot pay for cancer treatment? Should scrambling for a way to pay for treatment, should the humiliation of losing her job and not being able to pay, should potential bankruptcy — hell, potential homelessness — be a part of her reality now? How might that stress be affecting her chances for survival?

How is depending on charity in a situation like this, rather than according this woman and her family the dignity of healthcare justice, a conservative or American value?

Bag fulla baby

Morality: Two or Five Foundations?

I just linked from Onegoodmove.org to this New Yorker clip with cultural psychologist Jonathan Haidt talking about the difference between conservative and liberal moralities.

Not only is Haidt nice to watch — funny, entertaining, smart (oh, and handsome) — he's got some great insights here that explain some things that I became aware of while working for the Catholic Church. Haidt describes how liberals have primarily a two-foundational morality based on protecting the weak from harm and on fairness. Both of those values are intrinsic to a social species with vulnerable young and nursing mothers, and which has reciprocal social interactions that are damaged by cheating.

Those moralities are our American, Enlightenment values, and reflect the definition of morality that psychologists go by and that of a tolerant, diverse society.

However, traditional societies, as exemplified by Islamic society and fundamentalist, conservative and rural societies, have five foundations to their morality that liberals miss out on. Their additional moral foundations are based on:
• in-group thinking, that is, loyalty;
• authority, that is, respect; and
• purity, that is, temperance.

Haidt refers to studies that show religious and conservative people to be happier, and he explains that like this: "As society gets more modern and more free, the depression rate goes up and people get lost… if you simply measure how happy people are... conservatives are happier... and a lot of the reason for this is because conservatives participate in denser, more binding social structures. We think we want freedom but if you get freedom beyond a certain point it’s actually bad for you..."

Talking about the three Democratic candidates, Haidt says that Ds have spent way too long thinking that people will vote for the person with the best policies. He cites Malcolm Gladwell's book Blink, on rapid cognition — which happens in the blink of an eye, and how a lot of choices that we liberals believe we should be thinking through actually happen on that basis.

Haidt judges that Hillary isn't a natural at speaking to people in a way that inspires awe and makes people feel elevated — although she's getting better. He sees Edwards and Obama as naturals, with Edwards operating from that liberal, two-foundation morality and Obama able to also reach the five-foundation crowd.

The entire talk lasts a while but is completely worth the time.

Haidt left out the odd libertarian version of conservatism, which pretty much leaves out kindness, fairness, authority, and temperance, and leaves only in-group, with the in-group being basically just that one person or family and Ayn Rand — and she's dead.

He offered this analysis so liberals could understand where conservatives are coming from — in particular on gay rights and abortion. It also explains a lot about the Iraq war (authority and in-group values). It does not explain, however, the deadly American distrust of government that has played into the hands of those who have for so long successfully denied Americans the universal healthcare that is a right of citizenship in every other industrialized nation on earth.

At least we've got universal primary and secondary education. Keeps the kids off the streets.

21 May 2007

Sicko at Cannes and HCAC on KRFC

Tomorrow night's "Imagine Action" program, 6 - 7 p.m. on Fort Collin’s KRFC (88.9 FM or online here), will focus on health care reform. Guests will be Health Care for All Colorado and Physicians for a National Health Program member Dr. Cory Carroll, a local family practitioner and president of the Larimer County Medical Society; Rudy Deutschmann, president of the State Association of Health Underwriters; and HCAC board member Eliza Carney, who will discuss the 208 Commission and the political process around health care reform.

The call-in number is 970-221-5065.

In more international single-payer news, take a look at Salon’s feature article on Michael Moore’s new film Sicko. It will do your heart good.

Author Andrew O’Hehir writes that Sicko is

both a more finely calibrated film and one with more far-reaching consequences than any he's made before. Moore is trying to rouse Americans to action on an issue most of us agree about, at least superficially. You may know people who will still defend the Iraq war (although they're less and less eager to talk about it). But who do you know who will defend the current method of healthcare delivery, administered by insurance companies whose central task is to minimize cost and maximize shareholder return? Americans of many different political stripes would probably share Moore's conclusions at the press conference: ‘It's wrong and it's immoral. We have to take the profit motive out of healthcare. It's as simple as that.’

Sicko purposefully does not focus on the 50 million or so Americans who don't have health insurance, as scandalous as that is, but on the horror stories of middle-class working folks who believed they were adequately covered. There are so many of these they begin to blur into each other: the woman in Los Angeles whose baby was denied treatment at an emergency room outside her HMO network, and died as it was being transferred hours later; the woman in Kansas City whose husband was repeatedly denied various drugs his physician prescribed for kidney cancer, and who in the last stage of life was denied a bone-marrow transplant that could have saved his life; the woman who was told her brain tumor was not a life-threatening illness, and died; the woman who was told her cancer must have been a preexisting condition, and died.

If the Salon article whetted your appetite for more reviews, here’s one from The Guardian:
His question: what has happened to the idea of universal healthcare in the United States?

In four tidy acts, Michael Moore spells out the facts. Act one: 50 million Americans have no health cover, and 250 million who think they do, through costly health insurance schemes ($2,000 per person a year), are often denied treatment when they need it….

Act two: when did it all start going wrong, asks Moore. The answer: in August 1971. President Richard Nixon and his adviser Edgar Kaiser plot to break the system. "The less care they give, the more money they make," says Nixon, caught on tape….

Meanwhile astute national publicity campaigns have demonised the concept of universal healthcare by associating it with "socialised medicine", which in American English translates as "Soviet medicine" - the kind such oppressive regimes as Canada, Britain and France have adopted for their citizens….

Act three: Moore pays these regimes a visit….

Act four, the most powerful: Moore decides to test the US administration's claim that Guantánamo Bay prisoners get the best free healthcare in the world. He takes 9/11 volunteer rescue workers, whose health problems were not covered by the state because they weren't on its payroll when they ran to help, to Guantánamo Bay in Cuba….

And lastly, the news, also in The Guardian, that the U.S. government is trying to impound Moore's film – a claim that’s hard to dismiss considering everything else in our country’s recent past. “Now, according to movie mogul Harvey Weinstein, whose Weinstein Company is behind the film, the US government is attempting to impound the negative.”

The pretext would be Cuba. Moore had applied for permission to travel there but received no reply until this month, when “the treasury department notified Moore that it was investigating him for unlicensed travel to Cuba.

Watch a trailer for Sicko and more on Moore's website.

19 May 2007

HCAC makes the final cut!

The Health Care for All Colorado proposal to the Blue Ribbon Commission for Health Care Reform made the final cut and will go on to the evaluation firm, Lewin, for analysis. In fact, the proposal was the only proposal in yesterday’s discussion that seemed to have a clear mandate to go in – all the others were batted back and forth, some of them because they were so similar to one another that they didn’t offer clear enough differences for separate evaluation, others because of questions about their merits.

Here is a round-up of the four plans that will be evaluated, with their numbers. The plans names are similar, and although it would have been just as easy to refer to them by the submitting entity, i.e., HCAC’s plan, SEIU's plan, or the underwriters’ plan, commissioners were referring to them by number.

HCAC’s proposal (#16) the Colorado Health Services Plan, was submitted in coalition with the Colorado Nurses Association, the Older Women’s League, and the Physicians for a National Health Program. Rep. John Conyers is in favor of state efforts like ours, and we expect that he will endorse the proposal as well.

The proposal is a single payer, publicly financed program that covers all primary, preventive, specialty, surgical care, automobile and work-related injuries, prescription drugs, mental health services, chiropractic, dental, basic vision, audiology, home health, long-term care, and hospice services, among others. Under this program, all providers and hospitals would be paid the same for the same level of service, thus competing by the quality of care provided. Through it, every resident has equal access to program benefits. There is no opt-out provision.

It calls for a statewide, fully integrated information technology network to track outcomes, utilization and expenditures. Colorado Health Services would be a non-profit government “insurance company," administered and governed as a public utility with five districts.

The other proposals to be evaluated are those submitted by the Committee for Colorado Health Care Solutions, the Service Employees International Union, and the Health Insurance Underwriters.

A Plan for Covering Colorado (#12), submitted by the Committee for Colorado Health Care Solutions, requires all Coloradans to have health insurance. A fee would be assessed through income tax filing that would cover the uninsured. Employers would pay a portion of the employees' health insurance or an assessment to the state. This plan would create a single purchasing pool that could negotiate rates and plans, and which would have guaranteed issue and community rating. The plan would create the Colorado Health Insurance Purchasing Authority, which will define benefit packages. The standard set of benefits would be based on effectiveness and cost. The authority will also decide guidelines for performance of providers and determine the amounts paid to the providers.

Better Health Care for Colorado (#2), proposed by Service Employees International Union, provides premium assistance for purchasing private coverage. It would provide Medicaid-funded insurance subsidies for those under 300 percent of the Federal Poverty Level (FPL). Those subsidies would cover all of the premium’s cost for those at 100 percent of the FPL; with pro-rated subsidies for those up to 200 percent of poverty to ensure that they don’t spend more than 5 percent of their income on premiums. It would provide a basic benefit package (with annual benefits capped at $25,000 to $50,000) with no deductible through a pool. The plan would also allow individuals to use the subsidy for employer-sponsored insurance. This plan would also reform Medicaid by implementing pay-for-performance for Medicaid hospitals and Medicaid long-term care facilities and other methods.

Solutions for a Healthy Colorado (#5), submitted by the Colorado State Association of Health Underwriters, requires all Coloradans to have health insurance in a reformed market that would include guarantee issue product in the individual market. It would also require guarantee issue of a core benefit plan in the individual market that would include a “Core Limited Benefit Plan” that all carriers would be required to offer with guaranteed issue and with modified community rating. The government would subsidize purchase of the limited benefit plan for those up to 250 percent of the FPL. All provider reimbursements would be tied to one common basis, adjusted for performance on quality benchmarks.

Thursday's 208 Commission discussions

For those interested in a glimpse of what the commission’s discussion looks like, here’s a snapshot from Thursday’s discussion of Health Care for All Colorado's single-payer proposal.

Commissioner Mark Wallace, a physician from Greeley who may be closest to being a single-payer proponent on the commission, said that the Colorado Health Services (CHS) Program was a bold proposal, and he liked that. "Rocky is always bold," he said.

He was referring to Rocky White, MD, the Western Slope physician who wrote the proposal. The general agreement and laughter at that from around the table left me feeling as though Rocky was a rather mythic figure, something out of a movie about the Old West.

Mark Simon of the Cross Disability Coalition said that the proposal was unique in that it actually reforms the insurance industry (actually, it does away with it). He criticized the proposal’s claim that Medicare works well, when in fact he says it does not work well for his community. He very much liked the fact that the proposal addressed long-term care. However, he had a question about a 25 percent increase in home and community-based care, finding the following unclear:

Full long-term care will be incorporated over time, with consideration for the increased demand that will occur upon its initial inclusion. In the first year there will be allowance for a 25% increase in home and community-based care (in addition to any savings from institutional care and anticipated savings from consolidation of all current programs for LTC, including 80 federal programs). Long-term care will be financed by CHS, with the exception of ‘room and board’ payments by patients who are not low-income requiring institutional care.

“Increase from what?” Simon asked. He also had concerns about hospitals getting the same payment for everything. What about specialty hospitals, like Craig? They would need more, he thinks.

Bill Lindsay, the commission's chair and president of the Benefits Group, Lockton Companies of Colorado, Inc.
, said that the fact that providers would be reimbursed at the same rate everywhere was both good and bad in his mind. He would like to see some element of quality also being a contributing factor for reimbursement.

Sarah Schulte, the commission's technical advisor, liked the fact that the CHS plan offered two financing mechanisms, especially since most of the other plans had not addressed financing at all.

On that issue, Lindsay had earlier said that he liked the fact that another plan had proposed its own revenue stream that would be insulated from the legislature. Then he realized he was remembering a point from the HCAC plan, not from the one being discussed. (The commissioners — all of them people with jobs — frequently mixed up proposals, something that was completely understandable considering they'd been deluged with thousands of pages of dry descriptions.)

Regarding funding, Lisa Esgar, senior director of operations & finance, State Department of Health Care 
Policy & Financing, reminded the commission that there's really no such thing as an insulated fund. All it takes is another vote and the monies are no longer separate. She also worried about hospitals around the state receiving the same funding, as their costs are different, she said.

Elisabeth Arenales, director of the Colorado Center on Law & Policy, liked that the program has a reduction in premiums based on healthy lifestyles.

Dan Stenersen, president and CEO of Shalom Park a long-term care provider, also spoke favorably about the proposal. He said it's well articulated and does a wonderful job of expressing "what we've talked about for the last few months."

There was concern that there was a lack of accountability.

One of the new commissioners, Lynn Westberg, director of the San Juan Basin Health Department, liked that the plan hit the idea of "sin taxes," also that it dealt with the idea of workman's comp.

(Although earlier in the day, in regard to another proposal, there seemed to be general agreement over how bad Pinnacol, Colorado's privatized workers comp, was.)

Westberg said she'd like to see the HCAC plan modeled.

Discussions of other plans included Allan Jensen, an independent life insurance broker warning that Propsal #10, from the Colorado Coalition for the Medically Underserved, could drive away business by requiring employers who do not provide insurance to their employees to pay a fee. For this plan and several others, commissioners wondered what the enforcement would be that required people to buy insurance, especially with guarantee issue. "If it's guarantee issue, why buy it [before you get sick]?"

David Downs, president, Colorado Medical Society, said that plan's requirement was enforced through default enrollment into a public program. They liked that public health and environmental concerns were folded into this plan.

For Plan #11, a Community of Caring, Barbara Yondorf, senior program officer, Rose Community Foundation, said, only partly tongue in cheek, that she loved its language, and whatever plan the commission chose, she wanted to use its language – like "community of caring," and "safety-net stabilization." Commissioners also liked how the plan called for a paradigm shift on how Coloradans view health care; there was a problem with portability with this plan; no mention of long-term care; David Rivera, former state commissioner of insurance, likes the big risk pool here; Lindsay likes strong prevention and patient education. Someone described this proposal as a private sector single-payer plan. The plan generated Tabor questions for Lisa Esgar; in fact, she said, they needed to discuss Tabor in relation to all the plans. Allan Jensen worried about the plan putting insurance companies out of business -- although, he said, that might not be all bad. Bill Lindsay said it had similar concepts to the pool purchasing models of the '90s, the Federal Employee Health Benefit program, which worked well some places.

Yondorf's comment on language prompted Dr. Wallace to praise another proposal for its use of the word, "eschew."

A couple of commissioners said that proposal #12 was their favorite -- a Plan for Covering Coloradans. They liked its purchasing pool concept; its emphasis on quality and information technology. Lindsay wondered about the two-year phase in. Simon said it doesn't address long-term care. Peg Burnette, chief financial officer for the Denver Health and Hospital Authority, one of the new commissioners, said it was like single-payer but realistic. Dr. Downs said it addresses the delivery system, which he said was the elephant in the room. Donna Marshall, executive director, Colorado Business Group on Health, likes how it tiers providers by quality, and how well the premium collection process was thought through. Julia Greene of SEIU likes the "connector," the governance board, and the phase-in. Dr. Wallace pointed out that a previous proposal had elements that entered the housing market; this one has elements addressing getting grocery stores into every neighborhood and obesity in the schools. He wondered how realistic that was.

United Healthcare buys Lewin

How is that going to affect their modeling? UHC is a loser in healthcare delivery — will Lewin show that?

13 May 2007

Mother's Day weekend

Sarah and the baby are visiting. Babies are wonderful and exhausting. I have no idea how Sarah manages by herself.

HCAC's take on a Denver hearing

Michele Swenson, an HCAC board member, took notes at the Denver 208 Commission public hearing in Wheatridge, Colo., on Thursday, May 10.

Shamelessly sharing her observations with the world:
There were seven commissioners at the hearing: Carrie Besnette, Bill Lindsey, Arnold Salazar, Julie Greene, Donna Marshall, Joan Weber, and David Downs

Three hours of public comments included a representative of the Colorado Association of Health Underwriters who spoke in favor of mandating individual coverage — without addressing problems of private insurance cost. He mentioned all those people buying ski passes instead of insurance.

The chair of the Progressive 15, a 15-county rural area in northeast Colorado, spoke to the lack of providers and affordable insurance. He mentioned all those people buying food instead of insurance.

Many spoke of the need for primary preventive care. One doctor said primary care is undercapitalized in the United States: Inadequate reimbursement keeps down the numbers of primary care providers.

Bill Sample of the Balanced Choice group (a proposer group whose proposal has been eliminated by the commission) said the Balanced Choice plan had been miscategorized. It serves as a transition plan to single payer, he said. He hoped that the commission would revisit aspects of the plan that they had set aside for reconsideration.

Nathan Wilkes, another single-payer proposer, spoke about his struggle to retain insurance for his family after his son was born three years ago with hemophilia. Wilkes also submitted a single payer proposal that the commission has set aside.

Health Care for All Colorado members testified persuasively. Board member Howie Wolf, M.D., emphasized that insurance does not equal access; that sustainability is vital, and that high deductibles prohibit primary care. The Massachusetts plan is failing, he said, as shown by their falling rates of primary care and immunization. George Swan, a retired hospital administrator, spoke about the thousands of insurance plans, of value streaming, and eliminating the inefficiency of high overhead costs. Brenda VonStar, RN, also spoke about her experience as a provider to underserved populations who can't get needed care. HCAC board member John Valvano told the commission about Tommy Douglas, who brought single-payer-financed, universal healthcare to Canada. A poll recently found him to be the most admired Canadian of the last century. John said we needed to maximize health care dollars and cut unnecessary administrative costs. Health care access should reflect society's values.

Norin Elfton, Dave Bean, Bob Carlston, and Shelly Cohen also gave effective commentaries. Commissioner Donna Marshall asked Dave Bean for a copy of his comments. Dave described our current system as being adversarial. He emphasized that we don't want to have electronic medical records before we have universal access to health care: Otherwise all knowledge shared with insurers will be used against us.

I asked Donna if she was aware that victims of domestic violence have been unable to obtain any kind of insurance.

Barry Keene emailed his comments, asking the commissioners to use the criteria that they had come up with at the expense of so much time. Barry noted that they didn't use that criteria in their first elimination round of proposals.

My emailed comments noted the importance of a health care system of sustainability, with its other implied elements of access to primary preventive health care, controlling inflationary administrative costs and the current practice of cost-shifting. I suggested that the principle of "common good" is vital, because nothing other than true systemic health care reform could so quickly improve the quality of life for everyone, while improving the U.S. economy and freeing people to realize their true creativity.
I turned in my comments at the hearing — calling for quality, universal access, and cost-effectiveness that could ensure sustainability. Single-payer, in other words.

With just a couple exceptions, people seemed to either call for single-payer or call for options that only single-payer is capable of providing.

I'd put the mental healthcare advocates in that category. There were quite a few people speaking to the shameful lack of mental healthcare in this country. We jail people instead of caring for their mental health needs. Now there's a cost-effective plan.

A physician who taught comparative health systems at CU's med school was a disappointment. He told the commissioners that he'd heard people say they wanted everything for everybody — quality and convenience for all — and that was impossible. Therefore, the commissioners were going to have to be courageous in saying that we couldn't have it all. He said that the people of Colorado would also have to be courageous and understand that we can't have it all.

After all, who do Coloradans think they are — French? Canadian? German? Swiss? Israeli? British? Norwegian? Swedish? Belgian? Dutch?

Silly Coloradans. Universal healthcare is only for every other industrialized country in the world. Those people can make it work. We can't.

Do you believe that?

Don McCanne's quote of the day

Don McCanne, former president of Physicians for a National Health Program, has a list he calls the healthcare quote of the day.

A couple people forwarded this one to me. In it, Don has cited a new CNN poll (pdf) with this question:

30. Do you think the government should provide a national health
insurance program for all Americans, even if this would require
higher taxes?

64% - Yes
35% - No
2% - No opinion

Don doesn't just leave his readers with one item to think about — he also quotes Catholic Healthcare West's study on Health Security in America (May 9, 2007, also a pdf), in which respondents said:

The time has come for universal healthcare in America. (72%)

We need universal healthcare in America, even if it means
increasing taxes. (63%)

Don writes, "If these poll numbers were cast at the ballot box, this
would constitute a clear mandate from the American public. So why do
we keep hearing that national health insurance is not politically

The answer may be because those poll numbers have been the same for decades. They fall pretty easily, with just a few million dollars worth of well-planned propaganda. Americans are easily scared. Politicians know it.

11 May 2007

208 Commission picks 11 plans

On Monday, The Colorado Blue Ribbon Commission for Health Care Reform culled their 28 proposals down to ten — wait... make that eleven.

1) Better Health Care for CO - SEIU
2) Solutions for a Healthy Colorado - CO State Association of Health Underwriters
3) A Phased Approach to Achieving Universal Health Coverage in Colorado - Kaiser Permanente
4) Comprehensive Health Care Plan for CO - Club 20
5) An Individual Based Insurance System Combining Free Market Principles with an Appropriate Role for Government - South Metro Denver Chamber of Commerce
6) Connecting Care and Health for Colorado - CCHI
7) Community of Caring – Colorado Community health Network
8) A Plan for Covering Coloradans - Committee for Colorado Health Care Solutions (Barbara Yondorf is very fond of this plan)
9) Healthy CO Now - CCMU
10) CO Health Services Program – HCAC
11) FAIR — Brian Schwartz

Number eleven, a libertarian free-market plan submitted by Brian Schwartz only received two votes out of more than 150 possible (each commissioner present — 22 or so — could vote on seven proposals). For the most part, only plans that received 10 or more votes were passed. However, libertarian commissioner Linda Gorman said there was no need for her to return if it weren’t chosen and so it became the 11th proposal to remain.

There was almost no public comment during this meeting, and thus commissioners’ remarks, some of which mixed up proposals or included misinformation, went unchallenged.

Commissioners spent a lot of time comparing the single payer proposals, as most agreed that one of them should be chosen for evaluation. The six pure single-payer proposals together garnered 22 votes — 26 if Balanced Choice is counted. That meant that the single-payer type of reform got more votes than any other single category other than one. The commissioners said that proposals 16, 17, and 18 were very similar. (Those were from Health Care for All Colorado; Stuart Zisman, a professor at the University of Northern Colorado; and Nathan Wilkes, whose 3-year-old son's hemophilia has meant that the Wilkes not only have to gather their strength to best care for the physical needs of their son, but that they also must frantically scramble — every year — to keep insurance. I can't imagine the stress.)

During the single-payer discussion, Linda Gorman opined that there are two kinds of single payer, one with no private market competition, as in Canada, she said, and the NHS model, as in Great Britain. She differentiated between Wilkes’ and HCAC’s plan, saying that Wilkes’ plan was more like the Canadian model with "no competition."

Regarding HCAC's plan, she said it is problematic to limit spending to the growth in GDP.

Commissioner Alan Jensen, a health insurance underwriter, remarked that Wilkes' proposal, like the Canadian model, takes away the ability to choose providers. (These remarks obviously indicate misunderstanding about single payer and the Canadian system.)

Sarah Schulte, the commission's technical advisor, noted that HCAC's plan had no copays, whereas the Zisman plan did.

Commissioners liked another single- payer plan's focus on promoting wellness. (That plan being from retired CU professor Edwin McConkey.)

Another commissioner stated that HCAC's plan has more explicit benefits (that can be redefined) and a stronger program of reimbursement based on providers' quality of care.

Commissioner Mark Simon commented that he likes the HCAC plan except for the lack of consumer oversight of the program. He did not like the political appointment of the governing board.

Commissioner Elisabeth Arenales suggested that the HCAC plan would be the right single-payer plan to go with because of the group’s strong organization and support.

Commissioner Arnold Salazar said that consideration would make him vote against the HCAC plan.

Arenales countered that the commission was hoping to get a plan through the legislature, and that strong organizational support, such as that provided by HCAC, would help make that happen.

Commissioners decided to go with the HCAC plan as their single-payer model chosen even though commissioners liked many of the points in other single-payer plans.

Although the commissioners did not categorize the Balanced Choice plan as being a single-payer, they liked its rich benefits package and specification of itemized bills to patients to control fraud. Simon spoke to the risk of a two-tiered system of health care; he also praised it as the only plan that addressed non-residents.

Sarah Schulte, the technical advisor, rated a single-payer plan submitted by PULSE highest of all 28 plans.

Of the nine plans that Schulte scored as having at least two “high”s and no “low”s, five were single-payer plans: those submitted by HCAC, PULSE, Edwin McConkey, Nathan Wilkes, and Stuart Zisman.

The other four plans that scored high were those from Kaiser, the South Metro Chamber of Commerce, the Colorado Community Health Network, and the Committee for Colorado Health Care Solutions.

When commissioners voted on the plans, the results were far different.

HCAC’s plan and Stuart Zisman’s plan each got six votes; Nathan Wilkes’ plan and the Balanced Choice plans received four votes each, and Edwin McConkey’s plan received three votes.

Although the PULSE plan received only two votes, the commissioners were reluctant to take it off the table because of its innovative methods, specifically, the idea of a health care team of physician, nurse, social worker, and ombudsman. One commissioner remarked that PULSE was the only plan limiting administrative costs.

High vote getters (from 10 to 14 votes each) included the four non-single-payer plans that Schulte rated high, but also plans from SEIU (the Service Employees International Union), Club 20 (a conservative business group from Western Colorado), Colorado Consumer Health Initiative, and the Colorado Coalition for the Medically Underserved.

Several commissioners said that core benefit of the Insurance Underwriters' proposal was inadequate (capped at $50,000 a year, which Simon said was sure to create more uninsured). Commissioner Jensen, who has been chair of the underwriters, said at an earlier commission meeting that there is no need for comprehensive reform; one or two changes would reform health care. This proposal received seven votes.

05 May 2007

Healthcare plans in Rocky Mntn News

The Rocky Mountain News' editorial pages has been against single-payer financed healthcare. The News is generally considered the more conservative of Denver's two dailies — but also the paper that does more and better local reporting. It's doing good journalism in following Colorado's 208 Commission.

The 208 Commission, otherwise known as Colorado's Blue Ribbon Commission for Health Care Reform, was created by the Colorado legislature to advise the legislature on the best course forward in comprehensively reforming Colorado's healthcare system.

The commission put out a request for proposals for comprehensive reform, and they received 28, including one from Dr. Rocky White, a board member of Health Care for All Colorado. HCAC has endorsed that proposal, as has the Colorado Nurses Association.

The Rocky Mountain News ran summaries of four of the proposals in today's paper:
Club 20's,
HCAC's, and
the South Denver Metro Chamber of Commerce's.

My name appeared with the HCAC summary — fair enough, since I did write it, but I was fortunate to get a lot more editing help than I'm used to. From that description:
Everyone would be covered and be funded through individual and business contributions and federal tax dollars. The plan would offer better benefits, including mental health, dental, optical, home-health and long-term care, than any single private plan does today. Each resident would choose a health-care provider and choose a hospital.

Providers would stay in private practice and compete for business, but all payments would come out of a single health fund. Everyone (except for the very poorest Coloradans) would contribute to the fund. No one would need to fear bankruptcy because of health-care costs.

Colorado Health Services would basically be a publicly owned, not-for-profit insurance company, similar to a public utility. A board, accountable to the people, would manage the program. Administration would be under five regional boards.

Colorado Health Services would reduce administrative costs since everyone would be covered by the same comprehensive plan. Physicians and patients could make health-care decisions based on patient need and not insurance company policy. Doctors, hospitals and nurses would no longer need extra staff to negotiate billing with hundreds of companies and thousands of policies. The program would provide for retraining displaced workers.

03 May 2007

Understanding healthcare financing

I've been waking up mornings thinking about this powerpoint slide from AMSA. Except I didn't remember it was from AMSA — the American Medical Student Association, a strong supporter of single-payer.

Check out their powerpoint presentation page, and click on "Overview of the U.S. Healthcare System" for the powerpoint source for this slide -- and it's far better seen that way.

Note the arrow that goes to individuals/businesses from the government — that's the $100 billion in tax subsidies for employer-based insurance. Employees, through those subsidies, receive health benefits as a tax-free compensation, and employers can deduct the cost of the benefits because they're a cost of doing business.

Also note the government payments to private insurers — for the health benefits of millions of public employees and their families. The subsidies and the payments to private insurers are two elements of government funding that often get left out of people's conception of what the government pays for.

Now see how easy it would be to just eliminate the "private insurers" element of the diagram. Just erase it — so that the arrow coming from individuals/businesses went to the government instead. Much simpler diagram, eh?

That's what single-payer would look like.

Panexa: Ask your doctor

This is at least a year old, but if you haven't seen it, who cares?

It's at Panexa.

More MRIs? Who's paying?

Dr. John Daley in New Hampshire writes a rebuttal to an anti-single-payer editorial:
In New Hampshire, approximately 135,000 citizens lack health insurance, and for those who have it many can't get all they need. The MRI wait may not be long, but many people can't see their doctor, much less get an MRI. Now with health savings accounts and high deductible plans I have insured patients refusing their MRIs due to the cost.