28 December 2007

ERISA Strikes in California

A federal judge on Wednesday ruled against San Francisco's brave program to guarantee health care to all.

Merry Christmas.
At issue is the federal Employee Retirement Income Security Act [ERISA] that White concluded in his ruling prohibits the city from regulating employee benefits.

Frank Furtek, chief counsel for the state's Health and Human Services Agency, said his office is studying the ruling and was not ready to comment on its import to the state's health care program. He added, however, that he believed the ruling was overly broad.
It sounds as though Gov. Schwarzenegger's staff is now working on figuring out how to keep that ruling from being applied to AB1X, a healthcare bill that's been worked out between the governor and the Democratic leadership.

The bill is based on the hope that once everyone has access to a doctor and preventive care, the cost of care will go down. All employers will provide insurance for their workers or else pay a tax of 1 percent to 6.5 percent, based on payroll. That's the part that "may provide biggest obstacle to passage in light of White's ruling, which San Francisco intends to appeal."
But there are other issues that could spell trouble for the bill in a hearing set for Jan. 16 before the Senate's health committee, which is chaired by Sen. Sheila Kuehl, D-Santa Monica, a longtime advocate of a single-payer health system that would eliminate private insurance.

Kuehl pointed out that AB1X provides a cap on how much employers would be required to pay into the state purchasing pool. But there's no similar protection included for worker costs in co-pays and deductibles.

She said there's no clear protection that the kinds of policies that employers could offer in the state pool would provide good medical coverage.
ERISA was intended to protect people, not insurance companies. It is, however, always invoked by those who are against health care reform. There's a good round-up of its incomprehensible provisions at the National Academy for State Health Policy. The policy brief there (on the Maryland ruling against that state forcing Walmart to insure its employees) says that a universal health reform that didn't target one particular business would be less likely to trigger a successful ERISA suit. Evidently Judge White saw it differently. Here's the skinny from the NASHP:
Congress enacted ERISA (the Employee Retirement Income Security Act of 1974) to establish uniform federal standards to protect private employee pension plans from fraud and mismanagement. But the federal statute also covers most other types of employee benefits plans, including health plans, and has a potential negative impact on state health care legislation, including health insurance regulation.

Several of ERISA's provisions preempt state laws and complicate state efforts to make health care coverage more broadly available. Among the state approaches that raise ERISA preemption issues: employer mandates, individual mandates, government-operated programs, and state approaches to finance health care for uninsured perople with low incomes or medical conditions that make them uninsurable.
Another resource: There's a discussion of federal and state reform proposals at the International Foundation of Employee Benefit Plans.

New AP Poll: 54 Percent of Americans for Single-Payer

This isn't going to get a lot of play unless we push it. So let's push: According to the AP, 54 percent of Americans favor single-payer. Wow. That looks pretty close to a tipping point to me. Here are some of the points:

  • Nearly two-thirds of voters polled said the United States should adopt a universal health insurance program "in which everyone is covered under a program like Medicare that is run by the government and financed by taxpayers"
  • 54 percent said they supported a single-payer system whereby all Americans would get their health insurance through a taxpayer-financed government plan
  • Six out of 10 said they believe it is at least somewhat likely that the U.S. economy will enter a recession next year
  • 64 percent are worried about a major unexpected medical expense
  • Only 37 percent say immigration is "an extremely important issue"

Stopping Reform: Public Thoughts

CNN Money has a piece with advice for health insurance companies and Pharma on what to do about all the talk of health reform. I'm wondering who the target readership is — perhaps mid-level management types?

Hard to say.

The advice boils down to this: Not to worry. Act reasonable, then after the elections lobby as usual.

In a December report called "Beyond the Sound Bite," PricewaterhouseCoopers compared the health-related policies of seven major presidential candidates: ... Democrats Hillary Clinton, Barack Obama and John Edwards and Republicans Rudy Giuliani, Mitt Romney, John McCain and Fred Thompson. ...

The Democrats propose "broader and more immediate changes, with new mandates, programs and funding."

The Republicans want no new government programs, preferring "indirect approaches such as changes in tax incentives that could move insurance away from an employer-based model."

PWC boiled down the issues to these: covering the growing uninsured population, changing tax rules to support health system changes, controlling health costs, and improving quality of care....

[None of the] candidates propose a single-payer system along Canadian lines. All seven candidates tend to rely on expansion of the existing private insurance market.

But the report notes, "The Democrats say they would also create new public programs to offer more choice and compete with private insurers."
The PWC expert advised the insurance companies needed to devise a strategy to compete with the government, if Clinton's or Edward's plan goes through.
Even if the Democrats don't hold the Congress and/or take the White House, Republicans can't be expected to maintain the status quo, says John E. Calfee, a scholar at the American Enterprise Institute ...

That's because the momentum to do something to bring the 47 million uninsured into the system is too strong.

"You know there's going to be heavy action on the Hill over this even if the Democrats don't win," Calfee said.

He suggests that the insurance industry attack head-on the question of its efficiency. Some analysts put the cost of bureaucracy and paperwork at 30% of the $2.1 trillion (in 2006) spent on health care in the U.S.
As for Pharma, a USC professor of pharmaceutical economics says he expects that Medicare Part D will change, and receive the ability to negotiate drug prices. That could hold down prices and bring greater transparency to the market — a worrisome scenario for Pharma stockholders, no doubt.

The good professor's advice: "appear cooperative and happy to get along with a new regime. Then, after the election, lobby vigorously in Congress, as usual."

Hospitals & Fire Departments

Mark Harris at OpEd News writes an entertaining column on Fox News on "just how strained the conservative argument has become" on corporatized health care. Harris concludes:

"A CNN poll earlier this year found 64 percent of Americans thought it was the responsibility of the federal government to make sure the public has health coverage. Unfortunately, even the leading Democratic candidates favor keeping the insurance industry in the health-care loop. But this loop has become a noose hold for strangling the potential of the U.S. health care system. Paying for health care through competing private insurers, no matter how regulated, is just a bad system.

"If the local fire department belongs to the community, as Michael Moore asks in SiCKO, then why shouldn't the local hospital? It's a great question."

p.s. That's a photo of the face transplant operation done in France earlier this year. Another first for innovation and technology in a country with universal health care — tell me it isn't true, Laura!

Shame on Ohio Guv

The Akron West Side Leader has this letter to the editor:

To the editor:

It is bewildering to me that Gov. [Ted] Strickland will not allow Single Payer Healthcare proponents a seat at the table of the Ohio’s State Coverage Initiative (SCI) team. Colorado and California have both done model comparisons of health care options, using research collected by the Lewin Group, which submitted technical analysis of four health care plans, including Single Payer. The research determined that a single-payer health care system “could cover more people, for more services, for less money.”

The overwhelming need for health care reform is present in all 88 Ohio counties, none more so than in Gov. Strickland’s previous 6th District, where the unemployment average is higher than the national and state levels. The two counties with the highest unemployment rates in the state are in the 6th District. Unemployment and poverty have taken a huge toll on this area of the state, and Gov. Strickland has first-hand knowledge of this.

I heard the governor speak on WCPN this past year and he said he supported the single payer idea but it was not politically realistic that this plan would pass the Republican-controlled Ohio legislature. The Ohio House Committee on Healthcare Access and Affordability is chaired by James Raussen of the 28th District, an insurance analyst with Great American Insurance.

The Single Payer plan is currently before the Ohio Legislature in the form of House Bill 186 and Senate Bill 168, the Health Care For All Ohioans Act. These bills give the Legislature an opportunity to create a system of financing comprehensive lifetime access and comprehensive care for everyone in Ohio. Tens of thousands of people have signed initiative petitions for the Health Care for All Ohioans Act.

Please contact your Ohio legislators to request their support for these bills. Also call Janetta King, policy director for Gov. Strickland at (614) 466-3555 to request that these bills be evaluated by the State Coverage Initiative alongside those plans submitted by private insurance representatives.

Ohio citizens have a right to know all the possibilities being explored by the SCI team. To exclude Single Payer from this group is nothing short of criminal negligence on the part of the governor.

Mary Smith, Cuyahoga Falls

Headed In The Right Direction?

My mother was dirt poor growing up growing up in North Florida. She got out as fast as she could. Like many other poor Southerners in the 1940s, she headed to Chicago, where she graduated from Mount Sinai Hospital's nursing program.

Not too long ago she mused aloud how her life might have been different if her family hadn't been so poor when she was growing up. The casual observer might think that she'd done OK, poor childhood or not. Indeed, all the Joiner kids were part of the karmic reward of the American dream lifting all boats after World War II. All five siblings made it to the middle class, all but one, in fact, to the upper middle class. My mother and her younger sister married doctors; her older sister became a nurse and married a teacher, and the youngest sister married a city planner. My uncle became an engineer. My own mother never worked outside the home after her first child was born. She lived in a sprawling suburb of big houses on oversize lots and took a nap every afternoon.

But the naps, rather than giving insight into some innate laziness on her part (and there is some of that — in a never-ending rebuke to her own, driven mother), are more a legacy of the malignant effects of poverty. Debilitating, health sapping poverty. The Southern variety. My mother's health was never good, her stamina nonexistent.

The Public Library of Science's journal of Neglected Tropical Diseases has a piece on current U.S. health disparities. It's a reminder of how close the connection is between health and success.
During the early 20th century hookworm was a highly endemic soil-transmitted helminth infection in the American South, and a major cause of severe anemia and malnutrition in the region. Together with malaria, niacin deficiency (pellagra), typhoid fever, ascariasis, trichuriasis, and other conditions common to areas of tropical and subtropical poverty, hookworm helped to foster the concept of the “sick man of the South” or the “lazy Southerner.” The poverty-promoting aspects of these diseases are powerfully illustrated by the recent work of the economist Hoyt Bleakley, who has estimated that because of its impact on child growth and development, school performance, and school attendance, chronic hookworm infection in the American South was responsible for a 43% reduction in future wage-earning.
The writer's conclusion? "There are no excuses for allowing such glaring health disparities to persist in one of the world's wealthiest countries."

Except that, of course, there are plenty of excuses. A couple trillion dollars worth of excuses. Ask a progressive. They'll explain why real health care reform — that is, the proven reform that universal, single-payer health care brings, just isn't feasible.

And as long as that's the progressives' line, it's true. And as long as that's true, our nation will continue heading in the wrong direction, towards a developing world status in health care, education, and the chasm of disparity between rich and poor.

McCain's short circuit

John McCain's column on U.S. health care begins so well:
WE HAVE AN approaching perfect storm in health care, and no one seems to be watching the clouds gather.

More families are without health insurance as premiums increase beyond the affordability of our citizens and their employers. Our safety net programs of Medicare and Medicaid are headed to financial meltdown and draining dollars from critical programs such as education. Our companies cannot continue to compete outside the country because health care costs are so much higher in the United States.
Leave out that bit about Medicare and Medicaid, and you've got some truths (and of course, with the Big Pharma giveaway that is Medicare Part D — no negotiating with pharmaceutical companies over the cost of drugs for Medicare recipients — the Republicans did manage to make Medicare unsustainable). McCain then attacks the Democratic candidates for their "same old" solution of universal coverage, which really means, he writes, "massive tax increases, mandates and government regulation, and no solution to rising costs."

Fair enough, since that is indeed the truth to mandates — unless mandates are a back-door route to single-payer. That seems unlikely, given the dominance of the organized money behind insurance. What he calls instead is almost unintelligible. If I hadn't heard McCain's policy guy in D.C. earlier this month I would come away wondering if McCain might not be the Nixon to China conservative on single-payer.

Here's why. McCain writes:
I offer a genuinely conservative vision for health care reform, which preserves the most essential value of American lives -- freedom.

We should not attempt to substitute government coercion for the right of individuals to decide what is best for them. Our citizens should not pay for the collective sins of a failed health care system. We must use the tools that have served us so well in the past -- competition, American ingenuity and personal responsibility.
Exactly what we in the single-payer movement are calling for, and exactly what Canadians, the Japanese, French, Greeks, Brits, etc. all have: freedom (aka choice of physician and hospital; and the freedom to be treated for medical ailments), which leads to competition amongst the docs and hospitals, with a strong element of personal responsibility injected. We are each responsible for our health. It's our government's role to empower us to do that better, however, not to punish us for not doing it well enough.

What kind of society do we want to be, an empowering one or a punitive one?

McCain also sings the single-payer tune when he notes that we should all have to "pay for the collective sins of a failed health care system." So well put.

Unfortunately, he then turns to gobbledygook, advocating tax credits so that more people can pay premiums to the insurance industry protection racket. Too bad. Ideology and a long career in Washington have blinded McCain to the real way forward — the conservative solition, since it fosters freedom, competition and fiscal sanity.

p.s. McCain has taken a page from Bush, whose image guys have long stood him in front of graphics that make it appear as though he has a halo. McCain's is more like a victorious Roman general's armored head-dress. Appropriate — he's not depending on the Christian fundamentalists hoping for end-times.

12 December 2007

Americans like paying more for health care

Or at least they don't mind their work paying more for it. It's almost as if they don't think that savings would be passed along to them, almost as if the social contract were broken, as if people thought the basic standards of decency no longer are in effect in the U.S. — as if the Republican value of greed had taken over.
Here's the article.

09 December 2007

Where will reform come first?

A physician who sometimes speaks for Health Care for All Colorado returned from the Physicians for a National Health Program's national conference a couple weeks ago with the observation that he did think reform would come first at the state level — as it did in Canada — but that it wouldn't be Colorado.

I guessed he would bet on Vermont being the first — it's a liberal state and they've been doing education for a long time, and also their people know that the system works better in Canada than in the U.S.

He thought Kentucky.

Crazy, I know, but the next thing I knew I was talking with Walter and Kay Tillow, who head Unions for Single-Payer, and have long worked out of Louisville. The Kentucky Legislature actually endorsed HR 676, Reps. Conyers' and Kucinich's single-payer bill before the Vermont legislature did.

And before you write off the South, with its historic greater acceptance of inequality, take a look at this article on "Can You Say Single-Payer?" from, of all places, South Carolina.

This bit in the middle reminded me of Colorado's Independence Institute and its allies:
But the operative word to describe the health care plans put forward by the major, viable candidates is “timid.”
“Single-payer” is definitely not that — at least, not within an American context. Seen from the perspective of most advanced nations — which accept medical care as just another part of a nation’s infrastructure, like roads and post offices — it’s no big deal.
Not here, though — not by a long shot. Here, we have too many people preprogrammed to go ballistic at the mention of “single-payer.” That’s because of the identity of that payer.
It’s... well, it’s the government!
This column will now take a short break while libertarians run around shrieking until they turn blue and fall over... da-da-dum-dum, hmmm... readers might want to go look at the Sunday comics until we resume... da-dee-da-dahhh... Still screaming, so let’s get another cup of coffee... Ah, that’s good stuff...
OK, we’re back, and they’re still screaming, but we’ll just have to accept that they’re going to do that, and proceed.
“Government,” in America, is a word that we use for a free people banding together to do something that we can do far better working together than working separately. Some people don’t accept that fact. They seem to believe that “government” is some scary thing that intrudes on their lives from out there somewhere, like a spaceship full of aliens with ray guns that will turn us all into toads or something.