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?

Reality trips up D.C. mandates

The Washington Post reports that D.C. Council member David A. Catania (I-At Large) has reconfigured his plan to get universal health care to all D.C. residents. This is good. Catania's plan was a mandate, with a $250 fine for anyone who didn't buy health insurance, with subsidies only up to 200% of the federal poverty level - about $21,000.

George Jones, executive director of Bread for the City, shares his hopes and concerns in this May 4 article, with the piece on Blue Cross/Blue Shield's less-than-straightforward negotiations over the plan here. Jones cites Massachusetts as exhibit #1 as to whether fines work to force people to sign on for overpriced, largely worthless insurance.

Walter Smith, executive director of the public advocacy group D.C. Appleseed Center for Law and Justice, notes that Blue Cross/Blue Shield, as a federally chartered nonprofit, is legally bound to contribute to the community.

FL's Ben Graber & single-payer

Ben Graber, MD, is running a sleepy campaign against six-term Democratic Rep. Robert Wexler in Florida. Congressional Quarterly reports that Graber only raised $700 in the last quarter of 2007 -- unlikely to be enough to unseat an incumbent.

His lack as a candidate makes for bitter reading when compared to his good sense in health care reform. In an opinion piece in the Sun Sentinel, Graber writes, "A wise person once said, 'There is nothing as powerful as an idea whose time has come.' A single-payer health plan is that idea."

Here's are his talking points:

• Expand Medicare to include people 55 to 64 years old, veterans and the chronically ill.
• Eliminate the need for any HMO involvement in regular Medicare by stabilizing premiums. This is accomplished by providing a formula for a much expanded and reduced-risk population.
• Offer an affordable premium until age 74 and then freeze the premium at age 75 and beyond.
• Enhance the Medicare D program by eliminating the doughnut hole and negotiating with pharmaceutical companies worldwide for a bulk discount on medications.
• Remove research and development costs from the price determinator and offer independent U.S. research grants.
• Incorporate the Veterans Health Administration into Medicare and Medicaid.
• Fund Medicaid premiums for those below the poverty line — 75 percent by the federal government and 25 percent by the states.
• Develop Medicare and Medicaid buy-in programs to expand the single-payer system to all ages, including children.
• Place premiums for small businesses and individuals on a sliding scale based on the ability to pay.
• Change annually based on individual financial circumstances.
• Utilize existing infrastructure, saving billions in conversion costs.
• Allow insurers to participate, but in a new capacity as facilitators, product enhancers and recruiters.

This phased-in approach may have a better shot than HR676.

Vermont rallies - whoops

Single-payer supporters in Vermont seem to have lost it, according to the Rutland Herald. This is from a report on single-payer supporters meeting with legislators:

But as the crowd grew more raucous (some began interrupting lawmakers and insulting legislative staff), Rep. Patricia O'Donnell, R-Vernon, staged her own interruption as she came to the front of the room and asked people to treat their lawmakers with respect.

"If you want to be listened to, you have to be respectful," O'Donnell, a member of the House Health Care Committee, told the crowd before a chorus of people yelling "sit down" and "shut up" sent her out of the room, the door slamming behind her.

Maier told the crowd the criticism for legislative staff — who have researched aspects of the hospital plan for lawmakers — is off base. He added that while he doesn't "enjoy being yelled at, it is our job to listen and to ask the tough questions and to dig down."

"If we don't ask these kinds of questions we would be irresponsible," he said. "It's not our job to pass ideas and concepts."

Racine also told the crowd that their anger is misplaced and suggested that attention should also be focused on state and elected officials who do not support universal health care. He cited the new proposed budget from Gov. James Douglas, which he said underfunds Medicaid and will result in "$5 million in new co-pays and price increases" for Vermonters.

"I know the system is not sustainable. It's a national crisis," Racine said. "If some folks have ideas on how to make this work, I'm all ears."

On the opinion page,the editors opined:

In Vermont health care has taken on the feel of an ideological crusade among some supporters of universal care, partly because of the apparent simplicity of their proferred solution and because it is easy to vilify opponents as creatures of self-interest. So they are able to clothe themselves in the robes of virtue and lose sight of who is and isn't working to advance their cause.

Racine and Maier are working to advance their cause. But it is not simple. The bill that was up for discussion would place all hospital costs under the jurisdiction of the state in a step toward a single-payer system. The idea makes some sense, but there are many complications. If the tax hike supporting such a program were not offset by comparable cuts in health care premiums, what would happen? These are not questions to be dismissed lightly, and lawmakers are not less than dedicated to the cause for considering them.

The left is capable of blowing it this year. Self-righteous, ideological posturing is a turn-off to voters and does not encourage intelligent policymaking.

We should not make the mistake of the right-wing, who were so certain they were right they forgot the need to persuade the rest of us, who were pretty darn sure they were dead wrong.

Only about a quarter to a third of the country is pretty darn sure we're wrong. But we can increase that number if we're not careful.

Hell, even if we are careful that number's going to increase, because we've already awakened the giant.

Minnesota Health Plan

The Bemidji Pioneer reports that Sen. John Marty, a Minnesota state legislator, led a delegation of freshmen legislators to Bemidji to unveil the Minnesota Health Plan, a bill he introduced late last session and which he hopes will be heard this session.

It would create a single-payer system -- or, as the Legislators introducing the bill prefer, a single-administrator plan. A board, set up by the Legislature, would collect premiums from all Minnesotans -- based on ability to pay.

The plan obviously creates savings by centralized billing and by spreading premiums among all Minnesotans. They take pains to explain that the plan is not socialized medicine as providers such as doctors are still private.

Marty outlined the proposal as:

• Allowing people to go to the doctor, clinic or hospital of the patient’s choice.
• The plan covers all medical needs including prescriptions, mental health care, dental services, chiropractic.
• A patient cannot be rejected because of a pre-existing condition.
• No deductible or co-payments.
• Premiums on individuals and businesses are based on ability to pay.
• The plan is administered by a 15-member public board representing the public, not just insurance company executives.
• The plan focuses on preventive care and early intervention to keep people healthy and save money.

Marty expects it may take four or five years to make a full change.

Health insurance, he says, is not something we should be selling. It is rather something we should be making sure we all pay into and we all get the service, like we do with police and fire.

Well put.

Al Franken on Single-Payer

During a Minnesota Public Radio debate, Al Franken said that "states should pick which system works best -- maybe the Clinton plan would work in one state, but single-payer would work well in another."

PA Gov Aims To Fund Coverage for Uninsured

There's politicking going on in Pennsylvania as Democratic Gov. Ed Rendell has threatened to fund his plan to offer more affordable health care to nearly 800,000 uninsured adults by tapping into a $400 million state fund that helps doctors pay their malpractice insurance costs.

Time out. There's a state fund for comparatively wealthy physicians to cover the depredations of the insurance industry, but not for the working poor -- for whom it's a matter of life and death? Don't get me wrong, the cost of malpractice insurance is another example of the insurance industry run amok. But the fact that the state stepped in to help the doctors does show the relative strength of concern for physicians vs. for the working class. And how com the Right continues to argue that malpractice costs are part of the reason for high medical costs in the U.S., if there are, evidently, state funds helping out?

Here's a 2005 pdf report that shows that

• Over the last five years the amount the major medical malpractice insurers have collected in premiums has more than doubled, while their claims payouts have remained essentially flat.
• Some malpractice insurers substantially increased their premiums while both their claims payments and their projected future claims payments were decreasing.
• Malpractice insurers accumulated record amounts of surplus over the last three years.

Back to the governor -- a year ago he introduced Cover All Pennsylvanians. The single-payer movement in Pennsylvania was frustrated by that plan, because although Rendell has said he'd sign a single-payer bill if it passed the Legislature, instead he put forward his own plan, which does nothing to rein in costs. Those following the Pennsylvania reform effort call Rendell's bill "No Health Insurance Company Left Behind," and note that "Capital Blue Cross’s CEO, Anita Smith, was standing at Rendell’s side when he introduced his bill." Oddly enough, Pennsylvania lawmakers "showed little interest in helping to fund it with a tax on businesses that did not offer health insurance to workers."

The state's doctors could pay a price if no agreement is reached soon. The governor has declined to approve medical malpractice subsidies, known as abatements, through the state's MCare program until lawmakers agree to fund Cover All Pennsylvanians. If no deal is struck by March 31, the unsubsidized bills will come due.

Furthermore, the governor has pledged to campaign against Republican legislators in the fall, if they continue to balk.

The response seems to be a GOP yawn and shrug.

Big pool in New Mexico

The New Mexico Business Weekly may have finally gotten a better term than single-payer through my thick skull.

Single-insurer.

That's pretty clear, isn't it? Not so threatening?

The NM Business Weekly's article, "Little-known Health Security Act could make a splash thanks to two studies," explains the difference between Gov. Bill Richardson's compromised and designed to fail "health solutions act" and the real deal, the "Health Security Act":

The most profound difference in the plans lies in the role of private insurers. They would maintain and, presumably, expand their current roles under the Health Solutions plan, while the Health Security Act would relegate them to providing supplemental insurance.

In place of private insurance, Health Security would create a single insurer (supporters don't like the term "single payer") to cover all 1.6 million New Mexicans who are not federal government retirees, active and retired military or tribe members (who could opt in). The single big pool, supporters say, would mean lower insurance costs overall than the dozens of separate insurance pools that exist today.

Missouri plan won't work

A Families USA report has found that Missouri Governor Blount's health care reform proposal is a piecemeal plan that addresses only a portion of the individuals who lost coverage when he dramatically cut Medicaid several years ago. It wouldn't do a good job covering the 700,000 Missourians who are uninsured.

• Eligibility criteria exclude many low-income adults, including people who were once covered under Medicaid.


• Coverage offered is missing key benefits.


• Cost-sharing is too high for many low-income people.


• Shaky financing may do more harm than good.

The background information is that in 2005, Governor Blount cut the state's Medicaid program, resulting in upwards of 100,000 Missourians losing their coverage -- and more than 300,000 seeing their benefits sharply reduced. These cuts were some of the largest by any state in the history of the Medicaid program.

Low-income parents were the hardest hit. About 68,000 lost coverage. Missouri became the 41st state ranked in terms of working parents' eligibility for Medicaid.

This is part of the problem with health care being a charity rather than considered part of a government's legitimate protective functions.

Vermont rallies for single-payer

A crowd of 150 people rallied for single-payer yesterday. It's a Vermont plan that would begin by covering all hospital care. The story begins:

MONTPELIER -- Caroline Donnellan, a 21-year-old restaurant worker from Burlington, joined a crowd of more than 150 Wednesday to rally for a bill that hadn't received much attention -- until now.

Donnellan said she sees the bill as a significant step toward changing the way Vermonters pay for health care, a step she said it sorely needed. "The health insurance industry is a mess," she said, explaining that she based her assessment on her physician father's accounts and her mother's experiences as a cancer patient.

A Republican legislator, Francis "Topper" McFaun, introduced that bill, H. 304.

McFaun said he didn't recruit the sticker-wearing supporters who poured into the Statehouse on Wednesday morning. That was the work of a new coalition called the Citizens Advocacy Network. Still, he said he knew support for his proposal was growing outside the Statehouse. "People have been calling me," he said. "The more I talked about it, the more people say, 'Hey, this sounds pretty good.'"

... Dr. Deb Richter, a family practice physician and longtime advocate for dramatic health care reform, led the rally and made the case for the legislation. "It satisfies the governor's criterion of not increasing spending and has the potential of lowering property taxes. It satisfies the Democrats' agenda of wanting to cut premiums and expand coverage compatible with Catamount. And it does what no other bill before the Legislature does now: It includes everyone, cuts costs, cuts premiums and has a mechanism for holding down costs in the future."

Moving to Single-payer in Vermont

A Republican getting quoted on the need for single-payer? It's right here, in Advocates push new hospital care funding in the Rutland Herald:

MONTPELIER — While legislative leaders talk about a slow expansion of Catamount Health and Gov. James Douglas eyes reforms to stem jumps in insurance premiums, a wide-reaching proposal for the health care crisis is gaining steam among advocates.

The Vermont Hospital Security Plan would create a new statewide hospital budget to pay for all visits to the 14 nonprofit facilities, essentially creating a single-payer health insurance system for hospital care.

"As a state we need to deal with the rising cost of health care and a big part of that is the cost of hospital care," said Rep. Francis "Topper" McFaun, R-Barre Town, one of the three lead supporters of the bill. "With this proposal, no one would have to worry if they can afford an important trip to the hospital."

There are plenty of quotes from Dr. Deb Richter, a founder of Vermont Health Care for All.

The single-payer advocates in Vermont are working on a phased introduction of single-payer that goes about it exactly the opposite way from what a number of legislators are talking about here in Colorado. Here, such a plan would first cover primary care — that's pretty much low-hanging fruit, inexpensive and comparatively easier than taking on the entrenched, for-profit, anti-reform Colorado Hospital Association. In Vermont, all the hospitals are non-profit. Imagine.

Take Back Vermont Healthcare, a new statewide lobbying network of single-payer advocates, intends to apply some pressure on lawmakers to support the Hospital Security Plan. The group will kick off its efforts with a rally on the Statehouse lawn on Jan. 9 at 11 a.m.

"This is a bill that would do something for all Vermonters," said Dr. Deb Richter, a Cambridge physician who founded the Take Back Vermont Healthcare network. "No other bill out there would reduce premiums by 40 percent."

The Vermont hospitals aren't supportive, however, nor is the legislative Democratic leadership.

Unfortunately, the name of Dr. Richter's lobbying group, "Take Back Vermont," is distracting people from the point. It's the name of an anti-gay movement that evidently still has signs up.

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.

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

Shining Ithaca

Tim Joseph, chair of the Tompkins County Legislature, writes in the Ithaca Journal that a single-payer system would benefit Tompkins County.

The Pueblo County Commissioners said the same thing earlier this year when they offered testimony to the Colorado Blue Ribbon Commission for Health Care Reform.

The benefits of a single-payer system used to be a topic upon which reasonable, informed people could disagree, but that is no longer the case. At this point it's a no brainer that single-payer is the way to go.

Joseph gives a long list of cost savings from single-payer that aren't usually included in modeling or discussions:

* Our county, like every county, has an Office for the Aging. We have a 10-person staff, and the largest part of their work consists of helping seniors to navigate the health care system, find the programs that are available to help them and plan how they will manage health care costs now and in the future.

* We have a full-time benefits manager who is mostly occupied with assisting employees in dealing with the health insurance program. Those employees also lose productive work time consulting with the benefits manager and fighting insurance company denials, which can take hours from the workday.

* When we negotiate with our employee unions, health care is always the biggest topic. We have a health care consultant on retainer to help us examine and cost out plan changes that we present to our unions in an attempt to control costs. At least two-thirds of the staff time devoted to collective bargaining is spent on health care issues.

* We devoted hundreds of hours of staff time to developing and publicizing a discount prescription drug card available to all county residents to reduce drug costs for those without insurance.

* We have a $400,000 grant from the state to form a health insurance consortium among local governments so that we can purchase employee health care as a larger group. We will be hiring a consultant to help us through the process of forming that consortium and then finding a suitable plan. Various county staffers are devoting substantial time to moving this project forward.

* We have staff in our Mental Health Department, Public Health Department and Department of Social Services devoted to collecting fees from private insurers to reduce the public cost of programs that deliver various health services.

* We have people waiting in jail that judges are prepared to release to drug or alcohol treatment programs as soon as we can assure payment to the treatment center. Staff in local agencies and our Department of Social Services work on getting these inmates into health care programs, mainly Medicaid, that will cover treatment. Meantime, we pay the cost of incarceration.

* Our economic development staff encounters aspiring entrepreneurs who would like to start their own business but are tied to a job by the health insurance benefits. Young businesses that do get started often have trouble attracting the employees they need because they cannot yet offer a health plan.

Joseph evidently recently testified before a task force put together by Gov. Eliot Spitzer examining universal health care.

Good luck to them.

Rocky Mntn News reports: single-payer the one

This is a nice change: The Rocky Mountain News has published an article fairly positive about single-payer. In "Panel: Only 1 health plan would cut costs: Single-payer cited but 5th proposal still being studied," reporter David Montero writes that,

A proposal to put health care in the hands of the government is the only one of five being studied that would save money, a group working on reforming health care in Colorado told lawmakers Wednesday.

That plan, known as the single- payer system, would cut about $1.4 billion of costs from the current $30.1 billion being spent in Colorado on health care.

And of the original four plans - one submitted by insurance underwriters, one by the public employees union, another by health care providers and the single-payer - only the last was shown to cover all of Colorado's legal residents.

Montero doesn't have it quite right — the plan wouldn't put healthcare in the hands of the government, it would put healthcare financing into a non-profit single pool administered by a governing board — but he did get it right that the single-payer plan is the only one that would save money. He also reported that State Sen. Ken Gordon "said single-payer was the best plan that offered the state savings as well as broader coverage for everyone."

Divide and conquer

The Atlantic Monthly continues its downward spiral with a new writer, Megan McArdle, who fits their criteria for clever writing that leaves aside those quaint notions of morality, as Alberto Gonzolez has said. Entertaining!

The benchmark for this kind of dross ran a few years back, positing that the earth could easily support 30, 50, who knows how many billions of humans! and that our human population could vary by huge amounts — 30 billion to 3 billion! — within a few generations, without problems.

Right. Unless, I suppose, you consider starvation, war, pestilence and economic dislocations problematic.

Megan performs this trick on a smaller scale in "The Morality of Health Care Finance," by accusing those of us who see single-payer financing as a way out of the immoral and deadly morass in which healthcare is now mired in the United States. We are, she thinks, simply in love with government, and would be in favor of single-payer even if it could be proven that private health insurance could do a better, cheaper, more efficient job — "as long as a substantial population remained uninsured."

What?

Huh?

Megan. How is a system better if it leaves "substantial" numbers uninsured? How could that be cheaper in the long run? How more efficient? You've been reading too much Ayn Rand.

That's like accusing progressives of being against torture, even if it could be proven that torture does a better, cheaper, more effective job — "as long as a substantial amount of the information gathered turned out to be false."

See, the fact is that torture is wrong because it's immoral AND it doesn't work. Same as our private health insurance system.

Megan's argument that single-payer is a way to transfer money from the young and healthy to the old and infirm sounds like a trial balloon from the health insurance industry. Will we learn in a few years that she was lavishly compensated by that industry for this bit of "journalism"?

The fact is that our current system transfers money from the young and healthy to the old and infirm without benefit to the young and healthy. A single-payer system does collect from everyone, but its efficiency and appeal lie in the fact that there is benefit for the young and healthy. They have the security of knowing that if they hit a tree snowboarding next winter, they'll be cared for. They have the satisfaction of knowing that if they're one of the unlucky few who wake up tomorrow morning suddenly transformed by a diagnosis of cancer, suddenly no long one of the healthy but one of the stricken, that their children will continue to have a parent, and they can concentrate on recovery, not the consequences of bankruptcy.

Shame on you, Megan, for working to divide people, to set the young against the old, and suggest to them that their interests are served by turning their backs on others. She complains that liberals have been calling her "evil," but in fact, to work to divide people, one from the other, is an evil action.

First they came for the Socialists, and I did not speak out -
because I was not a Socialist.

Then they came for the Trade Unionists, and I did not speak out -
because I was not a Trade Unionist.

Then they came for the Jews, and I did not speak out -
because I was not a Jew.

Then they came for me - and there was no one left to speak for me.

Shame. We're in this together, Megan. Because it's moral, and because it's what works.

Cape Care moves forward

Cape Care has hired its first employee, and hopes to bring single-payer to the 11 communities on Cape Cod that passed a non-binding resolution in support of single-payer — called Cape Care. What they haven't done is passed a tax levy to support the system.

Under a single-payer system, every resident of Barnstable County would be entitled to comprehensive health care coverage, in the same way that all residents are entitled to municipal police protection or public school education.

The county would have its own insurance product and pay for coverage by assessing residents a certain amount, the mechanics of which have yet to be worked out.

Barnstable County commissioners haven't bought into the plan yet, nor do they know much about it. "We haven't heard any details on how much it would cost or how it would work," Commissioner Bill Doherty said.

The Cape Cod folks are pointing out that while taxes would go up, overall costs would go down. This could be a silver lining for mandates like those in Massachusetts. If you're forced to buy a bad product, you might be more open to paying more taxes (but less overall) for a better product.

Those clever health insurance companies. I couldn't understand why they'd be against the Massachusetts' plan — which, after all, forced people to buy their crappy product. It turns out they were thinking ahead. I'm afraid they're smarter than the rest of us put together.

Archimedes Project isn't single-payer

I met with Liz Baxter of the Archimedes Project yesterday in Portland, Ore. She's smart, savvy, and obviously well intentioned. She and former Oregon Gov. John Kitzhaber run the Archimedes Project, which I had thought was single-payer — especially since they couldn't get it through the Oregon senate.

Nope — it's just an effort to get a dialog started on what our healthcare reform should look like, with 15 priorities, some of which would make it almost impossible for health insurance companies to stay in the game.

I think its defeat may show that we might as well go straight out for single-payer, rather than dancing around it.

New Mexico looks at reform

A committee in New Mexico is looking at three plans that were analyzed by Mathematica, a Lewin competitor in the independent number crunching business. The three plans are:

• The Health Security Act, which would reduce the role of private insurance and was the least expensive of the three;
• The New Mexico Health Choices Plan, which would create a voucher system, and would be the most expensive;
• The Health Coverage Plan for New Mexicans, which would leverage public insurance while retaining private insurance.

What does that mean? Would "leverage" public insurance? It sounds like a junk bond scam.

The writer warned readers off the single-payer choice: "Because of a federal law concerning self-insured employers, it could face monumental legal challenges," says the reporter about the (almost) single-payer choice. "Also, Gov. Bill Richardson has said he wouldn’t support a single-payer system."

We all might tell Gov. Richardson that if he's going to take the most sensible, cost-effective solution off the table before it's even really given a chance, he should certainly be off the table when it comes to choosing a Democratic presidential candidate.

And this option isn't even actually single-payer. Mathematica reports: “However, the Health Security Plan probably would not ever be the only payer in New Mexico, and whether there is much provider administrative to be captured is uncertain.”

The "Choices" plan has Medicaid as 64 percent of its enrollment. Wow. Both it and the almost-single-payer plan "would essentially strip away employer-sponsored coverage. They also would get rid of individual private coverage, except for supplemental policies, the report says."

Kuehl's single-payer bill passes in CA

This is big news. Senator Sheila Kuehl's single-payer bill, SB840, for California passed the California Legislature on June 6. The vote was 22 to 14, with only Democratic votes in support and 13 Republicans plus Democratic State Senator Lou Correa voting against the measure. This story from KPBS gives positive but brief and balanced coverage:

The State Senate has approved a measure that would create a single-payer, universal healthcare system in California. Critics call it socialized medicine, but supporters say it’s the gold standard for healthcare reform. KPBS reporter Kenny Goldberg has more.

Under the single-payer system, all private and public money currently spent on health insurance would be pooled. The state would use that money to run one healthcare plan for all Californians.

Donna Gerber is with the California Nurses Association. She says a single-payer system would be run like Medicare.

Gerber: It leaves the private hospital and doctor and other providers in place -- it simply takes the insurance industry out, which also in the process saves 30 percent of every healthcare dollar.

Governor Schwarzenegger doesn’t like the idea. He vetoed a similar measure last year, and says he’ll do the same thing if the bill hits his desk again.