News from the Progressive Review, providing alternative news and comment for over four decades.

February 25, 2009


Physicians for a National Healthcare Plan - Sen. Max Baucus (D-Mont.), chair of the powerful Senate Finance Committee, will not allow consideration of single payer as an option for reform, and Sen. Kennedy (D-Mass.) is, by all indications, poised to promote the flawed Massachusetts health plan at the national level after months of secret meetings with insurance, business, and pharmaceutical company lobbyists.

While President Obama has acknowledged that single payer is the best option for reform, and while he opposed a mandate requiring all individuals to purchase private insurance during his campaign, it would appear he is poised to embrace the piecemeal, incremental approach that keeps the private insurance industry in place.

John Geyman, MD, Tikkun - The inefficiency and bureaucracy of our 1,300 private insurers are not sustainable. According to the Blue Cross Blue Shield Association, there are 17,000 different hea1th plans in Chicago.

Private insurers offer much less choice than traditional Medicare; there are near-monopolies in 95 percent of HMO/PPO metropolitan markets, enough to trigger anti-trust concerns by the United States Department of Justice.

Because of costs, about 75 million Americans are either uninsured of underinsured, with large segments of the population forgoing necessary care and having worse health care outcomes; the United States now ranks nineteenth among nineteen industrialized countries in reducing preventable deaths from amenable causes. . .

What is neglected by almost all economists, "experts" and pundits is that there is already plenty of money in the system, that we waste about one-third of our health care dollar on our inefficient multi-payer financing system and on unnecessary care, and that NHI will save money, not cost more. NHI is the most fiscally responsible thing we can do now about health care.

The Conyers bill in the House (H.R. 676) will be financed by payroll and progressive income taxes that will be less than what individuals and employers now pay. The health insurance industry is being propped up by government subsidies to the employer-based system and to privatized public programs. NHI can save some $350 billion through administrative simplification, while offering coverage for all necessary care, full choice of provider and hospital, and mechanisms for cost containment through bulk purchasing, negotiated fees, and global budgets.

NHI by itself will not solve all of our health care problems, but it will provide a structure (as no incremental approach can) to enable other necessary steps. These include acceptance of health care as a right, transition to a not-for-profit system, reimbursement reform, rebuilding of primary care, evidence-based technology assessment, and quality improvement. None of this will be possible by using reforms that leave an obsolete private insurance industry in place. . .

FDR almost went for NHI in the mid-1930s, but he backed off, mainly due to the AMA's opposition. Today, the AMA is marginalized with a membership of no more than 30 percent of physicians, and a majority of American physicians now support NHI. . . It has become an economic, moral, and social imperative.

Laura S. Boylan, MD, letter to New Yorker - In "Getting there from here" (Jan. 26), Atul Gawande suggests that the Massachusetts 2006 mandate plan is a model for national health care reform. He sees his stance as pragmatic, politically feasible, rooted in the particular history of American health care and gifted with the commonsense wisdom that we must start from where we are. Advocates of national health insurance (single payer) are characterized as ideologically driven extremists with "contempt" for pragmatists. I respectfully disagree.

Most Americans, including most physicians, supported national health insurance even before the recent economic collapse, polls show. Endorsers of the single payer bill H.R. 676 include 93 co-sponsors in the House of Representatives, 450 union organizations in 45 states, and countless others representing a wide range of constituencies. This is not a fringe movement.

High costs are the root cause of Americans' health insecurity. Gawande's analysis is flawed by use of a framework centered on insurance coverage rather than the more fundamental issue of health care value. Gawande sees employer-based coverage as the "path-defining" element of our current system because most people are covered by it. Well, it's all in how you look at it. We need to keep our eyes on the prize, the health care dollar, and follow the money. Government already dominates: tax dollars fund most health care expenditures in the U.S. This is because government covers the sickest and poorest people, tax-favors employer-based private insurance, and covers its own employees. To use Gawande's metaphor, the lifeboat is already bigger than the "main boat" of American health care. This is where we start.

Gawande asserts that Massachusetts "recently became the first state to adopt a system of universal health coverage for its residents." . . . A nearly identical assertion was made twenty years ago by then Gov. Dukakis about Massachusetts' 1988 reforms. More breathless proclamations heralded reforms in Oregon (1988), Minnesota (1992), Tennessee (1992), Vermont (1992), Washington (1993) and Maine (2003). These plans all had common themes: public spending initiatives, new regulations and mandates, and continued dominance of private insurance in covering low risk populations. None achieved universal coverage. The common denominator of the ultimate failure of all these plans was the absence of effective cost control. Two weeks ago Gov. Deval Patrick of Massachusetts warned that rising costs, "threaten to crush families and businesses and doom Massachusetts groundbreaking experiment with universal insurance.". . .

The repetition of failed experiments is not pragmatic, it is part tragedy and part farce. Electronic medical records, chronic disease management and more emphasis on prevention are all important for many reasons but we must admit that short and long-term cost implications are unknown. Some of these measures may actually increase costs. Medicare is not perfect, but it is demonstrably more cost effective than private insurance and beloved by most Americans. It is shovel ready. Single-payer supporters say: everybody in, nobody out.

Dr. Oliver Fein, Atlanta Journal-Constitution - However well-intentioned, the Obama/Baucus/Kennedy approaches share a fatal flaw: they preserve a central role for the private health insurance industry.

To varying degrees, they would mandate that everyone buy private health insurance - the private insurance that is failing us today. Some of these plans offer a Medicare-like, public option that people could buy into, but experience with Medicare shows that the private plans refuse to compete on a level playing field. They cherry-pick healthier patients and insist on more than their share of payment. . .

As long as we rely on private health insurers, universal coverage will be unaffordable. These companies generate immense overhead costs and force doctors and hospitals to spend heavily on billing and paperwork.

Administration consumes about one-third of every health care dollar in the U.S. By contrast, in countries with nonprofit national health insurance, administrative costs consume only half that amount. . .

Eliminating the private insurance industry would save $400 billion annually in administrative costs, enough to ensure that everyone is covered and to eliminate all co-pays and deductibles.

At this critical juncture, a single-payer plan is the only medically, morally and fiscally responsible path to take.

We already have an example of an American single-payer system that works - traditional Medicare. It's not perfect, but people with Medicare are far happier than those with private insurance. Doctors face fewer hassles in getting paid, and Medicare has been a leader in keeping costs down, at least until Washington politicians decided to pay private insurance plans to enroll seniors at a cost 12- to 19-percent higher than traditional Medicare.

Single-payer systems give patients complete freedom to choose their doctor and hospital. They also enhance cost containment through global budgeting, the bargaining power of being the sole buyer, and an emphasis on primary care and prevention. . .

Opponents of single payer often admit it's the best, most efficient and equitable way to provide quality care, but say it's not politically feasible and is therefore off the table in this round of the debate. How so? A solid majority of physicians, 59 percent, and an even higher percentage of the public, 62 percent or more, support national health insurance, recent surveys show. Single payer should be front and center.

Medicare for All is within reach, but only if we are prepared to take on the private health insurance industry.


Anonymous David Gelber MD said...

I am a surgeon in private practice in Texas. I agree that a single payer system modeled after traditional Medicare is the best alternative to the current healthcare crisis. I am in single specialty group practice with seven surgeons and two surgical assistants. About twenty per cent of our thirty four employees sole function is administration, primarily dealing with insurance companies. None of them contributes to patient care. However, with Medicare none of these administrative hassles exist. Within our practice Medicare is by far the most cost effective efficient system. Futhermore, our reimbursement is almost universally tied to the Medicare rate for reimbursement, usually equivalent to Medicare rates. This leaves us with higher costs for the same or less reimbursement.
The time has come to abandon the burdensome system of private insurers and bring the sanity of an efficient single payer system to healthcare.

March 14, 2009 12:31 PM  
Anonymous Anonymous said...

There seems to be a lot of overhead (administrative work) in every large enterprise. This is especially true of 'Education'. We have a building in our town, 7 stories high which accommodates what is termed 'The County Superintendent of Schools'. This building contains NO teachers, NO aides, NO principals and NO vice principals. Yet it is part of the 'educational system'. I don't know if it's 20 percent but probably close. We are doomed to be a nation of paper pushers.

April 21, 2009 12:41 PM  

Post a Comment

<< Home