By Margaret Flowers, M.D. for FireDogLake –

Leadership in Washington recognizes the damage our soaring health care spending is doing to our entire economy. Although their rhetoric differs, recent budget proposals from both Republicans and Democrats mistakenly place the blame on Medicare and Medicaid. Cuts to and privatization of these important public insurances will place us on a dangerous path that will leave health care costs soaring and more patients unable to afford necessary care.

Medicare and Medicaid must be left out of the discussion entirely until leadership has the courage to address the real reasons why our health care costs are rising, the toxic environment created by investor owned insurances and the profit-driven health care industry.

Health care spending in the United States is the highest in the world and in some cases is two times higher than spending in other industrialized nations, which achieve nearly universal coverage with better health outcomes than the U.S. Our soaring health care costs outpace our growth in GDP, inflation and wages. By any measure it is an unsustainable situation.

If we look at the various health care models in the United States, we find that the rise in spending is lower for traditional (non-privatized) Medicare and Medicaid than it is for the private sector. Our public insurances are our most efficient insurances with administrative costs of around 3%, despite the fact that they cover our most vulnerable and least healthy populations. Administrative and marketing costs for private plans are 15% or more, and the plethora of private plans further increase cost and complexity as patients and health professionals try to navigate their arbitrary and ever-changing rules.

Medicare and Medicaid are the victims of our current fragmented and profit-driven model of paying for health care which has resulted in high prices for health services and medications.

Private health insurers are financial institutions designed to create profit by obstructing, denying and restricting access to health care. They add no value to our health and in fact their business practices have polluted health care financing causing all insurances to adopt their practices in order to ‘compete’. They have also fragmented the health care market and thus the ability to negotiate for fair prices for goods and services leading to the highest prices for pharmaceuticals and procedures.

The commonsense solution is to eliminate wasteful and costly private health insurance and adopt a universal health care system modeled on the strengths of Medicare and given the power to negotiate for reasonable prices.

It is counterproductive to even discuss cuts to Medicare and Medicaid before addressing the fundamental reasons for rising costs. Yet, both Democrats and Republicans have focused on cuts to Medicare and Medicaid in their budget proposals.

The Ryan budget proposal, the Path to Prosperity, would fully privatize Medicare by moving to a voucher system in 2022 forcing all seniors to purchase private insurance. The vouchers are not designed to keep up with the rate at which health care costs are increasing so that over time seniors will either have to pay more out of pocket for health insurance premiums or will choose skimpier insurance plans that leave them unprotected should they have a serious illness or accident. Nearly half of Medicare enrollees have an income that is less than twice the federal poverty level and so have little room to absorb an increased share of health care costs.

Medicaid is significantly limited under the Ryan budget proposal which plans to cut overall Medicaid spending by $800 billion over ten years and change to block grants for each state. Block grants will mean that individual states will continue to be under economic pressure to limit who and what services are covered. As fewer are covered by Medicaid, they will have to either purchase private insurance through the exchanges or either seek a waiver from or be penalized for not purchasing insurance.

The Obama administration supports cuts to Medicare through the Independent Payment Advisory Board (IPAB) which is tasked with keeping per capita Medicare spending below a target level which is set to be lower than the current rate of health care cost inflation. Rather than blatantly privatizing Medicare as called for in the Ryan proposal, the President’s plan will slowly strangle Medicare leaving seniors struggling to find physicians able to care for them.

The IPAB was actually created in the Affordable Care Act (ACA). The President’s budget proposal would increase the power of the IPAB to cut Medicare costs. Medicaid spending is also capped under the President’s budget.

Sadly, the Peoples Budget put forth by the Congressional Progressive Caucus rubberstamps the President’s approach to cutting Medicare and Medicaid spending.

Underneath cuts to Medicare and Medicaid is a dangerous trend of increasing privatization of health care in the U.S.

There is a growing trend to put more of our population into private insurances and a growing privatization of our public health insurances. Over the past few years as the number of people able to afford employer sponsored health insurance has fallen, private health insurance profits have continued to grow as they move into providing insurance to or administering plans for the Medicare and Medicaid populations.

The ACA puts more people into the private insurance market by mandating that all uninsured who do not qualify for public health insurance purchase private insurance through the exchanges starting in 2014 and subsidizes the purchase of private insurance using public dollars.

Half of the newly insured under the ACA are eventually supposed to come from an expansion of Medicaid eligibility. However, the Department of Health and Human Services has already allowed state expansions in Medicaid coverage to lapse. A recent White House Fact Sheet also supported allowing states to place their Medicaid population into private insurance through the health insurance exchanges.

Privatization of health care is a failed experiment in the United States.

The United States differs from other nations in allowing investor-owned corporations to profit at the expense of human suffering and lives. After decades of experience with this unique privatized model of financing health care, the results are clear and startling.

The United States has the highest per capita health care costs, the highest prices for medical goods and services (and lower overall usage rates) and no control over health care spending. Despite attempts to patch the current health care situation, the number of uninsured and those with skimpy health insurance that leaves them unable to afford health care or at risk of medical bankruptcy continues to grow. Suffering and preventable deaths are higher in the U.S. than in other industrialized nations.

In addition, there have been no significant gains in important measures of health such as life expectancy and infant and maternal mortality rates. Our health disparities continue to grow, especially for those who have chronic conditions. And our health care workforce continues to be inadequate as health professionals quickly burn out from trying to practice in our complex and irrational health care environment.

It is time to recognize the failure of the market model of paying for health care and embrace comprehensive and effective health reform. The model for our ‘uniquely American’ solution lies in traditional Medicare, a single payer health system for those who are 65 years of age and over. Since its inception 45 years ago, Medicare has lifted seniors out of poverty and improved their health status.

Physicians for a National Health Program advocates for an improved Medicare for all health system, one that builds on the strengths of Medicare such as its universality, administrative efficiency and the patient’s freedom to choose a health provider, and also corrects the weaknesses of Medicare such as the lack of comprehensive benefits, out of pocket costs and low reimbursement rates.

Both Democrats and Republicans are missing the point by putting the emphasis on controlling Medicare and Medicaid costs without effectively addressing the reasons for our rising health care costs. Rather than embracing the Republican rhetoric which blames our public insurances, Democrats would do well to call out the real reason for our health care spending crisis, our current fragmented and profit-driven model, and advocate for a national improved Medicare for all.

Dr. Margaret Flowers is a pediatrician who serves as Congressional Fellow for Physicians for a National Health Program (www.pnhp.org).

By Kay Tillow for OtherWorlds.org –

More than a year after President Barack Obama signed the Patient Protection and Affordable Care Act into law, our nation’s health care delivery and coverage remain the disgrace of the industrialized world. There are more than 50 million uninsured Americans. Even if the health care overhaul works as planned, 23 million Americans will still lack health insurance in 2019.

The new norm is underinsurance. About 40 percent of us go without needed care because we can’t afford it. The health care law won’t change that, even once it’s completely phased in. Our plague of medical bankruptcies will continue too.

For unions, bargaining for health care is getting tougher as employers demand cuts and shift more costs to workers. Negotiations over better health coverage will become almost impossible when the excise tax on health benefits begins in 2018.

Many who saw the reform bill as “the best we could get” are disappointed that support for it hasn’t grown. The truth is that most people agree on the reform law. They love the parts that block insurance companies from denying coverage and care. They hate the parts that give away our tax dollars to insurance companies. They hate the mandate that will force everyone to buy insurance from the very companies whose profit motive is the source of most of our health care system’s problems. They hate the escalating costs of insurance and care.

Only a single payer system can bring us the parts we love and do away with the parts we hate. It would essentially expand Medicare coverage to all Americans, providing 100 percent guaranteed coverage regardless of employment status or pre-existing conditions. That may sound expensive, but it’s not. The “potential savings on paperwork, more than $400 billion per year, are enough to provide comprehensive coverage to everyone without paying any more than we already do,” according to Physicians for a National Health Program.

Every pro-patient measure in the law brings an ugly backlash from insurance companies, because they want to remain in the driver’s seat. For example, the act says children who have been sick can’t be denied coverage. Insurers have responded by refusing to sell child-only policies. The act says there must be minimal standards of coverage. Yet hundreds of companies have obtained waivers after threatening to drop coverage altogether.

The legislation is designed to expand Medicaid as the main way for states to cover more people. It prohibits states from dumping people currently covered. Yet with state budgets in crisis, Medicaid is under the knife. Arizona plans on dumping 250,000. Many states propose increasing patient co-pays, thus damaging the ability of patients to find doctors and fatally undermining rural hospitals.

Some assert that healthcare reform just isn’t working. Yet. Give it 10 years, and all will be fixed.

But our new health law is anchored on the private insurance industry–and that’s its fatal flaw. The insurers inflict enormous and unnecessary administrative costs on our system. This amounts to hundreds of billions of dollars every year and condemns us to spend about double, per capita, what other nations spend on health care.

Health care advocates must move beyond the health care reform law. Rep. John Conyers (D-MI) has reintroduced H.R. 676, the Expanded and Improved Medicare for All Act, which would bring all medically necessary care to everyone while assuring choice of physician. The bill is based on sound single-payer policy and progressive public funding.

If every other industrialized nation can make health care a human right, we can do it too. Our challenge is to pass effective legislation despite the powerful private health insurance companies and other corporations whose influence often trumps democracy.

First, we must have a powerful movement. We can’t build it around a shriveled dream. Only single payer, with its bolder promise of social justice, can inspire that movement.

Kay Tillow is the coordinator of the All Unions Committee for Single Payer Health Care, which builds union support for H.R. 676. She lives in Louisville, Kentucky.

President Obama’s speech unveiling his deficit reduction plan contained few big surprises—by its very premise, it was destined to preserve the faulty assumptions behind the whole deficit discussion—but some of his words were welcome. The president called Social Security and Medicare fundamental American commitments and, in a rebuke to Congressman Paul Ryan, left these entitlement programs largely untouched. He also refused to renew Bush’s tax cuts for the wealthy. It’s a pledge Obama has made—and broken—in the past, but let’s take at face value his sincerity on the matter. (All the better to hold him to it.)

From there the president outlined his plan to reduce the deficit by $4 trillion in the next twelve years, based on the principle of “shared sacrifice.” Here’s what that looks like: for every $1 raised by closing tax loopholes for wealthy Americans, Obama proposes $2 in spending cuts. Two-thirds of those cuts would come from education, health and other social programs while one-third would come from the military budget. The president’s vision of “shared sacrifice,” in other words, hits the poor and the middle class hardest. Meanwhile, wealthy Americans and the military are asked to sacrifice less, even though it was unfunded tax cuts and wars that got us a deficit in the first place.

The problem with starting with such skewed priorities is that Obama will be negotiating with the Republican Party, whose reverse–Robin Hood agenda proposes sacrifices almost entirely from the poor and middle class to pay for tax breaks for corporations and the rich. Indeed, just such a give-and-take is how we ended up with the 2011 budget compromise that averted a shutdown at the expense of $38 billion in spending cuts, the majority of which will come from the departments of education, labor and health. It’s a rotten deal, which the president curiously chose to hail as “the largest annual spending cut in history.” Any more victories like this and Obama will become a new American synonym for “Pyrrhic.” The cuts in the 2011 budget—“79 percent of what we wanted,” in Paul Ryan’s words—will be exacted immediately, despite an economy still struggling to recover from the worst downturn since the Great Depression, one in which 25 million people are still bereft of full-time work.

Lost in this discussion is what the country needs: a clear strategy to rebuild the economy and revive the middle class. That requires making the investments vital to our future and figuring out how to pay for them. It requires taxing what we have too much of (financial speculation and extreme concentrations of wealth) and investing in what we have too little of (education like pre-K and affordable college, twenty-first-century infrastructure, renewable energy). And it means addressing the real source of our long-term debt crisis: not Social Security or Medicare, not “entitlements” but a broken healthcare system, dominated by powerful drug, insurance and hospital lobbies, that costs about twice as much per capita as the health system of any other industrialized country and producing worse results.

The sad fact is, President Obama knows much of this. He spoke compellingly of the injustice of an economy in which the top 1 percent enjoys quarter-million-dollar windfalls while everyone else struggles. He gets that rising healthcare costs are a burden, and that deficit-cutting is no excuse for neglecting our country’s future. But his “balanced approach” conceded too much too early to the deficit hawks and austerity pushers. He needed to reset the debate, but instead he split the difference.

In advance of President Obama’s speech Wednesday on the budget deficit, the nation’s largest union and professional association of nurses today called on the President to oppose any cuts in Medicare, Medicaid, and Social Security – and strengthen the nation’s economy by restoring fair taxes on corporations and the super-rich, ending the wars, and creating good paying jobs.

“America is not broke, it’s just deficient in political courage and leadership,” said Jean Ross, RN, co-president of the 160,000-member National Nurses United. “It’s time to tell Wall Street and the politicians they finance in Washington and state governments that the American people have sacrificed enough. There can be no more cuts in healthcare programs for seniors, the disabled, and the disadvantaged, and no reductions in retirement security.”

NNU’s national executive board recently passed a resolution stating that it will not endorse any federal candidate in 2012, from the President to Congress, who votes to cut Social Security.

“We expect the President and our elected leaders in Congress to stand up, and protect our most basic safety net programs, which start with Social Security, Medicare, and Medicaid,” said Ross. “For 30 years, we’ve seen a massive shift of our nation’s wealth and resources transferred from Main Street to the executive suites. The result, record profits, and unbridled corporate corruption and thievery, while wages for working people stagnate, and income and health insecurity soar.”

If the President and the Democrats want to cut the deficit, said Ross, they should end the wars in Afghanistan, Iraq, and Libya, reduce military spending, close all the corporate tax schemes that have allowed more than 40 percent of corporations to avoid taxes, restore a fair tax system, and re-invest in America to create good paying jobs in the U.S., not China or India.

NNU is also calling for a Main Street Contract for the American People, a second bill of rights, that includes jobs at living wages, guaranteed healthcare for all, a secure retirement, a safe and healthy environment, a secure retirement for everyone, and respect for union rights.

Republican proposals to privatize Medicare, slash Medicaid, and make further deep cuts in safety net programs are “obviously reprehensible,” said Ross. “But without real leadership from the other party and the White House, and a clear road map for an alternative vision, these mean spirited proposals, and continued handouts for the wealthy and corporate elites, will surely follow. It’s time for the President to stand up for the working people of this country, not the corporations which brought us an economic tsunami.”

Representative Paul Ryan’s proposals to reform Medicare and Medicaid are mostly an effort to shift the burden to beneficiaries and the states. They have very little reform in them.
Related in Opinion

They certainly won’t solve the two most pressing problems in the nation’s health care system: the relentlessly rising cost of care and the shamefully high number of uninsured Americans — now hovering around 50 million. Mr. Ryan is also determined to repeal the new health care reform law. Never mind that the law would make real progress on both fronts, covering more than 30 million of the uninsured and pushing to make health care delivery more efficient and effective and less costly.

One of Mr. Ryan’s most damaging ideas is to change Medicare and Medicaid from entitlement programs — covering everyone who is eligible for a defined set of services. Instead, Washington would contribute set amounts that would almost certainly grow more slowly than medical costs. You will hear a lot about how squeezing outlays will mean more efficiency. The real result is that the most vulnerable — the elderly, the poor, the disabled — will have to pay more for care or forgo treatment.

The government currently pays half or more of the costs of Medicaid, which insures the poor. Under Mr. Ryan’s proposal, the federal government would give each state a lump sum that probably would not keep pace with rising costs or accommodate surges in demand. Right now when a recession hits, the federal and state contributions rise to meet the higher rolls. The states would be given great flexibility, but many would use that to reduce benefits or drop people from coverage.

Mr. Ryan would largely privatize Medicare starting in 2022. New enrollees would be given “premium supports” to help them buy private insurance. The rich would get lower subsidies, the sickest and poorest would get additional assistance. Once again, the federal payments would likely grow more slowly than costs forcing individuals to buy skimpier coverage or pay more.

Republicans hope that competition among the private plans would lead them to use the most efficient doctors and hospitals. The reform law also seeks savings from such competition but goes far beyond that, starting pilot projects and establishing new organizations to spread the most promising reforms throughout the system.

For decades the Republicans have made clear their antipathy toward Medicare and Medicaid. Now they are trying to use the public’s legitimate concerns about the deficit to seriously cripple both programs. This isn’t real reform. If it moves forward, Americans will pay a high price.

The Obama administration is delaying until next January its enforcement of some new rules designed to protect patients who appeal insurers’ decisions to deny or reduce health care benefits.

In the meantime, the Labor Department said in a posting on its website that it will revise the requirements to deal with objections raised by insurers. These rules were mandated by the health care law, and federal officials had earlier said they would start enforcing them in July.

The delays were defended by the administration and the insurance industry but worry consumer advocates.

Among the rules now on hold are:

– A reduction in the amount of time an insurance company is allowed to review a denial of coverage in urgent cases, from no more than 72 hours to 24 hours.

– A requirement that insurers provide information about the denial and how to appeal in appropriate language for non-English speaking beneficiaries.

– A requirement that insurers must provide consumers with specific details, which would include diagnostic codes used by doctors, hospitals and insurers, about what treatment isn’t covered and why.

When the administration first released the appeals rules, it said they would go into effect last January. Last fall officials revised that timeline to say enforcement of some rules would not begin until July to allow insurers appropriate time to get procedures in place.

But the low-key announcement posted on the Labor website March 18 tells insurers and self-insured employers that the enforcement grace period has been extended until 2012 because the government intends to modify the rules “in the near future.” What those changes might be were not disclosed, but the prospect concerns consumer advocates.

“We want to be sure that delays don’t mean it won’t happen,” said Cheryl Fish-Parcham, deputy director for health policy at Families USA, a health advocacy group.

“Once again the rights that were promised under the Affordable Care Act are going to be further delayed,” said Timothy Jost, a health law professor at Washington and Lee University School of Law and a consumer representative to the National Association of Insurance Commissioners.

The appeals announcement is the latest of several moves by the administration that slow down implementation of the health law. It has granted temporary exemptions to states seeking more time to comply with certain provisions of the law and given waivers to insurers offering limited-benefit policies known as “mini med plans.”

The government is “under a lot of pressure from businesses and insurers to make things work more smoothly,” said Jost.

But a Labor Department spokesman said in a statement that the new decision “struck a balance” in response to a variety of groups that had submitted comments on the rules, including health insurers, states, patient advocacy groups, employer-sponsored health plans and other.

In its comments to the government, America’s Health Insurance Plans, a trade association representing 1,300 insurers, said that providing detailed explanations to consumers using diagnostic codes would be an administrative burden and could even delay getting denial notices to beneficiaries. The group also said that since some urgent care decisions don’t involve emergencies, they don’t have to be made within 24 hours.

Translating appeals information to languages other than English would also create administrative challenges, the group said. The association’s spokesman, Robert Zirkelbach, said that it was better for consumers to talk to a live person who can answer questions rather than translating information in writing.

“The goal is to have a process that will work better and more efficiently for consumers,” Zirkelbach said.

One aspect of the new appeals rules that is not affected by the latest government announcement is the timeframe given to consumers to file an appeal. Under most plans, beneficiaries have 180 days after receiving a denial notice to request a review. The announcement also does not affect the right to appeal when coverage is canceled or denied because the treatment was not medically necessary, said Fish-Parcham.

A report released last week by the Government Accountability Office, the independent investigative arm of Congress, underscored the importance of appeals. The GAO analyzed data from four states and found that 39 percent to 59 percent of consumers succeeded in reversing a coverage denial when they appealed to their insurance company.

The suspended rules apply only to the first stage of an appeal, one that is filed internally with the health insurer and is required in most cases before the consumer can appeal outside the company. In February, 24 consumer organizations and patient advocates sent a letter to Health and Labor officials urging them not to relax some rules affecting the law’ provisions establishing the external appeals process.

Kaiser Health News is an editorially independent news service and a program of the Kaiser Family Foundation, a nonpartisan healthcare policy research organization. Neither Kaiser Health News nor the foundation is affiliated with Kaiser Permanente.

At its one year anniversary the Obama health care law is shrinking while the health care crisis grows. Americans who lack any health coverage still exceeds 50 million, over 45,000 deaths occur annually due to lack of health insurance, and 40 million Americans, including over 10 million children, are underinsured.

Premiums are rising and coverage is shrinking a new norm is taking hold in America: ‘Unaffordable underinsurance.’ This month, the number of waivers granted to the Obama health law broke 1,000 protecting inadequate insurance plans. The expansion of health insurance to the uninsured is becoming a mirage. The Obama administration has told states they could reduce the number of people covered by Medicaid as well as reduce the services provided. And, the centerpiece of the law is under court challenge – the mandate is the first time ever the federal government has forced Americans to buy a corporate product, private health insurance – is heading to a close Supreme Court decision.

The New Norm: ‘Unaffordable underinsurance’

To make insurance premiums affordable, the quality of insurance will need to be reduced so there is less coverage and more out-of-pocket costs, as Don McCanne, MD, Senior Health Policy Fellow for Physicians for a National Health Program writes: “’Unaffordable underinsurance’ is rapidly becoming the new standard in the United States.” The trend in health insurance is rising premiums and shrinking coverage for many Americans who get their coverage at work as well as on the individual insurance market.

Premiums have been increasing with reports ranging from 20% to 60% increases for many Americans and businesses. Further, the law may decrease employment-based insurance by 3 million people by 2019, according to the Congressional Budget Office (CBO) and the Joint Committee on Taxation. This combined with high unemployment and underemployment will push people into the individual insurance market. The individual market is particularly at risk for increased premiums which is of growing importance because of high unemployment. Blue Shield of California decided this month to withdraw a major hike in the face of public outcry. This proposed 30%-35% increase would have been the third rate hike since October, the three increases would have raised rates by 59% to 87% for 200,000 policy holders. While some hope the Obama health law will slow premium hikes, Claudia Fegan, MD of Physicians for a National Health Program writes under the Obama heath law “sudden premium hikes are still possible and, in my opinion, quite likely under the new law.”

Underinsurance, requiring Americans to pay more of the cost of health care, may become the norm because of the 2010 law. The new law will hasten the current trend toward underinsurance as plans where patients pay an average of 40% of their health care bills qualify to fulfill the employers’ obligations to provide coverage rather than pay an assessment. Massachusetts, the model on which the Obama reforms are based, recently found that medical bankruptcies have not decreased with the new law. The lesson – it is not just health insurance, but the quality of the insurance that matters. After deriding merely adequate insurance as Cadillac Plans,” the Obama administration is showing support for high deductibility plans with large out of pocket costs that do not provide financial or health security.

One promise of the Obama health plan was that millions of underinsured would get decent insurance coverage because the “reform” required minimum levels of insurance. But, waivers to the requirements of the 2010 law are being widely granted resulting in millions of Americans continuing to have inadequate health coverage. Waivers allowing poor quality insurance affect 2.6 million people and are being granted rapidly to businesses, unions, insurance companies as well as states who cannot meet the Obama law requirements. The administration says the purpose of the waivers is to avoid disruption in the insurance market, in clearer language it is to prevent employers from dropping coverage and insurance companies from leaving markets. The requirement for a waiver is relatively simple; the applicant must show HHS “a significant increase in premiums or a decrease in access to benefits.” Ninety-four percent of requests for waivers have been granted, the largest area where waivers have been denied has been for unions. Republicans have asked HHS for in-depth details about every waiver decision and request.

The major area of waivers are so-called mini-med plans, these are limited medical plans which provide workers with as little as $2,000 in health care coverage. The Obama health care law requires $750,000 minimum coverage in 2011. The mini-med plans do not provide security in the event of serious illness or accident. The vast majority of these waivers are for employment-based health coverage. Some of the initial waivers went to fast food chains like McDonalds and Jack-in-the-Box. Unions, insurance companies and state governments have also received waivers. Four states have received waivers, Florida, New Jersey, Ohio and Tennessee. Waivers are set to disappear in 2014, when people will be required to purchase insurance with tax payer subsidies – assuming that Obama health law survives and that low-paid workers can afford insurance even with a subsidy.

Expanded Numbers of Americans with Insurance Becoming a Mirage

The two largest areas of expansion, Medicaid and the insurance mandate are in jeopardy. States are cutting the number of people covered by Medicaid and reducing health coverage. The insurance mandate is under constitutional attack. And, there is little evidence that people are taking advantage of programs that provide coverage for those with pre-existing illness.

The area with the biggest immediate impact on reduced coverage is the roll backs of Medicaid. Medicaid was projected to be the largest area of expansion of medical care under the Obama health care plan, covering 16 million more people, making up half the projected increase in additional Americans covered with some type of insurance under the Obama law. That is now becoming a mirage.

HHS Secretary Sebelius wrote the 50 states letting them know benefits could be cut, poor people could be required to pay a higher share of costs and that federal law allows states to reduce people covered by Medicaid. Medicaid is health care for the poor and is jointly funded by federal and state governments. Medicaid currently covers 53 million poor children, poor pregnant women and disabled and extremely poor adults. Individuals must make less than $14,500 to be included in Medicaid.

More than half the states want permission to remove hundreds of thousands of people from Medicaid. Arizona alone is planning to reduce Medicaid coverage by 250,000 people and the Obama administration has indicated it will not oppose this reduction in coverage. In Wisconsin, where Governor Walker has proposed deep cuts to Badgercare (which includes Medicaid and other programs) up to 350,000 could lose health care coverage. Rather than an increase in the number of people covered, the nation is on a path to reduce total people covered.

Other states, like New York, Hawaii and California which are led by Democratic governors, are cutting benefits of Medicaid programs that already provide insufficient coverage. Medicaid is often one of the largest expenses of a state but because the cost is shared with the federal government it is also a large source of revenue. As a result it takes more than $2 of Medicaid cuts to save a state $1. When Medicaid is cut the economy is weakened and revenues reduced as for every dollar cut, health care jobs are lost. Cutting health care for the poor and disabled continues the downward economic spiral – the race to the bottom.

When it comes to people taking advantage of expected benefits of the health care law, thus far only 12,000 people have enrolled in the Pre-existing Condition Insurance Plan despite an aggressive marketing effort. The Medicare actuary, Rick Foster, told The Hill the low enrollment is a “surprise,” given that “millions” are eligible for the coverage. The Medicare actuary had conservatively predicted the new pools would enroll 375,000 people by the end of 2010, but that projection has not been met because the insurance is too expensive for most people who need it.

Better results might be being seen for young adults. Approximately 13.2 million 18-29 year olds are without insurance, 30% of that population. Under the health care law these youth can stay covered under the parents’ health insurance. There are no hard numbers for how many have taken advantage of this but the Obama administration estimates it could be as many as 1.2 million. As we see with the pre-existing illness option, predictions are one thing and reality is very likely another. Covering each dependent will cost about $3,380 in 2011, so it is difficult to predict how many families can afford that cost in these difficult economic times when unemployment and underemployment are up and incomes are down.

The Obama health care law may decrease employment-based insurance by 3 million people by 2019, according to the Congressional Budget Office (CBO) and the Joint Committee on Taxation. One estimate made by the CBO is that 8–9 million people currently covered under an employer plan would lose employer coverage because firms would choose to no longer offer coverage. They assume this would be balanced in part by those getting coverage on the exchange.

The other area where increased coverage was promised is the mandate forcing Americans to buy insurance. The mandate is hotly contested in the courts with 27 states challenging the law and over 20 lawsuits filed it. The courts have split 3-2 in favor of the mandate thus far. In the two decisions finding the mandate unconstitutional, a Virginia judge threw out only the mandate, while a Florida judge found the mandate so intertwined with the rest of the law that he would stop the whole law. The decisions have been issued along partisan lines, with three district judges appointed by Bill Clinton upholding the law; and two district judges — one appointed by Ronald Reagan and the other by George W. Bush — finding it unconstitutional. The U.S. Supreme court has five Republican appointed justices and four appointed by Democrats. It is generally viewed as four on the center-left, four on the right and Justice Kennedy as the swing vote. The vote on the Supreme Court will be a close one.

The health care law faces a congressional challenge, especially from the Republican controlled House of Representatives which has already voted to repeal the law, but more importantly, promises to use the power of the purse to not fund its implementation.

Single Payer Rising: Why Not Just Improve and Expand Medicare to All?

The imploding health care law is creating an opening which may require a re-consideration of health care reform within the next five years. Americans consistently favor simply expanding and improving Medicare to cover all Americans. Terry Dougherty, director of MassHealth, from a state which the model for the Obama law is in place is reaching the obvious conclusion: “I like the market, but the more and more I stay in it, the more and more I think that maybe a single payer would be better.” He notes that unlike the insurance industry government costs less, with much lower administrative costs and “We don’t build big buildings. We don’t have high salaries. We don’t have a lot of marketing.”

The low cost of publicly funded health care is consistent with the experience of America’s single payer system – Medicare. The administrative cost of running the Medicare program has remained under 2%. But, the bureaucracy of trying to control the insurance industry is already growing rapidly. The growth of the federal insurance bureaucracy, the federal office that regulates private insurance along with other important duties under the Obama health law, already has 252 employees and a budget of $93 million for 2012 budget requested by the White House.

While the single payer movement is growing stronger through groups like Health Care Now and Physicians for a National Health Program, the insurance industry is also getting stronger. Not only will they receive hundreds of millions in new annual tax payer subsidies but they are taking over other parts of health care. Kaiser Health News reports “Insurers have moved into technology, health-care delivery, physician management, workplace wellness, financial services and overseas ventures.” The Obama law is spurring the cancer of health insurance to spread throughout health care.

At the state level Vermont is striving toward single payer. Governor Shumlin, his technical advisers and Vermonters support a single payer program, and are considering a bill that reduces the number of funding sources and if federal waivers are granted, which Obama reportedly supports, it will evolve into a single payer program. The current version of the bill falls short of the goals of advocates who want health care treated as a human right as well as of physicians who seek a single payer program.

The “Expanded and Improved Medicare for All Act,” H.R. 676, a bill that sets up a single payer system has been introduced. It would provide health care to all and give consumers the most choice, provide strong health coverage as well as save money for government, business and individuals. Unlike the Obama law, improved Medicare for all would also be easier to implement. Medicare transitioned Americans over 65 from private insurance to Medicare within a year and did so without computers.

The failing Obama reforms shows that the obvious must be faced: confront the health insurance industry which makes coverage of all Americans unaffordable. President Obama knew before running for president that single payer was the solution, but after receiving $20 million in donations from the insurance industry refused to let the only real solution, improved Medicare for all, be considered. It is time to put in place a single payer health care program that ensures that all U.S. residents have quality health care at less cost than they currently pay.

Kevin Zeese is director of Prosperity Agenda.

“Sooner or later people are going to realize that decisions about whether one lives or dies should not be predicated on ‘How much money can I make off this?’” says Michael Moore, looking back at his film Sicko with Donna Smith of National Nurses United. They both note that it’s the health care workers who are leading the fight for a better system for all, even as those workers are under attack themselves.

To kick off our new series, The Nurses’ Station, Michael and Donna joined Laura in studio for a look back at Sicko and a conversation about what has changed since the film was made, and why it’s not enough.

March is Women’s History Month. But this year, for the vast majority of women in America, there is little to celebrate.

Over the past months, “deficit gurus” in the U.S. House of Representatives have unleashed the most devastating assault on women’s health in our nation’s history. If legislation already passed in the House is approved by the Senate and signed into law by President Obama, women’s rights and health will be set back by decades.

Many critical programs are on the chopping block, such as the Public Health Service Act or Title X, providing basic health services, including Pap smears, family planning services, and cancer screenings to more than 5 million low-income people, mainly women.

Slashing Title X will lead to thousands of unnecessary deaths. Maternal and Child Health Block Grants, chiefly benefitting poor women and children, will be cut by $210 million. The Centers for Disease Control and Prevention will be reduced by some $755 million, undermining many public health efforts such as confronting HIV/AIDS. Community health centers providing essential services to millions of women and families across the country will face a brutal $1.3 billion cut.

This onslaught against women joins that against U.S. working people. Look, for example, at the assault on Medicaid, or the drive to cut wages, benefits and collective bargaining rights. Wisconsin is only the most flagrant example of a nationwide phenomenon.

Or consider the chorus that, both from the right and from sectors of the “liberal” left, is calling for “saving” Social Security by reducing benefits, increasing eligibility age or privatizing the program. Yet Social Security is financially sound for at least another 27 years. Whatever problems it may have could be easily fixed by simply raising the cap on the taxable income of the very wealthy. And Medicare and other publicly financed health care programs, favorite targets of the budget cutters, pose a problem only because the U.S. health care system, pre- and post- the federal health law, is built upon a rotten foundation: for-profit health insurance.

Despite subtle differences, both sides of the political aisle convey the same message: “We” must pay for “our excesses” that caused “the deficit” by giving up on our “generous benefits.”

Notably, Wall Street excesses figure nowhere in these arguments, even if its benefits are clear. As President Obama noted candidly in his State of the Union address, “the stock market has come roaring back and corporate profits are up.”

Meanwhile, our “benefits” don’t even include guaranteed access to basic health care, as is the norm in every other wealthy nation. The new federal law has “reformed” the system essentially by mandating us to purchase for-profit insurance increasingly under-insurance under penalty of a fine, and expanding coverage, not necessarily care, through an underfunded Medicaid program. Finally, it leaves at least 23 million people uninsured annually a decade from now.

If this scenario is allowed to stand, women will suffer disproportionately. But in the spirit of International Women’s Day, women’s groups and others are fighting back, and championing the most just and cost-effective solution to our health care woes — single-payer national health insurance, an improved Medicare for All.

As we commemorate those 15,000 brave women who back in 1908 marched through New York City demanding shorter hours, better pay and voting rights, American women and working Americans generally must demand no less.

Claudia Chaufan is an assistant professor at the Institute for Health and Aging at UC San Francisco. She is also vice president of Physicians for a National Health Program — California.

It’s a club I will never be in. Michael Moore told us about them this week. The Forbes 400. The richest 400 people in America. They own more stuff and have more cash and assets than half of the rest of us (roughly 150,000,000+ people) combined.

But I had to dig deeper. It wasn’t offensive enough to me that just 400 people own so much that was as the result of the hard work and suffering of so many of the rest of us. I was willing to bet it was a deeper profile of power in 2011 America than that repugnant statistic alone indicated.

I was right. In the Forbes 400, most of the people are white guys. In fact, 365 are guys. Very few non-white people, and only 35 women are in the club. And Oprah is the only black woman. 365 plus 34 and Oprah.

That just about says what we need to know about our society. It’s a good ol’ mostly white boys and a few mostly white girls plus Oprah club. Their money controls our industries; their industries control our access to the good life or lack thereof. And they are still mostly male, mostly white and drenched in wealth – even 235 years after a bunch of mostly white, all male folks declared that all men had rights unalienable. They weren’t lying about the men part. I’ll give them that.

Sometimes when I am thinking we’ve advanced so far since the Founding Fathers set forth upon this continent a new nation that I forget reality slapping me in the face. I am not on the Forbes 400 or the Forbes 4,000 or the Forbes 4,000,000. And I never will be. I’m a working class white girl.

I guess I will have to content myself with the notion that I’m in a more exclusive club than they are. I am a cancer survivor who weathered financial collapse that followed being an American with inadequate access to healthcare and then had my story told in Michael Moore’s 2007 film, SiCKO. About a dozen of us were featured in that film, and we’re not in the Forbes cohort.

Just yesterday, the report came out that bankruptcies due to medical crisis had not been significantly reduced by the Massachusetts healthcare bill known as RomneyCare, or Chapter 58, the mandated purchase of private insurance, passed in 2006. More than half of all personal bankruptcies still flow from medical crisis and of those going broke, 89 percent had health insurance.

I think that my club, though small, is pretty diverse and full of good-hearted people (men, women and kids of all races, colors, sizes and shapes) who would trade the chance for all the influence and power on earth and a slot on the Forbes 400 list – and our moments of fame in SiCKO — for a transformed healthcare system that provided a single standard of high quality care for all without financial barriers. I like my club better.

Donna Smith is a community organizer for National Nurses United (the new national arm of the California Nurses Association), National Co-Chair for the Progressive Democrats of America Healthcare Not Warfare campaign, and Healthcare-NOW! Steering Committee member.