A year after President Obama signed his health care reform with strong support from the labor movement, advocates of a single-payer system might be tempted to ask, “How’s that working out for you?”

At last weekend’s conference of the Labor Campaign for Single Payer, a Plumbers and Pipe Fitters delegate pointed out that his members are paying $12.31 per hour for their health benefits.

The activists marshaled their forces once again in D.C. last weekend, where campaign coordinator Mark Dudzic reported progress on the group’s mission: “to establish and expand within labor the idea that labor has got to lead this fight” for single payer, or improved and expanded Medicare-for-All.

Indeed, the conference began June 3 at AFL-CIO headquarters and heard from President Richard Trumka himself. Trumka spoke of the reluctance of the AFL-CIO Executive Council to embrace single payer but pointed to disappointment with the president’s Affordable Care Act at the council.

He recalled meetings 20 years ago when he fought for single payer on the council and Karen Ignagni, then assistant to the AFL-CIO president, was “doing her damnedest” to thwart the effort. (Today Ignagni is CEO of America’s Health Insurance Plans, the lead lobby for health insurance corporations.)

Trumka referred to single payer as “the only way to cure the health care problem.” He proposed that labor should “continue to educate about Canada. It’s a big myth about Canada. I go there all the time. You sit down with someone over coffee and ask them: ‘Tell me about your health care.’ They say: ‘Oh, it’s a godsend.’ We need to get that message out.”

The AFL-CIO president also continued to gesture toward political independence for labor, saying, “We should strengthen our support for our friends and do less for our acquaintances.”

As signs of progress, Dudzic noted the federation’s financial support for the Labor Campaign, participation by Vice President Arlene Holt Baker in a press conference announcing single-payer legislation, and the fact that the AFL-CIO sent staffer Nick Unger to help the single-payer efforts in Vermont. (Unger was the same staffer who in 2009-2010 campaigned for single-payer activists to embrace the public option.)

Dudzic also reported progress within the Labor Caucus for Single Payer, a group of nine internationals chaired by Greg Junemann of the Professional and Technical Engineers. Dudzic suggested several unions in which single-payer activists should “insist that our leaders follow the direction of the members.”

Without the White House

The deafening silence coming from the White House was a recurring theme as participants discussed the state-by-state assault on labor, ongoing unemployment, and the relentless rise in the costs of care. Stuart Acuff of the Utility Workers counseled, “Our job is not to follow Obama. Our job is to hold Obama accountable.”

Although the chances of passing a single-payer bill this year are less than remote, delegates welcomed Representative Jim McDermott of Washington by conference call and Representatives John Conyers and Dennis Kucinich, co-sponsors of HR 676, in person. HR 676, which calls for a publicly financed, privately delivered health care system, has been introduced every year since 2003.

McDermott, a psychiatrist, recently introduced a single-payer House companion to one introduced by Senator Bernie Sanders of Vermont.

Delegates agreed to support both the McDermott and Conyer bills, yet took note that HR 676 covers the undocumented, forces for-profit hospitals to convert to non-profit status, and requires federal, instead of state-by-state, administration.

On more immediate efforts in the states, delegates heard a panel from Vermont, where the Act for a Universal and Unified Health System was signed into law May 26. Mari Cordes of the Vermont Nurses/AFT recalled that only two years ago single-payer advocates were called “bomb throwers” by Vermont legislators for sticking to a cause labeled “too hard” and “not possible.”

Jill Charbeonneau, president of the Vermont AFL-CIO, cautioned that the legislation was the first in a series of steps toward single payer—”a skeleton this year,” followed by a year-long process of defining the scope of health benefits under the plan, followed by a second to third year process “to decide how to finance the system,” and ultimately a need for waivers from the federal government.

A video excerpt from the Vermont Workers Center illustrated the grassroots campaign, predicting: “If Vermont Leads, the Rest of the Nation Will Follow.” On a panel about the effort in California, Cindy Young of the California Nurses Association laid out a multi-year strategy for achieving single payer in that state.

Don Tremontozzi, a local president who is running for the No. 2 job in the Communications Workers national union, described how his members phone-banked for single payer in Vermont this spring.

“Once it was, ‘I want what the unions have,’” Trementozzi said. “Now it’s, ‘Why should you have 100 percent coverage?’ We need to get to the public.”

He roused the room with a call to defend the existing benefits companies are trying to claw back.

Drawing parallels between his union’s upcoming contract negotiations with Verizon and talks now under way with General Electric, Trementozzi said, “Yesterday at the CWA headquarters Verizon made a presentation about how costly health care is. These companies make billions in profits! They pay their CEOs millions!”

Trementozzi said “these companies act like they make no money at all” when they come crying to jack up insurance rates and cut health benefits for retirees.

“I say, ‘Over my dead body!’” Trementozzi said. “When a company makes billions and pays no taxes—we won’t stand for it!”

House Republicans plan this week to propose more than $4 trillion in federal spending reductions over the next decade by reshaping popular programs like Medicare, the Budget Committee chairman said Sunday in opening a new front in the intensifying budget wars.

Appearing on “Fox News Sunday,” the chairman, Representative Paul D. Ryan of Wisconsin, also said Republicans would call for strict caps on all government spending that would require cuts to take effect whenever Congress exceeded those limits.

“We are going to put out a plan that gets our debt on a downward trajectory and gets us to a point of giving our next generation a debt-free nation,” Mr. Ryan said, even as he predicted that the politically charged initiatives he intended to lay out in the 2012 budget beginning Tuesday would give Democrats a “political weapon to go against us.”

“But they will have to lie and demagogue to make that a political weapon,” he said.

Republicans and Democrats remained divided over how to reach an agreement that would avert a government shutdown, which could come as early as Saturday, when a budget bill now financing the government is set to expire.

Senator Charles E. Schumer of New York, the chamber’s No. 3 Democrat, said progress was being made, but neither he nor other top lawmakers could guarantee that government agencies would be able to stay open after Friday.

Mr. Schumer said Democrats were urging Republicans to consider reducing some of the automatic annual spending in Agriculture, Treasury and Justice Department programs to reach a target of about $33 billion in cuts rather than insisting that it all come out of what is known in budget parlance as discretionary accounts.

A Democrat involved in the negotiations, who spoke on the condition of anonymity, said alternative spending cuts from the White House and Senate Democrats would range up to $8 billion. But to the Democrats’ dismay, not only were Republicans resisting those cuts, they were also proposing more spending than the Pentagon wants for military and homeland security programs.

“If you just cut from domestic discretionary, you’ll have to cut things like helping students go to college; you’ll have to cut scientific research, including cancer research,” Mr. Schumer said on the ABC News program “This Week.” “These things have created millions of jobs through the years.”

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A year after the passing of health reform, a new industry report revealed that consumers may be paying billions of dollars more in out-of-pocket health care expenses than was previously thought.

These “hidden” costs of health care — like taking time off to care for elderly parents — add up to $363 billion, according to a report from the Deloitte Center for Health Solutions, a research group.

That amounts to $1,355 per consumer, on top of the $8,000 the government says people spend on doctor fees and hospital care.

“We’re surprised that this number came in so high. It’s significant,” said Paul Keckley, executive director with the group.

The out-of-pocket costs that the government tallies usually include only insurance-related costs like premiums, deductibles, and co-payments.

Keckley said the study is the first to estimate how much consumers dish out on health care related goods and services not covered by private or government insurance.

These include: ambulance services, alternative medicines, nutritional products and vitamins, weight-loss centers and supervisory care of elderly family members.

“These costs can add up to billions of dollars, even eclipsing housing as a household expense,” said Keckley.
Big health care changes in 2012

The Deloitte study found that half the hidden costs are for supervisory care, or the unpaid care given by family and friends.

“We compared on an hourly basis the average number of hours per month taken off work to look after a family member or friend, and lost wages in doing this,” said Keckley.

The report estimates the value of unpaid care is $12.60 per hour, or $199 billion a year.

“It has been one year since the passage of health care reform,” said Keckley. “We wanted to understand the financial context behind decisions that consumers are making about how they spend their money on health care.”

As health reform rolls out over the next few years, Keckley expects that out-of-pocket health care costs to consumers will increase quickly. Health care costs continue to rise faster than household incomes and insurers are passing along more costs to their customers.

The average household income fell 1.9% last year while health care costs rose 6%, he said.

“This is a perfect storm in which consumers’ hidden costs will only increase exponentially in the near future.”

The Deloitte study looked at the most recently available health care expenditure data from the government. The firm, with Harris Interactive, also polled 1,008 U.S. adults,18 and older, between Sept. 29 to Oct. 4, 2010.

Shortly after noon on Friday, state Rep. Michael Dembrow stepped to the microphone and addressed a crowd of about 150 people gathered on the steps of the Oregon Capitol in Salem.

“You look so healthy,” he told his audience. “You must all have good health insurance.”

The line got a big laugh for the Portland Democrat, as he must have known it would. Dembrow is the chief sponsor of House Bill 3510, the Affordable Health Care for All Oregon Act, which would all but eliminate private health insurance in Oregon and replace it with a taxpayer-funded system covering everyone in the state: single-payer health care.

Dembrow’s bill was scheduled for a hearing before the House Health Care Committee on Friday afternoon, and the lunchtime rally on the Capitol steps was a bit of political theater calculated to show support.

Toting signs with slogans such as “Patients Not Profits,” “Single Payer Now!” and “Everybody In, Nobody Out,” the crowd chanted and cheered for more than an hour as speaker after speaker slammed the insurance industry, shared horror stories of Americans bankrupted by medical expenses and called on the legislature to enact Dembrow’s proposal.

The really funny thing was, none of them seemed to think it has a ghost of a chance.

Rep. Jules Bailey, one of the bill’s co-sponsors, exhorted the crowd to settle in for a long fight.

“Don’t stop,” Bailey said. “If we don’t get there right away, we will get there eventually. We will get there.”

As Dembrow himself put it, “It’s not all about the bill. Single payer is a movement.”

“A long-term effort”

For hardcore health care reformers, single payer is the holy grail, a system that would rein in out-of-control medical costs while extending coverage to everyone. But they face determined and well-financed opposition from insurers, pharmaceutical companies and tea party Republicans, who deride the idea as socialized medicine.

HB 3510 is not the first attempt to create a single-payer health care system in Oregon. That distinction belongs to Senate Bill 1066, which was introduced in 1995 — and promptly faded into obscurity.

The issue was resuscitated in 2002, when Health Care for All-Oregon mounted a statewide signature-gathering campaign that succeeded in placing Measure 23 before the voters — who shot it down by a 700,000-vote margin.

Now it’s back, and while Dembrow has no illusions that his bill will pass, he’s crossing his fingers that it will stay alive long enough to generate some genuine discussion in the legislature. He has two co-sponsors on the Senate side, where he’s hoping the proposal could get additional hearings.

If he can get enough lawmakers interested in the concept, they might be willing to commission an in-depth cost analysis, a step that could build additional support. And even if 3510 dies this session, as expected, he’ll push to send it to Oregon voters again as a referendum, possibly in 2013.

“The likelihood of this bill passing and us having a single-payer system in the next year or two is remote,” Dembrow acknowledged in an interview last week.

“I see the effort for single payer as being a long-term effort,” he added. “There is still a lot of education that has to happen and a lot of organizing that has to happen, and this bill is a vehicle for that.”

Coalition-building

As health care costs continue to rise faster than American incomes, more and more people are flocking to the single-payer banner. In Oregon as in other states, the coalition that has formed around the issue includes labor unions, doctors and nurses, churches and social justice organizations, all of which were well represented at Friday’s rally in Salem.

Peter Shapiro was the master of ceremonies, introducing the speakers and setting the tone for the event with his rabble-rousing commentary.

A retired mailman who now works as an organizer for Portland Jobs With Justice, Shapiro urged the audience to fight back against the attacks on public employee unions around the country.

“I have one of those gold-plated plans,” he told the crowd. “I’m one of those people you’re supposed to hate. And 25 percent of my federal annuity goes to insurance premiums.”

In an interview, Shapiro talked about organized labor’s shift toward single payer after years of fighting to protect hard-won insurance benefits — often achieved at the cost of significant concessions on wages.

“It’s a difficult transition for union members to make. It’s a mark of how badly our health care system has deteriorated,” he said.

“More and more unions are realizing we’re living on borrowed time as far as benefits are concerned, and they’re paying a greater and greater price to keep those benefits at the bargaining table.”

Portland Jobs With Justice has thrown itself into the campaign for single payer, reaching out to other labor organizations to broaden the coalition supporting HB 3510. So far, nine Oregon unions have officially endorsed the measure — including two that represent teachers, often targeted for having Cadillac health benefits.

In January, Shapiro helped organize a highly successful conference on single payer in Portland. More than 400 people turned out for the event, which featured keynoters such as Dr. Margaret Flowers of Physicians for a National Health Program and Michigan Rep. John Conyers, one of the champions of single payer in Congress.

And on Friday, Shapiro brought a dose of fiery union rhetoric to the rally for HB 3510.

“We have the most profit-driven health care system in the world, and you see where that gets us,” he reminded the crowd as the event came to a close.

“The fact of the matter is, health care is not a commodity, it is a human right. And we are not consumers of health care, we are human beings!”

Mad as hell

Radiation oncologist Mike Huntington of Corvallis has devoted himself to health care reform since retiring in 2006. He became convinced of the need for change after seeing too many of his patients delay treatment because they lacked insurance coverage, with disastrous results.

“I saw it happen so often that it made me sick and then sad and then mad,” Huntington said.

In 2009 Huntington and fellow Corvallis physician Paul Hochfeld helped launch the Mad as Hell Doctors, an Oregon offshoot of Physicians for a National Health Program. The group mounted a cross-country tour, holding raucous single-payer rallies in more than two dozen cities en route to a demonstration on the White House lawn in a bid to influence the congressional debate on health care reform.

No trace of single payer made it into the federal health care reform law, which failed to include even the “public option” initially promoted by President Barack Obama.

But the Mad as Hell Doctors are still on the case. Last year they staged a California road trip to promote a single-payer measure in that state, and they’ve been touring Oregon for several weeks in support of the Dembrow bill.

On Friday, a white-coated contingent of Mad Docs was on hand for the Capitol rally, including Huntington.

The way he sees it, the financial logic of single payer is simply inescapable.

“Even health insurance CEOs privately say it. How can health care expenses keep increasing 25 percent a year? Eventually they’ll run out of customers,” Huntington said in an interview before the rally.

“It’s a false reality, and I’m going to stick around until the real reality is too hard to ignore.”

In it for the long haul

Betty Johnson is a battle-scarred veteran of the fight for single-payer health care in Oregon. She got involved in health care reform in 1991 through her church, and her faith continues to inform her work for the cause.

“It is a moral imperative to ensure that everyone has the health care they need,” she said.

The Corvallis resident, a widely respected leader in the state’s Health Care for All chapter, was a key player in the campaigns for SB 1066 and Measure 23 and now is pushing hard for HB 3510. In fact, she had a hand in writing all three proposals.

Johnson attended the rally, too, but before that she led a small cadre of Corvallis and Albany health care activists through the Capitol corridors on a mission to lobby as many lawmakers as possible to support HB 3510.

The group started on the House side of the building, stopping by the offices of Sara Gelser, Jim Thompson and Andy Olson before crossing over to the Senate wing in search of Frank Morse.

None of the legislators was in, so the mid-valley activists spent their time chatting up secretaries and aides, passing out copies of testimony to be given in the afternoon hearing and laying the groundwork for future meetings.

At Olson’s office, Johnson and Edie Orner, a retired schoolteacher who heads the Albany chapter of the Archimedes Movement, won a small victory: the promise of a breakfast meeting early next month.

Olson, an Albany Republican, is not known as a supporter of single payer, but he is willing to listen. Orner considers it progress.

“Everything that you do is building momentum,” she said, “and you just have to keep doing what you’re doing and hope that eventually there will be a tipping point.”

Johnson agrees. Like Dembrow, she has no expectations that 3510 will actually pass this session. And like him, she takes the long view of the fight for single payer.

The campaigns for SB 1066 in 1995 and Measure 23 in 2002, she said, started the conversation about single payer in Oregon, and Dembrow’s bill has created the opportunity to take the discussion one step further.

“The world is a different place than it was in 2002 — and I can’t help but think that it’s a different place, at least here in Oregon, in part because of what we did in 2002. We informed a lot of people,” Johnson said.

“That was a building block. This is a building block. And this campaign is not going to die.”

MONTPELIER — Rutland City Mayor Christopher Louras on Wednesday urged lawmakers to pursue with force the single-payer health-care proposal now under consideration in the Statehouse.

At the risk of offending his former Republican colleagues and the Rutland business community at large, Louras said, he believes the state’s health-care system must be “blown up” and remade from scratch.

Enacting a publicly financed system that delivers universal care and decouples medical coverage from employment is the only way to save municipalities like Rutland City from collapsing under the weight of rising health-care costs, Louras told the House Committee on Health Care.

“I have not made friends among former colleagues with ‘Rs’ next to their names,” said Louras, a former Republican representative from Rutland who served on the same health care committee to which he testified Wednesday morning. “And I think it’s fair to say the city’s position on universal health and the Rutland Chamber of Commerce’s and business community’s may not be specifically aligned.”

Still, Louras said, pressure on the city budget wrought by rising health-care costs have compelled him to speak out in favor of the single-payer plan.

“I started out as a skeptic of single-payer universal,” he said.

After assuming his mayoral post four years ago and seeing firsthand the impact of health-care costs on the city budget, Louras said, his perspective has changed.

Rutland is on pace to spend $7 million in payroll expenses in 2011 for 150 city employees. More than $2.5 million of that, Louras said Wednesday, will be spent on health care. And the figure would have been higher, he said, if the city hadn’t negotiated a new higher-deductible plan that could require more out-of-pocket expenses for city employees.

Those figures don’t include the $15 million in unfunded liabilities associated with health-care benefits for retired city employees.

“It has created a situation where, frankly, as individuals retired, I have not replaced those retirees due to the double cost of covering health insurance,” Louras said.

Rutland pays $16,000 per employee annually for a two-person plan and “north of $22,000” a year, Louras said, for an employee who opts for the family plan. As a result, he has left many vacant city positions unfilled; the Rutland City Police Department has three fewer officers today than it did four years ago.

“We’ve been drawing down staff not because it was easy or there was fat in the budget, but drawing down staff as matter of necessity to keep the budget within a range that was tenable to taxpayers,” Louras said. “And the largest piece that we could not control is health care.”

Louras said “incremental” steps like Catamount Health, an initiative he voted against as a lawmaker, won’t solve the problem that cities like Rutland now confront.

“Controlling health-care costs, and therefore controlling budgetary costs associated with health care, is a problem that needs to be licked and frankly I do support, as chief municipal officer of the city of Rutland, the universal single-payer health care under the conditions that have been defined by the governor of the state of Vermont,” Louras said.

Louras said his support is conditioned on one caveat: public employees cannot be eligible for taxpayer-subsidized “wraparound” coverage to supplement the basic benefits package envisioned in Shumlin’s plan.

Exposing municipalities to the cost of supplemental coverage, he said, would undo the cost-cutting benefits of a single-payer system.

As House Republicans make their futile attempt to repeal health reform, join us in launching the “Will You Cry for Me, John Boehner?” campaign.

Because we know Speaker of the House Boehner has an emotional side, we want to tell him our stories of struggle – the stories that make us cry – in hopes that instead of pretending to repeal health reform, we should start talking about real improved Medicare for all reform.

Look – we don’t have anything against crying, but John Boehner cries for the wrong reasons.

American dream: tears.

Millions uninsured: not a drop.

Personally, I shed a few tears of frustration when I opened up nearly $4,000 in medical bills for a doctor ordered biopsy.

We were all stunned and saddened when the Arizona state legislature ended the life-saving transplant program for nearly 100 Medicaid recipients.

We certainly didn’t jump for joy when Blue Cross Blue Shield of California, a not-for-profit insurer, increased premiums by 59%.

Tell your story and we pledge to deliver each and every testimonial directly to Speaker John Boehner…along with a tissue for each of your stories.

But we don’t need just sympathy. We need action. We pledge to continue the Campaign to Strengthen and Protect Social Security, Medicare, and Medicaid – and demand that single-payer healthcare be seriously considered to control the deficit and solve the healthcare crisis.

It’s easy to participate. Sign on to this letter here and leave your personal comment for John Boehner – anonymously if you prefer.

If you have a web cam, flip cam, or other video camera, consider filming your testimonial and sending it to us directly. Your video could be featured on the campaign website. Post your video to YouTube (here’s some directions) and email us the link.

Let John Boehner hear from you today. We need a real solution to the healthcare crisis. We need improved Medicare for all.

Yours in health,
Katie Robbins
Healthcare-NOW! National Organizer

Obama’s Health Plan is fatally flawed because it uses insurance companies to deliver healthcare, but the Health Plan also directly threatens Medicare.

People talk about “the healthcare crisis,” but actually there are two healthcare crises.

For us, the healthcare crisis is 51 million uninsured, stripping workers’ health plans, unaffordable health insurance that denies claims and charges high co-pays and deductibles, medical bankruptcies, a tattered safety net, dangerous mistakes in hospitals, and some of the worst health indicators in the industrialized word.

For corporations, the healthcare crisis is the high cost of healthcare premiums for employers, raising the price of US goods so they can’t compete in the world market.

As the debate over healthcare reform developed, media attention shifted from our healthcare crisis to the corporate healthcare crisis. Obama certainly talks about the healthcare crisis from the corporate perspective, and we can see the Obama health plan reduces healthcare costs for government and business, but does not reduce costs for workers and their families.

In fact, the Obama health plan introduces huge increases in costs, by guaranteeing trillions of dollars in profits for health corporations, particularly insurance and drug companies. If the Obama health plan was structured to guarantee huge profits for health corporations, where is the cost containment supposed to come from? Whose costs will get reduced?

Medicare is where costs will be reduced. In fact, more than half the cost of the entire Obama health plan comes from reductions in Medicare spending over the next ten years. The entire Obama health plan will cost about $1 trillion over the next 10 years, and $575 billion[1] will come from scaling back future Medicare increases that are needed to balance out inflation and to care for the baby boomers, who start getting Medicare in 2011.

How big a cut is this $575 billion? Total Medicare spending for 2010 to 2019 was expected to exceed $7 trillion[2], so this $575 billion reduction is up to an 8% cut, applied over the same period that 35 million baby-boomers will enter Medicare. Put differently, for the past 20 years Medicare spending grew 8%[3] per year. The Obama Plan will clamp down Medicare cost growth to 6%[4] per year. It’s not fair: Medicare and its patients would have to reduce their healthcare enough to achieve overall cost savings, even though monumental waste has just been cemented in place.

What’s insidious about this plan is that these Medicare cuts will NOT be felt by Medicare patients as direct cost increases or healthcare restrictions. Instead, the Medicare cuts will be to providers of Medicare treatment: the doctors, and hospitals, and home care agencies, rehabilitation facilities, and even durable medical equipment suppliers. These cuts will reduce providers’ incentive to treat Medicare patients, until the providers finally stop taking them. Like today’s Medicaid patients, Medicare patients will have problems finding someone to care for them.

From 2010-2019, future Medicare increases will be scaled back by $575 billion’
Some highlights:

* $145 billion in payment cuts to private Medicare Advantage plans, scaling their payments back to the level of traditional Medicare.

* $233 billion cuts in direct payments to the providers of Medicare hospital and outpatient care, plus penalties for their expected failure to meet “productivity” goals.

* $50 billion in cuts to Medicare “DSH” payments to hospitals serving low-income Medicare, Medicaid, and uninsured patients.

* $24 billion in cuts ordered by the Independent Payment Advisory Board, a new, independent, high-power, cost-containment commission built into the Obama Plan.

* Payment reforms: putting Medicare doctors under Managed Care.

* Cuts in payments to “inefficient” hospitals, mostly in low-income, medically-underserved areas, often large teaching hospitals serving the poor and uninsured.

Let’s look at these cuts in more detail:

$145 billion in payment cuts to private Medicare Advantage plans, scaling their payments back to the level of traditional Medicare.

In 2012[5], Medicare will begin reducing payments to the privately-operated Medicare Advantage Plans. This will take 3-7 years, depending on how much reduction is needed to bring an individual plan’s payment down to traditional Medicare levels. This is the Medicare cut most people have heard about. Obama has tried to get us to support the Medicare cuts by conjuring up images of him slashing the bloated payments to greedy private insurance companies administering Medicare Advantage plans. (While off-camera he gives private insurers tens of millions of new customers in 2014!)

Medicare Advantage never should have happened. Traditional Medicare was developed in the mid-1960s. Since that time there have been significant developments in medicine such as pharmaceuticals, an increased ability to treat illness on an outpatient basis, and technical advances such as medical imaging, endoscopic surgery, and prostheses. Also, since the mid-1960s, there has been a new attention to diseases of older people, such as chronic disease or mental problems. The potential of these advances has unquestionably been marred by market forces, yet, on balance, they are advances.

These advances should have been incorporated into the government’s basic Medicare plan, allowing Medicare to advance in step with medical science. Instead, corporate forces have blocked Medicare’s evolution, and many of the last 45 years of medical advances are only available to Medicare patients through private corporations. Medicare patients’ two choices are either (1) private Medigap insurance policies, which Medicare patients buy themselves to add benefits on top of their traditional Medicare benefits or pay for their traditional Medicare’s patient charges, or (2) private Medicare Advantage plans, which contract with Medicare to provide all Medicare services, and are paid for mostly by patients buying into the plan, but partly by government subsidies to the corporations running the plans.

The government and Medicare didn’t intend to subsidize these private Medicare Advantage plans. In 1997, HMOs and their lobbyists originally promoted these plans promising that these private corporations could provide traditional Medicare services plus modern medical advances and make a profit. Almost 5 million seniors enrolled in these plans. But the HMOs found they could not make enough profits to satisfy investors, and they started withdrawing their plans. By 2003, 2.4 million patients had been dropped. [6] Rather than responding to this crisis by adding modern medical advances to basic Medicare, the government caved in to corporate pressure, and increased its payments to Medicare Advantage plans. Payments to Medicare Advantage plans have been roughly 120% of payments for comparable patients in traditional Medicare.

It is this government subsidy to private plans which the Obama Health Plan eliminates. The Obama administration is OK with letting Medicare patients bear the extra cost of buying private Medigap policies for complete and modern healthcare. This explains why AARP, which sells Medigap policies, did not oppose the Obama Plan. And the Obama administration is OK with letting patients with just traditional Medicare pay out-of-pocket for additional services. But the Obama administration does NOT want the government to even partly subsidize complete and modern healthcare for Medicare recipients. Once again, the Obama health plan lowers costs for government, but raises costs for beneficiaries.

The payments cuts to Medicare Advantage plans are expected to lead to huge premium increases, benefit cuts, or outright cancellation of programs, which would decrease Medicare Advantage enrollment by 50%[7]. Before we gloat, remember, private insurers might lose up to 5 million Medicare Advantage customers, but they’ll be gaining at least four times that number in 2014 when “universal coverage” kicks in. But the millions on Medicare Advantage patients who are forced back onto traditional Medicare will be stuck with higher out-of-pocket costs or forced to buy private Medigap policies.

To be sure, people’s feelings do differ about the government’s cutting back on payments to private Medicare Advantage plans, but the important thing to remember is that these cuts to Medicare Advantage plans are only ¼ of the total Medicare cuts. What are the rest of the cuts, and how will they affect Medicare beneficiaries?

$233 billion cut in direct payments to the providers of Medicare hospital and outpatient care, plus penalties for their expected failure to meet “productivity” goals. This will lead to a shortage of Medicare providers.

These two kinds of cuts apply to virtually every kind of Medicare provider except doctors. They include hospitals, long-term care hospitals, skilled nursing facilities, inpatient rehabilitation facilities, inpatient psychiatric facilities, hospices, home health agencies, and even durable medical equipment suppliers.

The first kind of cut is a scaling-back of the yearly payment increases these providers get to compensate for their increased costs in providing care to Medicare patients. Actually, these payment increases have never kept up with inflation of medical costs. The yearly payment increases have ranged from 2.0-3.5%[8] over the last decade, but medical care costs in general have increased about 6% annually. In spite of this, the Obama plan will deduct a significant fraction[9] of each year’s payment increase, and the deduction gets worse as time goes on. Medicare providers will have less and less incentive to treat Medicare patients.

The second kind of cut is a one-time penalty if providers cannot increase their “productivity” as fast as the rest of the nation’s economy. CMS, the Centers for Medicare & Medicaid Services, knows it will be virtually impossible for providers to meet this “productivity” target, and has already counted these penalties as an income source. Even if facilities know they can’t meet their productivity targets, there will still be a strong incentive to rush Medicare patients through as fast as possible, to maximize their productivity and minimize the penalty. One medical adviser wrote[10] “Within the next 6-12 months, healthcare organizations will need to find a way to reduce their expenses or increase revenue by 3-5% to offset Medicare productivity adjustments.”

The combination of the across-the-board reductions and the penalties for not meeting productivity targets means many providers will experience absolute decreases in funding from one year to the next.

Medicare’s own Actuary estimates these two types of payment reductions could cause 15 percent of hospitals and other institutions to become unprofitable and stop providing Medicare services by 2019. By 2030 it would be 25 percent of hospitals[11]. According to Richard Foster’s April 23, 2010 report “providers for whom Medicare constitutes a substantive portion of their business could find it difficult to remain profitable and, absent legislative intervention, might end their participation in the program (possibility jeopardizing access to care for beneficiaries). Simulations by the Office of the Actuary suggest that roughly 15 percent of Part A (inpatient) providers would become unprofitable within the ten year projection period (2010-2019) as a result of the productivity adjustments.”[12]

Cuts in payments to “inefficient” hospitals, mostly in low-income, medically-underserved areas, often large teaching hospitals serving the poor and uninsured.

Obama’s speeches on his health plan have tried to reassure older people that the Medicare cuts would be benign because they would be restricted to (1) cutting the bloated payments to greedy Medicare Advantage companies, and (2) improving efficiency in the Medicare system. The concept of efficiency has come to the forefront in the discussion of healthcare financing. How has this happened?

For two decades, the Dartmouth Institute for Health Policy and Clinical Practice has studied Medicare hospital costs and published its results in the Dartmouth Atlas[13]. The Atlas shows big geographic differences in how much is spent, and purports to demonstrate that the high-spending hospitals don’t have better medical outcomes, and sometimes have worse outcomes.

This has all been put together into wild claims by health policy researchers and Obama officials that 30%[14] of medical spending is waste and could be cut without affecting quality of care. Donald Berwick, Obama’s appointee to direct the Centers for Medicare & Medicaid Services, CMS, which administers Medicare and Medicaid, says 50%[15] of medical spending is waste and could be eliminated without affecting quality of care.

A cottage industry of motivational speakers has sprung up, urging seniors to empower themselves and assert their rights to refuse complex medical treatment. For example, pathologist Dr. George Lundberg spoke at San Francisco’s Commonwealth Club in July. He waved his arms and practically shouted to seniors in the audience “Forget those heart by-pass operations! You don’t need them!” He said the same thing about CAT scans and mammography and even advised women not to examine their breasts. After his talk, he praised the Dartmouth Atlas to the sky, and sold autographed copies of his book Severed Trust, Why American Medicine Hasn’t Been Fixed, which advocates limiting access to the healthcare system. Dr. Lundberg is currently editor of the online journal Medscape and was editor of the Journal of the American Medical Association.

Not surprisingly, Dartmouth Atlas director Elliot Fisher is a consultant[16] for the Peter G. Peterson Foundation, which has spent years trying to gut Social Security, Medicare, and Medicaid. Nor is it surprising that insurance companies help finance[17] the Dartmouth Atlas.[18]

One glaring problem with the Dartmouth Atlas study is that it only looks at patients who died 6-24 months after their hospital admission. So patients whose costly care improved their health and saved them from dying are excluded from the study. This biases the results to say that more spending does not improve outcomes. Other studies which include survivors say the opposite: that more costly care can improve outcomes. A December 23, 2009 NY Times article[19] focused on a comparison of hospitals treating heart failure, which included survivors. The UCLA hospital, often cited as high-cost by the Dartmouth Atlas, had 1/3 fewer deaths from heart failure.

The other glaring problem is that the high-spending poor-outcome “inefficient” hospitals cited by the Dartmouth Atlas are in urban or rural areas with high poverty, unhealthy living and working conditions, and poor access to medical care. Patients are already sicker when they go into Medicare, so they need more treatment, and more expensive treatment. These patients also have fewer resources for good after-hospital care. So of course these hospitals’ Medicare costs are higher and their medical outcomes are worse than the “efficient” hospitals in upper-middle class white areas.

In addition, the large, high-cost, “inefficient” hospitals are usually in big cities where salaries are higher, so all healthcare is more expensive. These hospitals are also often teaching hospitals, which have added expenses that are routinely (and legally) charged to Medicare.

The Dartmouth Atlas people, and their supporters in the Obama Administration, claim that they’ve factored these differences in, but other knowledgeable health policy people say this isn’t the case. A June 2, 2010 NY Times article[20] focuses on these issues.

The Dartmouth mania ties into Medicare cost reductions because in future years the Obama plan will decrease payments to “inefficient” hospitals with higher costs and/or worse outcomes. In 2012, incentive payments will go to hospitals with good quality-of-care data for heart attack, heart failure, pneumonia, surgeries, and healthcare-acquired infections. In 2013, incentive payments would also reward hospitals with low spending per Medicare patient[21]. These quality-of-care provisions of the Obama Plan must be “budget neutral,” so other hospitals’ payments will be reduced to pay for the incentive payments. There will also be penalties that will especially hit hospitals with sicker or poorer patients, and hospitals with tighter budgets. There will be $8.2 billion in penalties for hospitals with higher readmissions and $3.2 billion in penalties for hospitals with higher rates of hospital-acquired infections.

The “efficiency” and “quality” rewards and punishments are the medical equivalent of the “No Child Left Behind” program, which lowers school funding overall, and closes low-performing schools in areas of poverty, non-English-speaking populations, and chronically underfunded education.

$50 billion in cuts to Medicare “DSH” payments to hospitals serving low-income Medicare, Medicaid, and uninsured patients.

The Disproportionate Share Hospital (DSH) program provides special funding to hospitals in recognition of their higher costs in treating low-income patients. Starting in 2014, Medicare “DSH” payments to these hospitals will get big cuts.

The Medicare “DSH” payments to individual hospitals were started in 1986 to reflect the higher cost of treating Medicare patients in poor areas where Medicare patients are sicker. Over time, the rationale for Medicare DSH payments was expanded to assure hospital access for all poor and uninsured patients, and payments were based on individual hospital’s days of care for poor Medicare and Medicaid patients. In March of 2007, Medicare’s advisory board MedPAC estimated that 75% of DSH payments were not “empirically justified.”[22]

Beginning in 2014, hospitals receiving Medicare DSH funds will be assured of receiving only 25% of their normally-calculated DSH funds.

The remaining 75% of normally-calculated DSH funds have a percentage cut each year equal to that year’s percentage drop in uninsured population compared to 2013, plus an additional percentage which increases every year from 2014 to 2019. [23] The result is that the hospital’s DSH funds are cut faster than its drop in uninsured patients.

After 2019 DSH funds would be distributed to hospitals based on each hospital’s level of uncompensated care compared to total uncompensated care for all hospitals.

The CMS Actuary estimates these cuts be $50 billion from 2014 to 2019. [24]

$24 billion in cuts ordered by the Independent Payment Advisory Board, a new, independent, high-power, cost-containment commission built into the Obama Plan.

The Independent Payment Advisory Board (IPAB) is charged with clamping down the growth of average per-person Medicare costs. Its powers are essentially beyond the reach of Congress. The Board’s 15 unelected members are experts in medicine, health policy, health care delivery etc., and are appointed by the President with Senate concurrence. The Board can also recommend measures to cut total national health spending.

Starting in 2013, each year’s growth in average per-person Medicare cost will be compared with a threshold growth, based on a modified Consumer Price Index, or later, the Gross National Product. If, in any year, average per-person Medicare cost growth exceeds that year’s threshold, the Board must recommend legislation to either (1) reduce per-person Medicare spending up to 1.5%, or (2) otherwise limit Medicare cost growth to that year’s threshold, whichever is less. [25]

The Board’s cost-cutting recommendations become law unless the House and the Senate each adopt a resolution to block them, by a three-fifths majority. If Congress does reject the proposals, Congress must pass its own solutions yielding equivalent cost reduction within 7 months or Health and Human Services will implement the Board’s recommendation. No judicial review of a Board action is allowed.[26]

Since the Obama Health Plan gives insurance and drug companies such large profits and so little regulation, Medicare beneficiaries’ costs are bound to rise faster than the Consumer Price Index or the Gross Domestic Product, and the Board will have to clamp down on Medicare spending almost every year. Medicare’s own Actuary states that if such a Board had been established 25 years ago, it would have had to act in 21 of those years.[27]

The Board is prohibited from rationing care, increasing taxes, and changing Medicare’s benefits, eligibility or beneficiary cost-sharing, and there is a Consumer Panel that advises the Board to make sure the prohibitions are not broken. So the Board has to reduce payments to providers; physicians, home health, pharmaceutical and medical devices, durable medical equipment, and after 2020, to hospitals.[28] Medicare specialists are very worried.[29]

The Independent Payment Advisory Board is the Medicare cost-cutter of last resort. If any other cost-cutting mechanism fails, the board will make recommendations to make up the difference.

In Medicare Actuary Richard Foster’s April 22, 2010 Report, he wrote “limiting actual Medicare cost growth to a level below medical price inflation alone would represent an exceedingly difficult challenge. Actual Medicare cost growth per beneficiary was below the target level in only 4 of the last 25 years, with 3 of those years immediately following the Balanced Budget Act of 1997; (and) the (negative) impact of the BBA prompted Congress to pass legislation in 1999 and 2000 moderating many of the BBA provisions.”[30] (The 1997 Balanced Budget Act, that ended welfare as we know it, included Medicare cuts even more severe than the Obama Plan, including the Sustainable Growth Rate, SGR, formula for limiting Medicare doctor payments.)

Champion budget hawk Peter Orzag said the IPAB is among the most important of the health reform provisions for “sustaining” Medicare, saying for Congress it represented “the single-biggest yielding of power to an independent entity since the creation of the Federal Reserve.” Orzag called it more than a means of cutting government spending, but also a means of wresting the constitutional responsibility for budgeting away from powerful Congressional committee chairmen.[31]

Payment reforms: putting Medicare doctors under Managed Care

Much attention is being given to “payment methodology” reforms in how Medicare doctors get paid. Almost everyone is familiar with cases of real or hyped abuse of the “fee-for-service” payment system, where doctors are paid for each visit, procedure, or test they order, and so there is a profit incentive to over-treat patients.

But patient abuse also occurs under “per-capita” payment system, where doctors are paid a fixed amount to cover a patient for a year. Here, there is a profit incentive to under-treat patients or treat them as little as possible, since any treatment cuts into the amount of money the doctor was given to cover the patient. (In fact, the only way to remove incentives to over-treat or under-treat is for doctors to be paid by salary as workers, not business-people.)

Managed Care is a variation of the per-capita payment system, where an organization that hires doctors is paid the fixed amount to cover a patient for a year, and the organization maximizes its profits by encouraging the doctors to treat patients as little as possible, through either rewards, penalties, or threats. In the late 1980s and early 1990s, managed care dominated healthcare, which led to large numbers of cases of HMOs denying necessary medical care or providing poor medical care. A major push-back of patients led to patient protection laws and letting up of managed care pressures.

The main thrust of the payment reforms in the Obama plan is to move Medicare doctors away from fee-for-service payment, and instead to work under managed care payment.

One new way to push doctors into managed care is Payment Bundling. In Payment Bundling, doctors, hospitals, nursing homes, and other providers would work together to be jointly accountable for providing care for eight kinds of patient care, such as a hip replacement or cardiac by-pass. For each patient care episode, the group would receive its set fee and divide the money between the doctor, the hospital, the nursing home etc. Hospitals already get a fixed payment for particular episodes of patient care, called the DRG system, but Bundled Payments extend this managed care payment to doctors, since they would get a fixed payment per episode. Payment Bundling is an experimental program beginning in 2013, and Health and Human Services has not chosen what kinds of patient care would use bundled payment.[32]

Another new way to push Medicare doctors into managed care is Accountable Care Organizations (ACOs). ACOs would be groupings of doctors and hospitals who form a legal structure to (1) take responsibility for complete care of at least 5,000 Medicare patients, (2) accept fixed payments from Health and Human Services, and (3) distribute the fixed payments to the providers in the ACO. If, during a 3-year period, an ACO can reduce its average per-person Medicare spending to meet a goal set by Health and Human Services, the ACO can collect an award.[33] If ACOs significantly reduce Medicare costs, planners envisage them managing the healthcare of 40-75% of Medicare patients.[34]

As with any per-capita payment method, the incentive in both Bundled Payments and ACOs is to give less care, since any care given eats into the fixed payment the group receives. If the patient develops an infection, or fails to recover as fast as expected, any extra care given represents a loss in profits.

Many of these new payment reform strategies, like Bundled Payments or ACOs, are sketched out in the Obama Health Plan as “pilot projects,” meaning they are yet to be planned out and tested even on a small-scale basis. The term “pilot project´ has a legal meaning: it can be completely planned, expanded, and put into general practice by the Department of Health and Human Services, an arm of the Executive branch, without any oversight by Congress.[35] A particular pilot project could be completely planned out in secret, to be revealed only at the beginning of a 60-day comment period.

Are business and government serious about making these Medicare cuts?

The Obama Health Plan stabilizes and guarantees billions in profits to insurers, drug companies, and hospitals, yet demands that Medicare alone reduce its future expenses enough to control overall health costs, even as 79 million baby boomers are about to enter the system. This is patently unfair. As Brookings Institution’s Henry Aaron told the House Budget Committee in his June 2008 testimony, “Growth of Medicare spending per person has closely tracked growth of per person spending on health care in general. That parallelism simply reflects the central purpose of Medicare and Medicaid: to assure that the elderly, disabled, and poor receive care similar to that available to the general population. … Holding growth of per person spending on Medicare and Medicaid below that for the general population would imply the gradual abandonment of the national commitment to assure the elderly, disabled, and poor standard health care.”[36]

Many critics, both from the left and the right, criticize the Obama plan, saying it cannot control costs. Critics from the left point to the huge profits to healthcare companies. But many other critics are saying the Medicare cuts we’ve outlined will never happen; that as the cuts come due, Congress will reverse them.

As evidence, they point to the limits on Medicare doctor payments that were written into the severe cuts in the 1997 Balanced Budget Act. These laws said Medicare doctor payments could not grow faster than a so-called Sustainable Growth Rate (SGR). Year after year Congress backed away from enforcing the SGR limit, so that enforcing it now would require a 21% payment cut to doctors. (Attempts to appropriate money to fill this hole were called the “doc fix.”)

Nobody has a crystal ball to see the future with certainty, but I see absolutely no reason why Congress would prevent these cuts from being made. Given the determination of business and government to cut services, particularly federally mandated services to seniors, and given the enthusiasm in Congress to make the same cuts, I think it highly probable they will try to make these Medicare cuts, even as they see the wave of 79 million seniors approaching. But before we place our bets, let’s look at some aspects of the Obama plan that might show promise.

Government Intervention: Quality Control? Cost Control? Is there a distinction?

These new payment reforms are being combined with much greater monitoring and oversight of doctors’ and hospitals’ practices, quality of care, and costs, This new monitoring and oversight are described as “value-based purchasing” or “rewarding value over volume.” These methods would standardize patient care, by adopting standard care plans and prescribed drugs that would be developed through studies of comparative effectiveness and cost. The methods would also require doctors and hospitals to report detailed data on their Medicare costs and quality-of-care indicators. “Quality-of-care” data would report both bad indicators like dosage errors, infections, bedsores, falls, etc. Quality-of-care data would also measure adherence to the standard treatment plans and drug choice protocols.

These interventional aspects of the Obama Health Plan could actually improve patient care by promoting “evidence-based medicine” and close monitoring of quality-of-care data. This standardization and quality control could be very welcome to committed clinicians who are discouraged because so much medical research is sponsored by drug companies or who are outraged because of the laxness and lack of uniformity in medical practice, where a doctor can prescribe powerful adult anti-psychotic drugs off-label to an 18 month old child, as reported recently.[37]

But Dr. Marcia Angell, former editor of the New England Journal of Medicine wrote an important and fresh perspective on these improvements in the Obama plan: “Initiatives such as electronic records, case management, preventive care, and comparative effectiveness studies may improve care, but the Congressional Budget Office and most health economists agree that they are unlikely to save much money.”[38]

Marcia Angell’s position is a very different from Obama’s position, which states that these improvements in healthcare will save significant money. Why is this difference important? It is important because by conflating healthcare improvement with cost reduction, Obama is making the Medicare “savings” seem benign, as though the “savings” are an additional payoff of these measures to improve care. It is similar to Obama’s casting Medicare cuts as improvements in efficiency in order to make the cuts seem benign.

In fact, these interventional measures give Health and Human Services and Centers for Medicare & Medicaid Services tremendous centralized power to ratchet back costs to the point of compromising patient care. It gives the government power to standardize patient care plans and drug choices, to reduce payments to doctors for not following the plans, to reduce payments to doctors who spend too much, to reduce payments to hospitals for not meeting productivity standards, to set the payments doctors and hospital get for particular treatments, to push doctors into managed care and then set the payment for coverage per-person per-year, and finally to give an independent commission carte blanche power to reduce provider payment. Given the rampant deficit hysteria in Washington, and demands for corporate tax cuts “to stimulate the economy,” can we be sure these interventions aren’t to ration care to Medicare beneficiaries?

Ultimately, our decision whether to embrace these interventions as a prelude to better healthcare, or fight them as a prelude to rationing, should depend on how much influence we have over policy development. Judging by our recent struggle just to have single-payer mentioned, I would say we have little influence, and therefore these interventions are a threat we need to warn people about.

One can’t ignore the context in which these cuts are being introduced. – Deficit hysteria cultivated in Washington. — Strong agitation by both Democrats and Republicans to cut Social Security, Medicare, and Medicaid. – Demands for corporate tax breaks “to stimulate the economy.” — Economic meltdown followed by persistent, high, long-term unemployment. — Years of huge projected shortfalls in State and County budgets with deep health and welfare cuts. — Years of war projected to secure oil, pipelines for oil and gas, or containment of China or Russia.

These are times when business’s and government’s backs are to the wall. For them, health and social services for elders, people with disabilities, kids, and poor people are not necessary. We are going to have to fight like hell to keep them.

My earlier remarks on health reform still apply:

First single-payer was off the table. Then a public option anyone could use was off the table. Then the Medicare buy-in was off the table. And negotiated drug prices. And cost controls. And .. And…

Most of us are angry, and whipsawed back and forth between pessimism and optimism. The health bill is a gigantic bailout for insurance, drug, hospital, and doctor industries, forcing us onto private insurance, while at the same time forcing down the value of that insurance and making us pay more out-of-pocket, and taking five hundred billion dollars from Medicare over the next ten years. Our optimistic side says maybe 30 of the 50 million uninsured will get insured in four years, though many won’t be able to afford it and will choose to pay extra taxes instead. Many of us have children barely able to keep a roof over their heads, maybe they’ll qualify for Medicaid, though Obama wants to cut Medicaid costs. And what if this awful health bill failed? These thoughts drive us nuts.

It has been a very bitter pill to see how marginalized we are. Deep down, we hoped or expected that once business realized the cost of insurance-based healthcare was unsustainable, our day would come, and our plan of removing insurance companies would be taken seriously. We were wrong.

The truth is we do not have a movement that’s capable of mounting a serious threat to the functioning of the economy or government, through strikes, sit-ins, or occupations. We do not have the General Strikes that forced the government to cough up Social Security. Nor the emerging sit-ins and marches against Jim Crow racism that forced them to cough up Medicare and Medicaid. We cannot expect different results until we have the kind of movement, that can, and will, stop the gears for long enough to inflict serious pain.

Is healthcare more of a human right than food, when a quarter of US children are food-insecure. Is healthcare more of a human right than housing, when families with kids wait for months for shelter beds in San Francisco? What about education?

We need to stop asking for our needs to be on the table. We need to kick the table over.[39]

[1] Centers for Medicare & Medicaid Services, ”Estimated Financial Effects of the “Patient Protection and Affordable Care Act,” as Amended,” April 22, 2010, p. 2

(Available at https://www.cms.gov/ActuarialStudies/Downloads/PPACA_2010-04-22.pdf )

[2] Congressional Research Service, “Medicare Provisions in the Patient Protection and Affordable Care Act (PPACA): Summary and Timeline,” June 30, 2010, p. 5

(Available at http://www.aamc.org/reform/summary/crstimeline.pdf )

[3] Congressional Research Service, “Medicare Provisions in the Patient Protection and Affordable Care Act (PPACA): Summary and Timeline,” June 30, 2010, p. 7-8

(Available as http://www.aamc.org/reform/summary/crstimeline.pdf )

[4] Congressional Research Service, “Medicare Provisions in the Patient Protection and Affordable Care Act (PPACA): Summary and Timeline,” June 30, 2010, p. 7

(Available as http://www.aamc.org/reform/summary/crstimeline.pdf )

[5] The Commonwealth Fund, “Timeline for Health Care Reform Implementation: System and Delivery Reform Provisions,” April 1, 2010, Accessed Sept 15, 2010, listed under “2011, Medicare Advantage”

(Available in cached version at http://tinyurl.com/29cqu4e )

[6] San Francisco Chronicle, “40,000 could lose Medicare, U.S. insurers say payments not up with medical costs” September 9, 2003

(Available at http://tinyurl.com/25zhtsu )

[7] ABC News, “Report Says Health Care Will Cover More, Cost More” April 23, 2010

(Available at http://abcnews.go.com/print?id=10454567 )

[8] Centers for Medicare & Medicaid Services, “Actual regulation market basket updates,” July 29, 2010

(Available at http://www.cms.gov/MedicareProgramRatesStats/downloads/mktbskt-actual.pdf )

[9] Congressional Research Service, “Medicare Provisions in PPACA (P.L. 111-148),” April 21, 2010, p. 88, Appendix B. (Available at http://www.aahsa.org/WorkArea/DownloadAsset.aspx?id=11313 )

[10] West Johnson and Gordon Mountford, “Key Healthcare Reform Initiatives – Medicare Market Basket Productivity Adjustments,” August 12, 2010.

(Available at http://www.goarticles.com/cgi-bin/showa.cgi?C=3218684 )

[11] Centers for Medicare & Medicaid Services, “Projected Medicare Expenditures under an Illustrative Scenario with Alternative Payment Updates to Medicare Providers,” (August 5, 2010), p. 6

(Available at http://tinyurl.com/2cokhh5 )

[12] Centers for Medicare & Medicaid Services, “Estimated Financial Effects of the ‘Patient Protection and Affordable Care Act,’ As Amended,” (April 22, 2010), p. 9-10

(Available at http://tinyurl.com/2cw2e2e )

[13] The Dartmouth Atlas of Healthcare, a project of Dartmouth Institute for Health Policy and Clinical Practice

(Available at http://www.dartmouthatlas.org/ )

[14] Dartmouth Institute for Health Policy Clinical Practice, “Reflections on Geographic Variations in U.S. Health Care,” May 12, 2010, p. 3

(Available at http://www.dartmouthatlas.org/downloads/press/Skinner_Fisher_DA_05_10.pdf )

[15] Health Leaders Media, “Berwick’s First Reimbursement Challenge,” July 26, 2010

(Available at http://www.healthleadersmedia.com/content/FIN-254267/Berwicks-First-Reimbursement-Challenge )

[16] Fiscal Sustainability Teach-In, “Countering the Peterson Foundation’s “Let Them Eat Catfood (and die) Summit,”” April 27, 2010

(Available at http://www.fiscalsustainability.org/node/58 )

[17] New York Times, “Critics Question Study Cited in Health Debate” (June 2, 2010)

(Available at http://www.nytimes.com/2010/06/03/business/03dartmouth.html?pagewanted=all )

[18] Dartmouth Atlas, “About Us.”

(Available at http://www.dartmouthatlas.org/AboutUs.aspx )

[19] New York Times, “Weighing Medical Costs of End-of-Life Care,” (December 22, 2009)

(Available at http://www.nytimes.com/2009/12/23/health/23ucla.html?pagewanted=all )

[20] New York Times, “Critics Question Study Cited in Health Debate” (June 2, 2010)

(Available at http://www.nytimes.com/2010/06/03/business/03dartmouth.html?pagewanted=all )

[21] Foley & Lardner, “Health Care Legal News Alert,” (May 2010), p. 1

(Available at http://www.foley.com/abc.aspx?Publication=7151 )

[22] Congressional Research Service, “Medicare Provisions in PPACA (P.L. 111-148),” April 21, 2010, p. 9.
(Available at http://www.aahsa.org/WorkArea/DownloadAsset.aspx?id=11313 )

[23] The Hospital & Healthcare Association of Pennsylvania, “The Patient Protection and Affordable Care Act

(PPACA) of 2010 and the Health Care and Education Affordability Reconciliation Act (HCEARA) of 2010,” April 9, 2010, p. 6

(Available at http://www.haponline.org/downloads/HAP_Summary_2010_PPACA_HCEARA_April2010.pdf )

[24] Centers for Medicare & Medicaid Services, ”Estimated Financial Effects of the “Patient Protection and Affordable Care Act,” as Amended,” April 22, 2010, p. 26, section 3133

(Available at https://www.cms.gov/ActuarialStudies/Downloads/PPACA_2010-04-22.pdf )

[25] Timothy Stoltzfus Jost, “The Independent Payment Advisory Board,” (April 28, 2010), slides 3 and 4

(Available at http://www.fresh-thinking.org/docs/workshop_100504/Jost_4_28_2010.ppt )

[26] Timothy Stoltzfus Jost, “The Independent Payment Advisory Board,” (April 28, 2010), slides 7 and 8

(Available at http://www.fresh-thinking.org/docs/workshop_100504/Jost_4_28_2010.ppt )

[27] Centers for Medicare & Medicaid Services, “Estimated Financial Effects of the ‘Patient Protection and Affordable Care Act,’ As Amended,” (April 22, 2010), p. 10

(Available at https://www.cms.gov/ActuarialStudies/Downloads/PPACA_2010-04-22.pdf )

[28] Timothy Stoltzfus Jost, “The Independent Payment Advisory Board,” (April 28, 2010)

(Available at http://www.fresh-thinking.org/docs/workshop_100504/Jost_4_28_2010.ppt )

[29] Fierce Healthcare, “Specialty Physicians Support Senate Bill to Repeal the IPAB,” (July 27, 2010)

(Available at http://tinyurl.com/2dplc4y )

[30] Centers for Medicare & Medicaid Services, “Estimated Financial Effects of the ‘Patient Protection and Affordable Care Act,’ As Amended,” (April 22, 2010), p. 10

(Available at https://www.cms.gov/ActuarialStudies/Downloads/PPACA_2010-04-22.pdf )

[31] New York Times, “For Budget Chief, Not All Farewells Are Fond,” (July 28, 2010)

(Available at http://www.nytimes.com/2010/07/29/us/politics/29bai.html )

[32] Foley & Lardner Legal Newsletter: Health, “PPACA Will Drive Quality Health Care Reform,” “National Pilot Program on Payment Bundling”

(Available at http://www.foley.com/publications/pub_detail.aspx?pubid=7141 )

[33] Foley & Lardner Legal Newsletter: Health, “PPACA Will Drive Quality Health Care Reform,” “Medicare Shared Savings Program — Accountable Care Organizations (ACOs)”

(Available at http://www.foley.com/publications/pub_detail.aspx?pubid=7141 ) and

Congressional Research Service, “Medicare Provisions in the Patient Protection and Affordable Care Act (PPACA): Summary and Timeline,” June 30, 2010, p. 31

(Available at http://www.aamc.org/reform/summary/crstimeline.pdf )

[34] National Healthcare Reform Magazine, “Bending the Curve(s),” (August 3, 2010)

(Available at http://healthcarereformmagazine.com/article/bending-the-curve-s-.html )

[35] Health Beat, “What Many Liberals Don’t Understand About Health-Care Reform,” (June 16, 2010)

(Available at http://tinyurl.com/276xpjj )

[36] Henry J. Aaron, TESTIMONY to COMMITTEE ON THE BUDGET, U.S. HOUSE OF REPRESENTATIVES

on H.R. 3654, June 24, 2008, p. 4

(Available at http://budget.house.gov/hearings/2008/06.24aaron.pdf )

[37] New York Times, “Child’s Ordeal Shows Risks of Psychosis Drugs for Young,” (September 1, 2010)

(Available at http://www.nytimes.com/2010/09/02/business/02kids.html?pagewanted=all )

[38] Boston Globe, “Held hostage by the health system,” (May 23, 2009)

(Available at http://tinyurl.com/oosgxs )

[39] Michael Lyon,” Health Reform? Off The Table,” (March 23, 2010)

(Available at http://wp.me/p3xLR-nL )

June 14th 2010 – Atlanta, GA – Rededicating themselves to the fight for single-payer health care, the League of Women Voters US (LWVUS) passed a resolution with a wide majority at their national convention “to advocate strongly for bills that legislate for improved Medicare for all.”

LWVUS is a nonpartisan political organization with 150,000 members that is active in all 50 states and has recently celebrated its 90th anniversary. The League encourages informed and active participation in government and public policy issues by using education and advocacy.

The convention vote took place shortly before the arrival of Kathleen Sebelius, President Obama’s secretary of health and human services, who was scheduled to address the gathering and to plug the administration’s new health law. When Sebelius arrived, she was greeted by delegates holding a banner that read, “LWV Supports Improved Medicare for All.”

After the vote, League member from New York State and Healthcare NOW! board member, Rebecca Elgie stated, “We need to follow the example of our foremothers, the Suffragettes, in fighting for the rights of everyone, not settling for less than 100% inclusion. This resolution is an important message to our leaders, the job of health care reform is not done and will not be done until we have a national health plan that is affordable, comprehensive and not for profit.”

“We voted to direct our LWVUS Board to advocate for our health care position – improved Medicare for all,” says Judy Deutsch, Healthcare Specialist and member of the Massachusetts League. “Now we must be vigilant to see that our vote is implemented.”

Currently, HR 676, sponsored by John Conyers, is the legislation that would implement an expanded and improved Medicare for all system available to everyone residing in the U. S. It would cover every person for all necessary medical care including prescription drugs, hospital, surgical, outpatient services, primary and preventive care, emergency services, dental, mental health, home health, physical therapy, rehabilitation (including substance abuse), vision care, hearing services including hearing aids, chiropractic, durable medical equipment, palliative care, and long term care.

After the recent passage of the new health law that will leave an estimated 23 million uninsured in 2019, Lisa Stiller, Chair of N. Nevada LWV, emphasized that “this resolution will help us add one more very strong voice to the growing cry for a health care system that lets everyone in and keeps nobody out.”

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Healthcare NOW! is an education and advocacy organization that addresses the health insurance crisis in the U.S by advocating for the passage of national, single-payer healthcare legislation. Healthcare Now! is a 501c4 organization that is fuelled by committed volunteers, activists, and interns supporting single-payer national health care.

Health Care Resolution passed by LWVUS – June 14, 2010

Whereas the League of Women Voters of the United States believes quality health care at an affordable cost should be available to all U.S. residents; and

Whereas the current and proposed systems do not achieve the League goals of affordability and access to everyone; and

Whereas an improved Medicare for all, a publicly funded and privately delivered national health care plan, is consistent with this goal;

Therefore, be it resolved, we, the representatives of local and state Leagues assembled at the 2010 LWVUS Convention, call upon the LWVUS Board to advocate strongly for bills that legislate for improved Medicare for all.

By Ivan J. Miller –

Download the full report here.

A new health care system could improve the bottom line for most businesses, reduce the impact of government related regulation, and free employers from managing employee health care. A redesigned health care system using single payer financing offers these major advantages, yet it has been overlooked by most of the business community. Why? How much does single payer financing really benefit business? What role should employers play in shaping the future of health care?

Important points include:
• Historical precedent is the only logical reason that employers should be responsible for employee health care.
• Single payer improves the bottom line for most employers.
• Single payer means less regulation and more freedom.
• Single payer encourages entrepreneurs and saves the family farm.
• The multi-payer, temporary insurance market is unable to meet America’s health care needs.
• Single payer does more to preserve choice.
• Single payer does more to protect from rationing and “death panels.”
• Some single payer proposals restore normal market forces to health care.
• Single payer can bend the cost curve of escalating health care costs.
• Single payer is the “buy American” health care proposal.
• Single payer is good for global competition and the entrepreneur.
• Transition to single payer is affordable for small business and benefits unions.