“Oregon’s current health care system is neither humane nor cost-effective.”

(PORTLAND, Ore.) – Delegates from 28 unions, nonprofits and grassroots organizations gathered in Portland on Friday, January 27, to form a new coalition that will advocate for universal health care in Oregon and the U.S. Seven labor unions joined with 21 community organizations to sign the membership agreement, approve bylaws, and elect an interim executive committee.

The coalition grew out of a partnership between four organizations–Health Care for All–Oregon, Portland Jobs With Justice, Mad As Hell Doctors (MAHD) and Physicians for a National Health Program (PNHP). Two years ago these organizations formed the Oregon Single Payer Campaign (OSPC), which last year organized a conference at the First Unitarian Church in Portland attended by 500 people. OSPC also spearheaded the introduction of HB 3510 last year in the Oregon legislature by Rep. Michael Dembrow (D-HD 45). HB 3510 would create a single-payer financing system that guaranteed universal access to health care for all Oregonians, including the more than 600,000 Oregonians who do not have health insurance. Rep. Dembrow was in attendance at the founding meeting of the coalition.

The goal of OSPC was to get the issue of universal access health care on the table, since its advocates had been shut out of the federal health care reform debate,” said Michael Moore, delegate from Sisters of the Road and newly elected interim president of the coalition. “The goal of the new coalition is to engage all communities across Oregon in a conversation about what we can and should expect from our health care system. We think providing universal access, as almost all other industrialized nations do, is the only truly humane and cost-effective system available. We need a broad and diverse coalition of organizations to help us understand how to take that message to all the constituencies we need to reach.

Oregon’s current health care system is neither humane nor cost-effective. The only health care resources available to many uninsured adults are hospital emergency rooms and pay-for-service options at some clinics. Even in communities such as Scappoose, only 21 miles from Portland, the Oregon Health Sciences University clinic does not accept uninsured patients. In Oregon, it is estimated that the cost of uncompensated care for uninsured and under-insured adults and children will exceed $1.1 billion in 2012.

Rosalie Pedroza, delegate from the Rural Organizing Project, said, “In rural communities, many areas don’t have insurance options, and facilities are limited. Current cost increases are unsustainable; we need affordable health care for all.”

The unions signing on to the coalition’s founding are: American Federation of Government Employees Local 2157, Communication Workers of America Local 7901, Laborers Local 483, National Association of Letter Carriers Branch 82, National Association of Social Workers ­ Oregon, Oregon Nurses’ Association and Service Employees International Union Local 49. The nonprofits joining them are: Alliance for Democracy, Center for Inter-cultural Organizing, Community Alliance of Tenants, Elders in Action, Fellowship of Reconciliation, Health Care for All Oregon, Health Care for All Oregon–Eugene, Jobs with Justice-Central Oregon, Jobs with Justice–Portland, Jobs with Justice–Southern Oregon, Mad as Hell Doctors, Mid-Valley Health Care Advocates, Oregon Action, Oregon Latino Health Coalition, OSPC-Florence Organizing Committee, Physicians for a National Health Program–Eugene, Mid Valley and Portland, Rural Organizing Project, Sisters of the Road. The Tree Institute, and Universal Health Care for Oregon. Six affiliated or pledged organizations were unable to attend, and ten organizations sent delegates as observers.

The coalition does not plan to introduce legislation this year. In the near term, it will focus on grassroots community organizing and outreach. It plans to meet again in six to eight weeks to elect a full board of directors, develop a strategic plan and finalize the selection of a name.

You can’t see them. They’re hidden from view and probably always will be. But the health insurance industry’s big guns are in place and pointed directly at the citizens of Vermont.

Health insurers were not able to stop the state’s drive last year toward a single-payer health care system, which insurers have spent millions to scare Americans into believing would be the worst thing ever. Despite the ceaseless spin, Vermont lawmakers last May demonstrated they could not be bought nor intimidated when they became the first in the nation to pass a bill that will probably establish a single-payer beachhead in the U.S.

When he signed Act 48 into law on May 27, surrounded by dozens of state residents who worked for many years to achieve universal coverage, Governor Peter Shumlin expressed great pride in what had been accomplished.

“We gather here today to launch the first single payer system in America, to do in Vermont what has taken too long—to have a health care (system) that is the best in the world, that treats health care as a right and not a privilege, where health care follows the individual, not the employer,” Shumlin said.

The problem for Shumlin and his allies is this: it will take five years before Vermont can fully implement its new system, partly because the federal health care reform law prohibits states from undertaking more far-reaching reforms until 2017 unless granted waivers from the feds to do so. And though Vermont’s Congressional delegation is on board to pursue a waiver that would let the state set up a single payer system two years from now, the insurance industry’s friends in Washington are not keen to let that happen. That’s because they want to use those five years to persuade Vermonters that they really don’t want to go the single payer route after all.

During my 20 years as a health insurance PR executive, I was involved in numerous efforts to make the very term “single payer” toxic to most Americans. We even spent hundreds of thousands of premium dollars in 2007 to help finance the operation of a front group, called Health Care America, for the sole purpose of trashing a movie — Michael Moore’s “Sicko” — that put single payer systems abroad in a favorable light. You can rest assured that the industry will spend much, much more to make sure that Vermont does not succeed.

I have observed in Vermont over the past several days just how the invisible hand of the insurance industry is working. Insurers know their efforts will be more effective if they can get others — third party advocates, they call them — to carry out them out. I recognized the campaign because the tactics are the same as those used in previous attempts to kill reforms insurers don’t like.

Part of the strategy is to get key groups of individuals to begin raising doubts, to get Vermonters to second-guess themselves. Among the first groups the insurers have targeted are those most easily spooked — certain business owners and physicians, especially specialists who thrive in the current system.

Last Wednesday, legislators got a sampling of what they’re in for. At a hearing on creation of the state’s health care exchange, or marketplace — mandated by the federal reform law — employers worried about losing the ability to choose from numerous competing insurers. And they worried too about not being able to shift their employees into benefit plans with high deductibles. Insurers and employers have been collaborating for the past several years in a mutually beneficial effort to shift more of us into high-deductible policies. The higher the deductible, the less insurers and employers have to pay for our care. This collaboration has been so successful that increasing numbers of American families filing for bankruptcy are, at least theoretically, insured.

At a hearing a few days earlier in Rutland, this one for health care providers, several physicians were, wittingly or not, using some of the same industry talking points I used to write for insurers’ allies.

Dermatologist Dan McCauliffe was one of several doctors there who suggested that patients needed to pay more — not less — out of their own pocket for care. Ironically, this skin doctor joined other physician specialists in arguing that health care costs would never stabilize until patients had “more skin in the game,” a term my former colleagues used frequently as we tried to spin the “advantages” of high-deductible plans. According to statistics from the American Medical Association, dermatologists are among the highest paid specialists, making on average more than $230,000.

So why do insurers care so much about Vermont? Even though Vermont is a small state where most for-profit insurers have little business, the insurers don’t want a single state to go single payer. Just last week, single payer advocates in California fell just a few votes short of getting a bill to the floor of the Senate for a vote. If Vermont succeeds, California lawmakers might actually get the votes they need.

Health insurers make enormous amounts of money off of us, something they cannot do so effectively in other countries, especially Canada. The four largest insurers, United, WellPoint, Aetna and CIGNA, reported earning a combined $11 billion on nearly $220 billion in revenues last year. For years insurers have been successful in persuading Americans to believe something that is at best debatable — that they play a useful role in the U.S. health care system. They are nervous that if Vermont proves to the rest of the country that health insurers are about as useful as teats on a boar, they might have to figure out another way to make a few billion bucks.

Looking at millions of individual bills that makeup the 2.7 trillion dollars of annual health care costs opens a gigantic window on the massive waste, redundancy, profiteering, fraud and sometimes criminal over-billing.

Here is a partial example of what I mean, in the words of Philip M. Boffey, the estimable science writer for the New York Times:

“Why does an appendectomy in Germany cost roughly a quarter what it costs in the United States? ($3,285 compared to $13,123). Or an MRI scan cost less than a third as much, on average, in Canada? ($304 compared to $1,009).”

“Americans continue to spend more on health care than patients anywhere else. In 2009, we spent $7,960 per person, twice as much as France, which is known for providing very good health services. And for all that spending, we get very mixed results–some superb, some average, some inferior–compared with other advanced nations.”

Moreover, France and Germany, Italy, England, Canada, Belgium, Sweden and all other western countries plus Japan and Taiwan cover almost all their citizens, unlike the U.S. where 50,000,000 people are uninsured.

Boffey, who wrote a book on the National Academy of Sciences, (The Brain Bank of America: An Inquiry into the Politics of Science), under our sponsorship in 1975 goes on to cite the comparative price report of the International Federation of Health Plans in 2010. They are stunning! For Britain, Canada, France, Germany and the U.S. respectively, the average cost in dollars for bypass surgery is $13,998, $22,212, $16,325, $27,237 and in the U.S. $59,770. For cataract surgery the bill is $1,299, $927, $3,352, N.A. and in the U.S. $14,764.

Boffey adds other explanatory factors. These include higher administrative costs to deal with insurance paperwork, higher insurance company profits and executive compensation and less developed electronic health records leading to costly errors.

Except for Germany there are somewhat longer waiting times for some patients to see a specialist in these countries. But in the U.S. seeing specialists is often prohibitively expensive, and if you cannot afford such services, that is the longest waiting time of all.

A recent commentary in the Mayo Clinic Proceedings last August by Charles. W. Slack and Warner V. Slack, MD suggests another compelling comparison–between outcomes in different states in the U.S. They ask “why, for example, do Mississippi, Louisiana, and Georgia have such a high rate of mortality amenable to health care when compared with Idaho, Oregon and Washington.” Wide differences between states and counties have been documented regarding the cost of identical operations, frequency of operations such as cesarean sections or hysterectomies and other surgical disparities studied under controlled variables.

Health care bills come with hefty levels of fraud. From the historic study twenty years ago by the then General Accounting Office of the Congress to the present estimates by the nation’s leading expert in this field, Professor Malcolm Sparrow at Harvard University, fully ten percent of all health care expenditures are the result of computerized billing fraud and abuse. That will be $270 billion this year.

Dr. Sparrow, an applied mathematician, says it could be higher if the federal government would simply do a more detailed study. He adds that the enforcement budget should be one percent of the estimable volume of fraud. In actual practice, the enforcement budget is less than one/tenth of one percent, even though every dollar of enforcement brings in at least seventeen dollars back. (See Dr. Sparrow’s website: http://www.hks.harvard.edu/fs/msparrow/)

Obviously the corporate fraud lobby is stronger than the taxpayer/consumer lobby in Washington, D.C. But why the health insurance companies, a formidable force in their own right when it comes to protecting its turf against single payer or full Medicare insurance (see singlepayeraction.org) do not do more to stop fraudulent billing practices, is a puzzle.

All in all, the health care industry is replete with rackets that neither honest practitioners or regulators find worrisome enough to effectively challenge. The perverse economic incentives in this industry range from third party payments to third party procedures. Add paid-off members of Congress who starve enforcement budgets and the enormous profits that come from that tired triad “waste, fraud and abuse” and you have a massive problem needing a massive solution.

So, voters, why not start challenging all candidates for elective office to make this vast daily heist a front burner campaign issue?

Ralph Nader is a consumer advocate, lawyer, and author. His most recent book – and first novel – is, Only The Super-Rich Can Save Us. His most recent work of non-fiction is The Seventeen Traditions.

Most of you have likely heard the disappointing news that our bill, SB 810, the California Universal Health Care Act, failed to move off the Senate Floor by January 31st, meaning it cannot advance further in the legislative process this year. Despite our unwavering advocacy, too few members were willing to cast votes in favor of SB 810 this year, including several members who had voted for the legislation before. Unfortunately this means that Californians will continue to have a broken health care system in dire need of change, but that is not for lack of effort.

I want to thank and recognize the valiant efforts of the many groups and individuals who worked so hard to make our universal health care bill a reality. First, the California School Employees Association and California Nurses Association led lobbying efforts on behalf of SB 810 all year. Also, Campaign for a Healthy California, Health Care for All, California Physicians for a National Health Plan, California One Care, Single Payer Now, California Alliance for Retired Americans, California Health Professional Student Alliance, League of Women Voters and many other groups organized their members to advocate on behalf of the bill.

Finally, thousands of individual advocates made phone calls, attended meetings, marched and held signs at rallies, and sent letters, faxes and emails in favor of SB 810. Together, these efforts sent a strong message to legislators that the single-payer health care movement is here to stay. I thank all of these passionate supporters from the bottom of my heart.

The single-payer movement is based on a long-term vision and strategy. This setback does not change our work to advocate for universal health care. We have always found the courage to speak out for health care for all, even when others around us told us it was not the right time. Ultimately, the powerful interests that favor doing nothing to repair our health care system can only be overcome by courage and determination – something our movement has in abundance.

I encourage you to continue building support for universal health care at the grass roots level within your communities. Reach out to your co-workers, neighbors, friends, and family members about why their elected officials should vote for Medicare for All. Help build our case to the governor, other elected officials and those who are currently seeking office so that they know the people of California support single-payer legislation.

As the author of SB 810, I share your deep commitment to this cause, this movement, and the people behind it. We will not stop fighting until we have comprehensive health care for every Californian.

California’s “Medicare for all” universal health care legislation fell short of the 21 votes needed to pass the state Senate today.

Senate Bill 810 failed on a 19-15 vote during this morning’s floor session, with four moderate Democrats abstaining and one voting no.

Democratic Sen. Mark Leno, who authored the bill, said the proposal would stabilize health care costs and expand access to coverage.

He called the bill, which does not include funding to cover the projected $250 billion annual cost of running the single-payer system, the first step in a “many year project” that will likely require asking voters to approve financing. He encouraged members to support the bill to allow the policy discussion to continue.

No Republicans voted for the bill. Sen. Tony Strickland, R-Moorpark, criticized the proposal as an attempt to create “another costly and inefficient bureaucracy.”

“There’s no doubt that we need health care reform, there’s no doubt that we need to improve our health care system, but members, this is not the bill to move forward,” he said.

The bill faces a Tuesday deadline for passing the state Senate in the current legislative session. Several similar bills have cleared one or both houses in recent years. The last version to win legislative approval was vetoed by then-GOP Gov. Arnold Schwarzenegger.

By Amanda Waldroupe for TheLundReport.org –

January 19, 2012—Healthcare advocates, medical professionals, and legislators are developing a state-wide grassroots campaign to start educating the public about a single payer health system to provide universal coverage for everyone.

“It’s really the only way that we can assure affordable, high quality healthcare for all,” said Rep. Mike Dembrow (D-Portland), who introduced such legislation during the 2011 session which received a courtesy hearing in the House Healthcare Committee, but never came up for a vote.

Dembrow doesn’t plan on introducing a similar bill when the Legislature meets next month. Legislators can only introduce two bills each, and a single payer bill wouldn’t get any further than another public hearing. “There’s not that much value in having another public hearing,” he said.

But Dembrow does intend on reintroducing such legislation during the 2013 session, and anticipates that bill will be referred to the voters for approval. “If it involves funding, it will inevitably go to the ballot,” he said.

Meanwhile, advocates continue to support and discuss how a single payer system would work in Oregon because of their strong belief that it’s the best way to reform healthcare, lower costs, and ensure that all citizens receive adequate health care.

“Single payer is always going to be a topic when people talk about making healthcare better,” said Dr. Sam Metz, an anesthesiologist who belongs to an advocacy group known as Mad as Hell Doctors. “Nothing has happened to change the crisis that is before us that is American healthcare. The Affordable Care Act will change very little. It has consumed political capital, and allowed people to think we’ve solved the problem.”

Metz thinks Oregon might be in a better position than other states to implement a single payer system. He points to large employers such as Intel and Nike that are self-insured, as well as Providence Health System and Kaiser Permanente which cover their employees with the insurance offered by them — all versions of single payer. Medicaid, Medicare, and healthcare for veterans are also variations of single payer. “So many people are already half way there,” Metz said.

But major obstacles continue to loom. “The current system has a lot of momentum.” according to Larry Steward, a retired professor at Portland State University. “A lot of people believe in it. There’s a whole lot of money involved in it, and a lot of institutions and private industry. There’s a whole infrastructure. All of that needs to be overcome to create a better system.

Private insurance companies are one of the greatest obstacles to creating a single payer system. “If we go to a single payer, they go out of business,” Metz said. It is thus highly unlikely that insurance companies would support legislation or any effort that would “lure the insurance industry to its destruction.”

The complexity of the insurance and healthcare system also make it difficult to educate consumers. “It is going to be a real struggle,” Dembrow agreed. But public education and getting people to “start agitating” will go a long way, he said, to helping people understand that “there are other models out there.”

Recently, Mt. Hood Community College hosted a forum on single payer and the topic was also discussed at a conference held by an organization known as We Can Do Better.

By Arnold Relman for the American Prospect –

Most people assume that insurance is an essential part of the health-care system. Some think it should be provided through public programs like Medicare, while others prefer to see it purchased from private insurance companies, but the majority believe that insurance is needed to help pay the unpredictable and often catastrophic expenses of medical care. That is why so much public policy focuses on extending coverage to as many people as possible and controlling its cost. I think this emphasis on insurance is mistaken. We would have a much better and more affordable health-care system if the reimbursement of medical expenses through public or private insurance plans was replaced by tax-supported universal access to comprehensive care, without bills for specific services and without insurance plans to pay those bills.

Insurance is not simply a mechanism for spreading financial risks and paying for medical care. Because it usually tries to limit payments to providers, insurance often is an intrusive third party in the doctor-patient relationship and, particularly with private insurance, restricts the freedom of doctors and patients to select the services, specialists, and facilities they want to use. At the same time, insurance coverage tends to encourage the “moral hazard” of overuse of elective services, by reducing patients’ awareness of costs and limiting their out-of-pocket expenditures. Furthermore, all insurance plans have administrative expenses, and most private plans take profits that add to the cost of their premiums. The billing and collecting operations that are an integral part of any insured health system are a major expense for doctors and hospitals as well. Billing and collecting through insurance also offer abundant opportunities for fraud and abuse, which skim off as much as 5 percent to 10 percent of the total expenditure on health care.

For-profit insurance companies, which control most of the private market, are the greatest problem. They have a direct conflict of interest with their customers, because a plan’s net income is increased by avoiding coverage of patients with serious illnesses (who, of course, are most in need of insurance), restricting access to services, and limiting coverage of expensive medical conditions. Provisions in the new Affordable Care Act, which take effect in 2014, will prevent private insurers from denying or dropping coverage because of illness, but the act will also put many more people into for-profit insurance plans, which will still be permitted to raise premiums. According to the Centers for Medicare and Medicaid Services, the business costs and profits of these plans currently take more than $150 billion from their premiums before paying for medical services and are projected to increase more rapidly than national expenditures on health care. Additionally, the private insurance industry adds costs to doctors and hospitals that must spend tens of billions in billing and collecting from multiple plans, each with its own rules and regulations.

Apologists for the for-profit insurance industry claim that its high overhead costs are justified by greater control of providers’ charges, the provision of preventive services, and the promotion of the quality of medical care. No credible evidence supports these claims. The rapid turnover of membership in private plans makes continuity of oversight by insurers nearly impossible and limits the effectiveness of preventive and quality-promoting programs. Despite insurers’ efforts to control costs in the private sector, they continue to rise more rapidly than in public programs.

The private insurers’ “managed care” plans did stabilize the costs of care in the private sector for a few years in the mid-1990s by limiting patients’ choices of physicians and hospitals, monitoring physicians’ recommendations of expensive procedures, and reducing elective hospitalizations. However, a backlash from patients and physicians forced the plans to change these tactics, which were seen as an intrusion into the practice of medicine. By the end of the decade, private health costs had resumed their rapid rise. Private for-profit health insurance has now grown into a huge industry that exerts a powerful self-serving influence on national health policy.

Public insurance through Medicare also has its problems. Although its overhead costs (less than 5 percent of expenditures) are much lower than those of private insurance (about 15 percent to 25 percent of expenditures), it also encourages overuse of elective services. Medicare also struggles with constantly rising expenditures. According to the Congressional Budget Office, the program’s costs will almost double over the next decade. The increase has caused a federal budget crisis requiring urgent efforts at cost control. Payments to hospitals are being cut, and more medical costs are being shifted to Medicare beneficiaries. Provisions in the Affordable Care Act authorize trials of new forms of payment and new organizations of physicians and hospitals to receive these payments (accountable-care organizations). The administration of these trials, though, will require so much new bureaucracy that their number will be severely limited—even if Republican opposition in Congress doesn’t block their implementation. Most experts think that without major reforms, Medicare’s rising costs will not be sustainable much longer, but there is little agreement on what reforms will rescue the program or whether any of the proposed cost–saving measures will succeed.

There is, however, a practical alternative to health insurance and the fee-for-service system with which it is usually associated: a not-for-profit system in which a public single payer provides universal access to comprehensive private care delivered by primary-care physicians cooperating with medical specialists in group-practice arrangements. Like health systems based on insurance, this system would not require that patients have much “skin in the game” and therefore might pose a moral hazard that would lead to overuse of elective services. However, unlike insurance-based systems, physicians would be paid by salary rather than fee-for-service, so it would give physicians no financial incentive to recommend unnecessary procedures. Each group’s management would determine and pay salaries, under federal regulations that would cap the fraction of the group’s budget allocated to salaries but would allow management to determine individual compensation. Furthermore, in this insurance-free system, primary-care physicians trained to avoid unneeded care would counsel patients.

Successful examples already exist of systems that are based on a single payer and group practice centered on primary care. They are self-insured, not-for-profit staff-model HMOs such as Kaiser Foundation health plans, Geisinger Health Plan, and the plan designed by and for the New York hotel and restaurant workers’ union. In self-insured plans, there is no third-party insurer to pay the charges; these plans assume the insurance risk of providing their members with the medical care for which they contract. These plans support a multispecialty group practice that provides a specified range of comprehensive medical services. Their members usually choose a primary-care physician in the group who directs their treatment and refers them to specialist colleagues and other personnel in the group as needed. Some plans have no bills for individual services; others charge small token fees for each visit. Evidence shows that plans like these deliver quality, cost-effective care.

The recently reorganized Veterans Affairs medical-care system, once viewed unfavorably, now is often cited as another example of a single-payer system that provides comprehensive care by teams of salaried physicians and other health professionals, without insurance reimbursement. The federal government funds the program, but its patients contribute modest payment for some services.

In the system I envision, there would be no bills, although there might be small token fees at the point of service to discourage overuse for trivial complaints. Regulated private accountable-care organizations of salaried physicians that delivered the treatment would be responsible for staying within budgetary limits set by the agency that paid them on a per-capita basis. Physician groups would be nonprofit; low-cost public reinsurance would compensate them for any losses due to caring for extremely sick patients. Net income could not be used to enhance salaries or make capital improvements but could be applied to upgrading patient services. Physician groups could be expected to pay hospital costs, or hospitals could be separately paid by the single payer, but all hospital charges would be regulated.

Congress would not have a separate health-care system. Everyone, including legislators and government officials, would be in the system and would pay their share of the progressive, designated health-care tax that supported the program. This would, among other things, prevent legislative underfunding. People would be free to choose their primary-care physician and physician group and could change doctors and group membership as they wished. They would also be free to pay for any medical services they might choose outside the publicly funded program.

The envisioned system would be much less expensive than the hodgepodge we now have, because the profits and overhead costs of private insurance would be gone. Without bills, there would be little or no fraud and abuse and less administrative hassle. Without fee-for-service, physicians would have no incentives for unnecessary elective services. And with medical care based on nonprofit groups of cooperating specialists centered on primary-care physicians, there would be good reason to expect services to be efficient and of high quality.

Given what we know about the added costs of private insurance and given informed estimates of the costs of fraudulent billing and of unnecessary and duplicated services, a conservative guess of the total savings from eliminating these problems might be one-third or more of the entire cost of medical care. In any case, these savings would amount to many hundreds of billions—far more than enough to pay for the cost of providing good care for everyone. A reformed system based on group practice could also reduce the cost of defensive medicine (procedures done in response to concerns about malpractice liability). This would probably add a substantial amount to the projected savings. The federal government would have ultimate control over rising costs, because it would set the rate of the designated, progressive tax that funded the entire system and would thereby determine how much could be spent on health care each year. At the beginning of reform, the health tax would presumably collect an amount close to the current total cost of health care. Subsequent tax rates would reflect the new system’s needs and its savings.

Converting the present system to the one I have proposed would require a sea change in public opinion and government policy and would also need the support of most of the medical profession. To say the least, it would be a long and difficult process that would be bitterly opposed by the private insurance industry and its friends and by all those who fear a “government takeover” and cling to the groundless belief that the free market can best govern the health-care system. Nevertheless, there are reasons I believe this transformation has at least a chance of becoming reality.

First, physicians are flocking to join group practices in great numbers, and this could be the beginning of a major national reorganization of medical care. About 200,000 physicians (approximately 25 percent to 30 percent of all those in practice) are now employed by multispecialty groups owned by physicians or by hospitals, and this number is increasing by about 10 percent annually. Most of these groups pay their physicians at least a partial salary—only a few pay full salaries. The majority, though, still receive payment from insurance plans on a fee-for-service basis.

A rapidly growing fraction of practicing physicians are beginning to see the advantages to themselves and their patients of organized group practice with partial or full salaries. At the same time, the traditional conservatism of doctors seems to be changing. If this trend continues—and I believe it is being accelerated by the increasing number of women in medicine, who tend to favor group practice and health-care reform—we may see physicians and many medical societies urging basic reforms that would include a single-payer system. Women will soon represent half of all practicing physicians, and their attitudes will influence the profession, patients, and the general public. Legislators, now largely responsive to the financial inducements of lobbyists and vested interests, might begin to appreciate that they need votes even more than money and might become more receptive to proposals for reform that their constituents widely support.

The private health-insurance industry would be a formidable opponent of the reforms I propose, and its position would be supported by those who worry about the many thousands of jobs that might be lost if this industry were to disappear. However, a huge compensating gain in jobs could result from the expansion of employment in businesses that would no longer have to pay the ever-increasing costs of their employees’ health insurance. Because health benefits were originally given to employees in lieu of salary increases, employers should be expected to share their savings with their employees in the form of increased wages to help them pay their health-care tax. However, if the new system reduced health-care costs and controlled their rate of rise as much as expected, both employers and employees would benefit.

Private insurers would not be appeased by these developments but might be satisfied if the industry’s investors were compensated for their equity interests. Some of the health-care-tax receipts could be used for this purpose over a period of time, perhaps by issuing government bonds to investors in exchange for stock in the private insurance companies.

The phasing-out of private insurance could also be accomplished through competition from a government program. Medicare coverage could be offered to those under age 65 as an alternative to private insurance in decade-by-decade steps. This would allow time for physicians to develop their group-practice arrangements and for the government to carry out trials of capitated payment to groups (that is, payment on a per-capita basis for comprehensive care). To control costs, capitated payments would ultimately have to replace Medicare’s current fee-for-service arrangement, and this would mean a change in the way most Medicare beneficiaries receive their care. Instead of being subsidized by government to obtain health care on a fee-for-service basis, beneficiaries would be expected to select a group practice in a system that would meet all their medical needs at a cost no more—and probably less—than they would pay for Medicare coverage. Opponents of reform would nevertheless claim this abandons entitlements for the elderly, so it would take a lot of public education—and the medical profession’s reassurance—to convince Medicare beneficiaries that they would be much better off in the new system.

Experiments at the state level could facilitate national conversion to a single-payer system. Vermont recently passed legislation to establish such a system and is working toward reorganizing the delivery of medical care. As economic pressures for reform continue to grow, other states may follow. The Hawaii Legislature is considering a universal health system, and Massachusetts is looking at replacing fee-for-service with some form of global payment. The success of state experiments like these would embolden the federal government to act on a national level.

I do not underestimate the complexity of the changes I am proposing. The odds against it are daunting. Congress might not even begin to debate major reform until the health system is near collapse. But what seems clear is that the best—possibly the only—hope for achieving universal, affordable care lies in the eventual elimination of private insurance and fee-for-service payment and in the creation of a tax-supported system based on group practice. Although this proposal makes good medical, social, and economic sense, its ultimate fate will be decided in the political arena. It cannot become a reality without an informed and aroused public bolstered by the medical profession’s strong support for the reform.

Note: What follows is some of the media coverage given to parallel marches and rallies held on Monday, Jan. 9, in Sacramento and Los Angeles protesting the continuing injustices in U.S. health care and calling for a universal, single-payer health system. The protests were sponsored by the California Health Professional Student Alliance (CaHPSA), the Campaign for a Healthy California, Occupy LA, Occupy Sacramento, PNHP California and other groups. In Sacramento, the rally was immediately followed by student lobbying efforts in the state Capitol.

Health care students demonstrate for single-payer insurance

By Special to The Enterprise
The Davis Enterprise (Davis, Calif.), Jan. 10, 2012

Wailing a mournful tune, an eight-piece New Orleans funeral-style jazz band led about 500 California health professional students and their supporters Monday down Capitol Mall to the north entrance of the state Capitol in Sacramento.

Carrying two mock coffins, they demonstrated their support for a single-payer “Medicare for all” reform to the state’s health insurance laws.

The reason for the coffins was that there are an estimated 1,000 deaths per month in California due to lack of access to health care, demonstrators said. In this state, nearly 7 million do not have health insurance, a major reason why many have difficulty finding care.

The Davis contingent included Mary Zhu, M.D.; Paul Ulbrich, D.O., a retired emergency room physician; Millie Braunstein, R.N., Ph.D., the state vice chairwoman of Health Care for All; and Joan Moses, former president of the Davis League of Women Voters.

The demonstrators, who included more than 30 from Davis and the UC Davis medical school, were mainly composed of medical, nursing, pharmacy and public health students.

Dr. Henry Abrons, chairman of Physicians for a National Health Plan — California, a retired intensive care doctor, observed that he often may treat an asthma, cardiac or respiratory patient on life support in the intensive care unit who was seen in the ER a few weeks earlier, but couldn’t afford to fill a prescription, or have follow-up care by a primary care specialist.

Senate Bill 810, authored by Mark Leno, D-San Francisco, which was positively voted out of the Health Committee last spring, is due for a crucial vote in the Senate Appropriations Committee on Jan. 17. It would establish the process for building a single-payer health insurance agency in California, similar to the federal Medicare agency. Assemblywoman Mariko Yamada, D-Davis, is a co-author of the bill.

Leno said private and public employers have found that their health care premium rates have increased an average of 153 percent over 10 years, compared with an inflation rate of 29 percent. Many speakers at the rally pointed out that the United States spends far more for health care than any other advanced economy, but many public health statistics show poorer outcomes.

SB 810 is designed to use health care dollars more wisely, while providing universal coverage, supporters said.

***
Rally procession brings attention to health coverage

By Kathy Robertson, Senior Staff Writer for Sacramento Business Journal, Jan. 9, 2012

Nurses, medical students, seniors, doctors and members of the Occupy movement rallied in downtown Los Angeles and at the Capitol in Sacramento on Monday to rouse support for guaranteed health coverage for all Americans.

The local rally started at Third Street and Capitol Mall at 11 a.m. and progressed to the Capitol steps at noon. The Occupy movement planned to target insurance denials by health plans.

A New Orleans-style funeral procession remembering those who die every year without coverage gave way to a rally in support of Assembly Bill 810, which seeks to establish a single-payer system in California.

The bill was suspended on the Assembly floor late last session by author Mark Leno, a Democrat from San Francisco. Proponents argue the bill would address California’s budget emergency by lowering state expenditures through a more rational, more cost-effective health care system. They have been trying for at least eight years to get a single-payer system into law. Health insurers oppose it.

The bill would establish a state-administered single-payer system to provide health coverage to all Californians without regard to income or employment status. It would establish a new state agency under control of an appointed healthcare commissioner to run the program.

It’s unclear how the program would jibe with federal health reform, although the federal law allows states to opt out of insurance exchanges in 2017 and get a waiver for innovative alternatives.

***

Supporters Of Single Payer Insurance System March In Downtown LA
CBS Los Angeles, Channel 9 television news, Jan. 9, 2012

Finally these additional sources of coverage:

PNHP’s Dr. William Bronston offers a gallery of photographs of the Sacramento march and rally.

Indymedia’s coverage of the Sacramento march and rally includes a photo of PNHP’s banner at end.

Thanks to PNHP for pulling this together.

After wincing a bit from the free flu shot, my young patient turned to me and said, “What you’re doing here is awesome – it’s so hard get health care!”

“Here” happened to be New York City’s Zuccotti Park in mid-November, the epicenter of Occupy Wall Street, just days before the encampment was broken up by hundreds of Mayor Michael Bloomberg’s armor-clad police in the dead of night. But it could have been anywhere in the United States.

Health care is in fact increasingly unaffordable for the 99 percent. More than 50 million Americans lack health insurance and thus reasonable access to treatment. A recent Harvard study showed about 45,000 excess deaths annually can be linked to lack of insurance.

Even people with insurance face formidable barriers to care like rising co-pays and deductibles. As a result, they are putting off care, getting sicker and ending up in our emergency rooms with serious complications – often facing crushing medical bills later.

This increased “cost sharing” by patients helps explain this week’s report by U.S. Health and Human Services showing the use of medical services has slowed. People can’t afford it.

But lack of care invites serious illness or worse. That’s part of the reason why I and scores of other doctors, nurses, medical students and social workers came down to Zuccotti Park and volunteered our time to give out free flu shots.

But I confess that my desire to help went beyond the Samaritan impulse of preventing illness and aiding the sick, an impulse that, remarkably, still persists among our nation’s health professionals despite the toxic atmosphere of our for-profit health system.

I and many others were impelled to take action because the Occupy movement struck a chord with us. We’re angry that our health economy – like the overall economy – has more than sufficient resources to take care of all of us, but the resources are siphoned off by profit-driven corporations in the interest of “the 1 percent.”

Working on the front lines of health care, we see that economic and social inequalities in our present system make our patients sick. The lack of jobs and decent wages, affordable housing, healthy food and quality education takes a heavy toll on the mind and body, and each workday we see the casualties mounting.

We also recognize that the private health insurance industry and Big Pharma exemplify one of the Occupy movement’s central themes: that unchecked corporate greed tramples human needs. Need I recite the billions in profits these companies make each year, or the outlandish salaries of their CEOs, based on skyrocketing premiums and denials of care?

The private insurers, with all the bureaucracy and paperwork they inflict on us, add enormous costs to the delivery of health care, but add no value. Yet, unfortunately, they remain at the very center of our health system under the federal reform law.

There is a clear solution to our health care crisis. Put patients ahead of corporate greed and establish a nonprofit single-payer health care system – an expanded and improved Medicare for all – with no co-pays or deductibles.

A single-payer system would provide high-quality, comprehensive care for everyone – without exception – for no more money than our nation is paying now. We’d save about $400 billion annually due to lower administrative costs. Such a system would also give us tools to rein in costs, like the ability to negotiate lower pharmaceutical prices.

While helping out at Zuccotti Park, I was gratified to hear others chant a slogan I and millions of other Americans have long embraced: Health care is a human right. We will not stop fighting until that principle is enshrined in law and delivered in practice.

Now that will be truly awesome.

Mary O’Brien, M.D., practices internal medicine and serves on the faculty at Columbia University’s College of Physicians and Surgeons in New York. She is a national board member of Physicians for a National Health Program and co-editor of the book 10 Excellent Reasons for National Health Care.

To the Editor:

The Athens City Schools and many Ohio school districts are sorely in need of revenues. We see talented and dedicated teachers and teacher aides’ positions eliminated or threatened in Athens County. We read of the recommended closing a gem of a school and community, Chauncey Elementary.

There is a way that this school system and every school system in Ohio could save enough money to avoid such deep budget cuts. The new budgeting would take at least four years to fully institute, but would then save around $3 million every year for the Athens City Schools. The strategy: elect reform-minded legislators to the Ohio Assembly who would support single-payer health care in Ohio.

The present “sick care system” is dominated by for-profit insurance companies whose purpose is to keep the returns on investment high so that their shareholders and top executives can maximize their gains. The health of customers who directly or indirectly acquire insurance is secondary and too often unethical. Insurance companies have their place — but not in health care. The thousands of Ohio people currently employed in health-care billing deserve legislated transitional monetary supports. With a fair payroll and income tax, we can reap enormous savings for schools and government while improving the physical and financial health of families.

The purpose of single-payer health care is to keep people healthy. It is possible to have such a system without any co-pays, deductibles or health-related bankruptcies.

Over 100,000 people in Ohio have signed petitions for the enactment of single-payer health care, the Health Care For All Ohioans Act. Information is available at the Single-Payer Action Network web site, www.spanohio.org. An average of 14 people die every week in Ohio because they have no health-care coverage.

There is a way that every medical provider can be paid for every person receiving services. There is a way to create fairness, freedom from medical bankruptcy, and everyone in, nobody out. We can keep our private doctors, hospitals and medical providers, and create a “Medicare for all” type of system that will be sustainable.

Join the local advocates of Democracy Over Corporations and SPAN Ohio for a free screening of “The Health Care Movie,” a documentary film narrated by Keifer Sutherland, at United Campus Ministry, 18 N. College St., 7:30 pm on Wednesday, Jan. 11. This is a summary of the Canadian people’s struggles to obtain single-payer health care and the uphill challenges facing Americans today. This is a film about the reasons that ordinary and office-holding Canadians are grateful for their universal health-care system. It points to the role that corporate influence in politics has played in this country, keeping us locked into our present, entirely inadequate “system” and preventing movement toward real health-care reform.

Arlene Sheak, volunteer coordinator
SE Ohio SPAN
Athens