Ted McLaughlin : Are We Moving Towards Single-Payer?

Photo by Glyn Lowe Photoworks / Flickr. Image from OtherWords.
The pressures moving the U.S. closer
to a single-payer health care system

There will be a huge pressure to reform Medicaid -- and the only way to reform it adequately is to make it a federally-administered program.

By Ted McLaughlin / The Rag Blog / July 3, 2012

It looks like the Affordable Care Act (Obamacare) is here to stay. After last week's Supreme Court decision, the only way it can be overturned now is for the Republicans to win the White House and both houses of Congress in the coming election (which is very unlikely) -- and even then, they might find public pressure would prevent its repeal.

Right now, a slight majority of people don't like Obamacare. Some have projected this to mean that a majority of Americans would like to see it repealed. That is just not true. One recent poll showed that 79% of Americans like most of the reforms and don't want it all repealed.

The only part they're not crazy about is the individual mandate. But as the program kicks in fully in the next couple of years, people will begin to realize that the individual mandate only applies to between 2% and 5% of the population -- and the program will become more and more popular.

Another fact commonly overlooked is that among those who are against Obamacare, about 22% don't want it repealed but made stronger. These people would like to see a public option at a minimum (and really want a single-payer system like those in other developed countries). When the program was first passed, I was among those opposing it because it didn't go far enough. I was afraid that all it really did was to delay the United States from going to a single-payer health insurance system.

But after a lot of thinking about it, and a few facts coming to light, I'm starting to change my opinion. I now believe that Obamacare might actually hasten America's progress toward a single-payer system, instead of delaying it. That's because the program is responsible for creating (or increasing) three pressures on the health care system as a whole to move toward a single-payer system. These three pressures are:

1. Forcing private insurance companies to pay a bigger percentage of their premiums for real medical care.
2. The continuing decline in employer-based insurance coverage.
3. The refusal of many states to increase Medicaid coverage for the poor.

Let me take these in order. First, in the past the insurance companies have not been required to spend the money they get for real medical care. While government-run Medicare has an overhead expense of 3% to 4%, many of the private insurance companies were putting 30% to 40% of their premiums toward "overhead."

And the more they put into this area (and the less into medical costs for consumers), the more profit they had. This was a primary reason for the record-breaking profits those companies were showing.

Obamacare ended that. A private insurance company must now put at least 80% of its premium income toward actual medical costs of its consumers (and the giant companies must spend at least 85% on medical costs).

The companies tried to get around this by declaring some administrative costs as medical costs (like the money spent paying their salesmen to sell the policies), but the government didn't go for it. They demanded medical costs be actual medical costs (rather than hidden administrative costs). And if an insurance company fails to spend the proper percentage on medical costs, then they must refund a big enough part of premiums received to get them down to the proper percentage (and the first refunds are currently being issued).

While this still allows the insurance companies to make a decent profit, it has put a serious crimp in the outrageous profits they were making (by denying claims and raising premiums). Now if they raise premiums, they must also increase the amount they spend for medical costs (or wind up refunding the raise).

In other words, the large insurance companies no longer have a license to steal -- and they don't like that. Forbes Magazine reports that some insurance companies are already getting out and searching for other, more lucrative, ways to do business -- and this movement out of insurance to other things will probably just continue to grow.

Second, is the move away from employer-based insurance for workers. This started before Obamacare was created (or the recession hit). As the chart above shows, the percentage of Americans covered by employer-based insurance fell from 69.2% in 2000 to about 58.6% in 2010 -- and the trend continues to move downward. If 2010 had the same percentage of coverage as 2000, then 28 million more people would have employer-based insurance than currently have it.

The hope of the writers of Obama's reform program was that the law would stop this decline in employer-based insurance coverage (through tax breaks for businesses, creation of health insurance exchanges, and a penalty charged for companies that don't provide insurance). I think that's mostly wishful thinking. Any business with less than 50 workers will be exempt, which means there is no incentive for small businesses to provide insurance. And as medical costs (and therefore insurance premiums) rise, many other businesses may decide it is cheaper to pay the penalty than to provide insurance coverage.

And those companies choosing the penalty over insurance coverage will just be a short step away from approving of single-payer insurance (which would most likely be funded by employee/employer contributions just like Social Security), as they realize it would be cheaper for them than providing their employees with ever-rising private insurance.

Third, and perhaps the biggest pressure for single-payer insurance, is the Republican state governments refusing to institute the Medicaid reforms called for in the program. The red states in the map above (from ThinkProgress ) are those with Republican leadership. The 10 states in dark red have already said they will not adopt the Medicaid reforms to cover most of the poor (even though the federal government would pay all of the cost for three years and then pay 90% of the cost). And it is extremely likely that the lighter red states will soon follow suit.

That means many millions of Americans who thought they would be getting insurance coverage because of the reforms, will be denied it because the Republicans will just continue the current inadequate Medicaid programs. They will do this because they don't consider medical care to be a right, but only a privilege available to people who can afford it.

For them, their ideology is more important than the lives and health of many millions of their fellow citizens. And they can get away with this because the Supreme Court killed the provision that would have forced the states to reform Medicaid.

Now one of the primary reasons Obamacare was passed was that there are 50 million people in this country without any kind of medical insurance. Some of these will now be able to get private insurance because of the health insurance exchanges and government subsidies. But a large part of this 50 million (the poor and the working-poor) were meant to be covered through Medicaid.

If this doesn't happen, there will be a huge pressure to reform Medicaid -- and the only way to reform it adequately is to make it a federally-administered program (like Medicare). And the easiest way to do that is to let those making less than a certain salary qualify for Medicare (and do away with Medicaid).

This huge swell in Medicare, combined with decreasing employer-based insurance and insurance companies leaving the business, will bring great pressure to go to a government-run single-payer insurance system.

The experience of other countries has shown us that the money spent on medical care overall will then decrease (since we spend much more per capita than any single-payer country). It will also decrease premium costs for both individuals and businesses (since high overhead and huge profits will be eliminated).

The way I see it, Obamacare did not delay going to a single-payer system. In fact, it has probably created (or increased) the pressures propelling us to adopt a single-payer system much sooner. It has to happen. There is no other real solution to our current broken health care system. Obamacare made some improvements, but it didn't fix the broken system. But maybe it is pushing us much closer to the real solution.

[Ted McLaughlin, a regular contributor to The Rag Blog, also posts at jobsanger. Read more articles by Ted McLaughlin on The Rag Blog.]

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Dr. Stephen R. Keister : Calvinism, Pride in Ignorance, and Health Care Reform

John Calvin: Some are blessed by God.
Reflecting on the health care law:
Flawed bill fixes some problems

By Dr. Stephen R. Keister / The Rag Blog / September 23, 2010

There has been time for reflection about the health care legislation -- the Patient Protection and Affordable Care Act (PPACA) -- since its passage this year. My thoughts were called into focus this past week after I attended a seminar led by Chuck Pennacchio who heads the movement for single payer health care in Pennsylvania.

There is a reasonable possibility that such a plan will be passed before the current governor departs office. The program is all-inclusive and will reduce health care costs for ALL members of the Commonwealth, including municipalities and employers, by some 30-40 percent.

At the seminar, I had a discussion with a retired professor of political science. We talked about why decent, low priced health care seems unobtainable in the United States, considering that such systems are alive and well in virtually every other civilized nation in the world. In two nations that actually have "socialized medicine -- the United Kingdom and Canada – the percentage of patient satisfaction, according to polling, runs in the 90’s.

In all the European nations, plus Japan, Korea, and Taiwan, insurance coverage is provided at a reasonable price. My colleague pointed out two salient differences between our society and those of the European countries: the European insurance companies see themselves as providing a public service rather than being vehicles for profit for their executives and stock-holders; and the European consumer looks at the welfare of the community rather than just looking out for himself, and thus is willing to share the costs and benefits.

I discussed this further with a sociologist, an ex-Jesuit, who pointed out another factor to me: the wide spread Calvinistic influence in the United States and the pervading idea of predestination -- the assumption that there are those who are born blessed by God, and those who are destined to be poor and inferior.

Thus, there is little reason for those who have the ability to pay their way to help out those who cannot. Why argue with divine will. Why deprive yourself of a Florida golf vacation to succor some poor inner city family with three children and no jobs due to the fact that their employer moved his production to China. (They probably are not of white Anglo-Saxon heritage in any event.)

Of course this thinking helps explain the "tea-bagger” opposition to health care for all and reinforces the conclusions of Sherman DeBrosse in his article about the psyche of the political right that recently appeared in The Rag Blog. It also further explains why PPACA has been a flawed bill from the beginning, as it is merely a national version of the poorly conceived Massachusetts health care plan put in place by then governor Mitt Romney.

It appears that President Obama and Congress passed all that was possible under the circumstances. Those circumstances being that the big corporations overtly and covertly lead the discussion, excluding the medical profession and the public from any meaningful input.

And, of course, the discussion of health care becomes confused by the interjection of the abortion issue, led by the Council of Bishops, spurred on by the insurance and pharmaceutical industries. I may note that I am a member of Physicians for A National Health Program and have never seen the question of abortion mentioned in thousands of pages of literature about how we can best take care of the sick, the disabled, and the infirm.

The health care legislation that was passed may have the following positive results:

1. Many low income families will receive subsidies to help buy private insurance and Medicaid will be expanded.
2. The “doughnut hole” in medicare prescription drug coverage will begin to close.
3. Some provisions will help expand primary care coverage.
4. There will be limited insurance reforms including elimination of "pre-existing conditions" and lifetime limits on coverage. (It should be noted that these benefits will vary from state to state, based on the numbers of folks enrolled.)
5. Children will gain a few years coverage on their parents’ policies.

Yet many problems will continue to exist:

1. 45 million Americans will be left uninsured or underinsured.
2. Health care costs will increase, not decrease.
3. Insurance companies will still control the healthcare market and reap enormous profits.
4. Millions of people will be required to buy private insurance or face thousands of dollars in fines.
5. Insurance will cost more for families and employers.
6. We will continue to have severe shortages of primary care doctors as the bill did nothing to support a funded program of medical education.
7. America will continue to spend twice what other countries spend for healthy care.

I joined the Rag Blog family at age 87 and now face my 89th birthday. I have never been so discouraged about this nation, which my ancestors helped build starting prior to The French and Indian War. The United States has become a corporatocracy with a populace interested primarily in their own well being and in the acquisition of wealth.

I watch the street demonstrations peopled by folks who take pride in their own ignorance, holding the educated person up to derision. This in turn influences our failing educational system. I see an increasing injection of "faith" into politics. I think of Glenn Beck speaking in front of the Lincoln Memorial, and I'm reminded of another speech:

My feelings as a Christian points me to my Lord and Savior as a fighter. It points me to the man who once in loneliness, surrounded by a few followers, recognized these Jews for what they were and summoned men to fight against them and who, Gods truth was greatest not as a sufferer but as a fighter.

In boundless love as a Christian and as a man I read through the passage that tells us how the Lord at last rose in His might and seized the scourge to drive out of the Temple the brood of vipers and adders... Today, after two thousand years, with deepest emotion I recognize more profoundly than ever before the fact that it was for this that He had to shed his blood upon the Cross." -- Adolph Hitler, speech on April 12, 1922.

Of course unlike Hitler, Glenn Beck, standing at the Lincoln Monument, was speaking about our Moslem brethren and not about the Jews.

[Dr. Stephen R. Keister lives in Erie, Pennsylvania. He is a retired physician who is active in health care reform.]

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Private Health Insurance : Going the Way of the Dinosaur

CLICK ON IMAGE TO ENLARGE

In the map above, the countries with universal health care are in blue. Those trying to get it are in green. Note that the United States proudly takes its place among the third-world countries of Central Asia, Africa, and parts of South America. We should be ashamed.

Private insurance:
Bound for extinction

By Ted McLaughlin / The Rag Blog / March 3, 2010

One of the things the Democrats were elected to do was to fix our badly broken health care system. It looks like they are going to fail to do that. They might wind up passing the anemic and pitiful Senate health care reform plan, but that falls far short of really reforming the health care system. It does little but continue the broken system we currently have with a few modest and mainly cosmetic changes.

One of the worst failures is to leave Americans with no choice except to purchase private health insurance. While this will guarantee huge profits for the large private insurance companies for some more years into the future, it is ultimately doomed to an ignoble failure. We are already beginning to see that these private companies just can't do the job indefinitely. Consider the current situation with Wellpoint (whose subsidiary is Anthem Blue Cross of California).

Anthem Blue Cross is the company that recently announced it is raising most of its premiums by a whopping 39%. The Wellpoint CEO recently went before Congress and said they have to raise the premiums that much because, "One, people are getting older. Two, people are becoming unemployed, and if they're healthy they're dropping out of the insurance pool. Three, the cost of diagnostic testing is soaring." She asked for government help.

But frankly, there is little the government can do for these problems (and the terrible Senate bill does nothing to solve them). The fact is that the jobless situation is going to be around for quite a while, because it was not only caused by the recession, but by outsourcing jobs which continues unabated. And of course, people are going to keep getting older and medical costs and testing will continue to get more expensive.

That means the private insurance companies will continue to raise the price of their premiums and cut the number of things those premiums will cover. I can remember that years ago a private insurance policy would cover virtually all medical costs. These days a person is lucky if their private insurance covers a significant part of the costs (and there are many medical procedures not covered at all because private insurance considers them too expensive).

With each rise in premium cost, more people are squeezed off the insurance rolls -- thus making it necessary for the companies to again raise premium costs and further cut coverage. Soon we will be left with expensive private insurance policies that cover virtually nothing.

I believe the CEOs of the insurance companies know they can't keep their spinning plates in the air indefinitely. They know that at sometime down the road their policies will become so expensive and cover so little that the health care system will implode. They just don't care as long as they can continue getting windfall profits for as long as they can stretch this farce out.

Consider the following: Anthem Blue Cross brags that a woman can still get a private insurance policy for only $156 a month. That may sound good to some until they consider this policy has a $1500 deductible, and then only pays for 30% of most medical procedures and tests, makes the woman pay up to $500 a day for a hospital room, and doesn't cover pregnancy or delivery costs at all. How good a policy is that?

Whether the Republicans and the private insurance companies want to admit it or not, the days are numbered for private insurance health care policies. In an effort to continue their profits, they will keep raising premiums and cutting coverage until they price themselves out of the marketplace. Then they will be replaced by a single-payer government health care system like other developed nations have.

It is not a question of whether we want it to happen -- it has to happen. There is no other option. The Congress could have saved a lot of time, money, and heartache by passing a public insurance plan this year, but they're going to blow it. So we're going to get more years of insurance companies raising rates and denying coverage, of many more Americans going bankrupt, and millions more Americans dying because their insurance (if they have any) won't pay for their treatment.

Teddy Roosevelt failed, Bill Clinton failed, and now Barack Obama has failed, but single-payer public insurance will come. If for no other reason, the economics of the situation demands it. The right-wingers and blue dogs need to get used to the idea. There is literally no alternative.

[Rag Blog contributor Ted McLaughlin also posts at jobsanger.]

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Rewind and Restart : How the Dems (Could Have) Made 'Health Care' Happen

(A New Years fantasy)

Once more from the top:
An alternative scenario for health care reform

By Zoltan Zigedy / The Rag Blog / January 10, 2010

In February of 2009, with his poll numbers and public expectations exceptionally high, President Obama announces that he supports the House health care reform bill with the most co-sponsors: HR 676, the universal, single payer plan. He notes that this has always been his answer to fixing the broken, for-profit system that now fails patient needs and burdens our economy.

Immediately, the health care industry and big Pharma go into full attack mode, condemning the bill as "socialism." Obama meets with Democratic House leadership and emphasizes that "the American people need this bill and we will give it to them. This victory will pave the way for an overwhelming victory in the 2010 elections!"

House conservative Democrats join Republicans in attacking the House bill, citing industry generated polls and conservative pundits in arguing that the "American people do not want a government plan, but one that leaves health care in the hands of the private market." The health care industry and its friends rush multi-million dollar attack ads into play, much as they did during the Clinton administration.

In the early spring, Obama holds a town hall meeting, nationally televised, in which he brings together, from around the country, hundreds of people who have been victimized by lack of insurance, poor insurance, coverage denials, and obscene health care costs. In a major address, Obama cites the tens of thousands who die every year from a lack of insurance coverage. He declares this as criminally tragic as the September 11 attacks. Also, he emphatically states that placing petty concerns above delivering adequate health care to all is unpatriotic.

That same week, House leader Nancy Pelosi publicly announces that HR 676 must be passed and she will hold Democrats' feet to the fire with all the resources available to the Democratic Party, including election funding, committee seats, and primary challenges. CNN reports live on a conference of pollsters, health care providers, doctors, nurses, and economists who discuss the bill thoroughly, followed by a full endorsement. National media coverage is extensive. The Sunday morning gasbags devote their shows to the bill, grilling opponents in light of the Administration offensive.

As the Senate takes up a health care bill, progressive Democrats call for a rally in support of the bill to take place in DC in the summer. They pressure the House leadership to endorse the rally. The AFL-CIO, NOW, MoveOn, and all other liberal groups endorse the rally.

While seemingly endless debate goes on in the Senate, hundreds of thousands pour into DC to hear a wide range of speakers, musicians, and Congressional leaders in support of the Senate counterpart bill introduced by Senator Sanders. The crowd stirs with the spreading rumor that the President may well appear. Near the end, the crowd roars as President Obama briefly appears, thanking the demonstrators.

The Democratic Senate leadership, stiffened by the unprecedented rally, announces that they will bring the bill quickly to the floor. Senator Reid -- the Senate Democratic leader -- announces that this bill is as significant as any legislation since the Voting Rights Act. He wants his place in history to be identified with this vote. Administration staffer Rahm Emanuel reportedly caucused with Senate Democrats and says: "I don’t give a s*** about Lieberman. And Ben, you better get your ass on board or there will be hell to pay. You can’t even imagine the hell we’ll bring down on you. I want this f***in’ bill passed with ALL the D’s supporting it." Emanuel denies this report.

The Republicans and a few Democrats howl in indignation. Fox news vilifies the House and Senate Democrats with wild charges of socialism and fascism. Harry Reid speaks in the Senate, holding a copy of the Constitution: "Maybe you folks in the Republican Party should read this. Americanism has never been to side with the bullies, and the insurance industry, their rich executives, big Pharma, and their consultants and lobbyists are bullies, forcing their profits ahead of the needs of the American people." The media is shocked by his bold leadership.

Desperate Republican leaders announce a filibuster with the intent of forestalling a majority vote. The President goes on television with a sober, reasoned plea to have the bill passed. When asked by the press about the threatened filibuster, Obama replies with a wry smile: "Bring it on!"

As the Republican filibuster continues into the fall with Republican Senators droning on and on to an empty Senate chamber, public anger grows and grows. Late night comedians devote most of their shows to parodies of Senators quoting Glen Beck and Rush Limbaugh. Constant picket lines of doctors, nurses, and victims of the broken U.S. health care system surround Senate office buildings. Media commentators question this tactic, blaming the Republicans for bringing legislation to a halt. Polls show Republican favorable ratings at an all time low.

Senator Reid is quoted as chiding a Republican colleague: "Don’t stop now. Keep it up until the interim elections!" Senator Reid denies saying this.

Late in November, Republican leaders huddle, recognizing that continuing to filibuster will destroy any chances of survival after the November 2010 elections. They quickly agree to call it off.

In early December, the Senate passes its version of Medicare for all by a vote of 51 to 25, with many Republicans nervously abstaining.

President Obama goes on national television, thanking all of those who worked so tirelessly and intensely to achieve an efficient, universal, and comprehensive health care plan that will rival any system in the world. He assures the American people that all the failings of the current system, referring to World Health Organization’s parameters, will be reversed and the U.S. will become a widely admired leader in delivering the best health care to its people. He promises to sign a final bill before Christmas, stating that he hopes that the new legislative act will serve as a long overdue but welcome gift to us all. "Happy holidays!" he concludes.


Of course this is a fantasy. We do not have the health care bill that we could have had. In fact, almost nothing in this fantasy is true. The President didn’t get behind the House bill with the most co-sponsors, the Democratic leadership didn’t fight hard for real change, there were no tough back room threats, the media didn’t give serious advocates a megaphone, there was no attempt by political leaders to engage and rally the base, political leaders did not show courage, and Democrats did not call the Republican bluff.

I ask my liberal friends and soft-left comrades that they try, in the New Year, to understand why things went so awry. I ask that they turn away from the comforting notion that we live with an economic and political system that can deliver democracy, justice, and equality by our simple participation in the permitted rituals. I ask that, in the New Year, they desist from finding scapegoats for this disaster that should shame us all: whether it be Obama’s betrayal, Blue Dog treachery, or that rotten renegade, Lieberman. It’s the system. Seriously, it’s the system...

[For more from Zoltan Zigedy, visit ZZ's blog.]

Thanks to Jeffrey Segal / The Rag Blog

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Doctors Want Real Health Care Reform

Cartoon from LTSaloon.org
Doctors show support for health care reform;
Lobbyists, Blue Dogs and Republicans work to gut real change

By Dr. Stephen R. Keister / The Rag Blog / July 28, 2009

This past Wednesday I listened to President Obama's press conference at which he discussed his ongoing efforts for reform of our health care system. I thought his presentation was uninspired although, as Dr. Paul Krugman and other economists pointed out, he did lay out the costs involved and the savings to the individual American, as well as the need for better medical care for the nation at large. I was, however, concerned that the “public option” issue did not arise until near the end of the conference, and that the President did not discuss it in any detail.

At times I felt that I was listening to Hamlet's soliloquy, or perhaps Richard III's, (Act V, final scene): "A horse, a horse, my kingdom for a horse.” In keeping with the Shakespeare analogy, we can always think of Sen. Baucus as Iago, and any of several Republicans as King Lear in Act 4, Scene 6, as he wears roses as a crown.

In any event several new issues have come to light. There are new television ads supporting universal health care sponsored by the health insurance industry but they stress their support for a BIPARTISAN health care bill. I would think it apparent to any perceptive person that there is no such thing as a "bipartisan" approach to universal health care, making this concern of the insurance industry mere fluff. Another ad in support of universal health care is sponsored by the pharmaceutical manufacturers and Families USA. I have also learned of an upcoming ad from a recently formed physicians group opposing universal health care. One can almost be assured that some well financed spin-off of the insurance or pharmaceutical industries is behind this.

A recent poll of physicians nationwide conducted by the Indiana University School of Medicine shows the following breakdown of support for national health insurance among practicing physicians in a range of fields: psychiatrists, 80%; pediatric subspecialties, 70%; emergency medicine, 68%; general pediatrics, 65%; general internal medicine, 62%; medical subspecialties, 60%; pathology, 58%; family medicine, 57%; ob-gyn, 56%; general surgery, 55%; surgical subspecialties, 45%; anesthesiology, 40%; radiology, 30%.

Obviously the great majority of physicians –- or, in the vernacular, insurance industry “providers” -- ARE in favor of universal care. I am certain, as well, that none of the doctors polled received compensation for their participation. Again, be suspicious about any sponsored TV ad showing doctors in general to be against health care. The old admonition: "Follow the money.”

Returning to President Obama’s near omission of any mention of the public option in his press conference. This, I feel, is a cause for great concern, and makes one wonder just what goes on in the legislative process behind closed doors. Are we being hoodwinked? Are we being fed a political fairy tale? Kip Sullivan of Physicians for a National Health Program suggests a frightening scenario, and I would suggest that all interested in health care reform read this rather extensive article and prepare to recalibrate your thinking.

Many of us felt, from the very beginning, that universal/single payer health care was the single viable option, especially when we take into account the fact that insurance companies do not really do anything to make people healthier, but are merely efficient gatekeepers for their shareholders. Profits at ten of the country’s largest insurance companies, according to Rep. Anthony Weiner in Politico, rose 428% from 2000-2007. Yet, many of our elected representatives, the Republicans and Blue Dog Democrats, maintain their allegiance to the health insurance cartel, the pharmaceutical manufacturers, and the medical device manufacturers, rather than representing the public.

Daily I become more concerned about the apathy of the American public concerning this most important legislation, which is in their interest and in the interest of their children and grandchildren. I would guess that 5-10% of the public is actively and passionately involved in the fight for health care reform; from the rest we hear nothing but dead silence.

You can be assured that if the French populace were to be deprived of decent health care the boulevards would be filled with peaceful demonstrators; the unions, which in France work in concert with their employers, would be organizing a general strike, and the age old cry of “liberty, equality, fraternity,” would once again be heard. In the United States? Mostly dead silence!

For more than 200 years the French have been cynical of politicians and their promises. They have learned to question, not to accept everything on blind faith. They benefit from the cultural influence of Voltaire, Zola, Proust, Kafka, and Sartre whose work has served to stimulate critical thought. In France, though there have been great individual achievements, there is a sense of community and of looking out for your neighbor.

In America, many feel that to question authority is heresy. The American culture teaches subservience, uncritical belief in authority, even if morally flawed and bogus; the Horatio Alger myth and Calvinistic theology teach that God rewards the righteous by giving him/her financial rewards. Our educational system, more and more, teaches that one should not question, and as a matter of fact tends to discourage original thought and to fear the truly educated.

Rev. Howard Bess writes in Consurtium News, "One of the ironies of modern American politics is that many people who profess to follow the teachings of Jesus Christ are among the most vociferous advocates of war, the most disdainful of the poor, and the staunchest defenders of personal wealth." This is worth reprinting and passing out to your more “devout' acquaintances.” I was amazed some time ago to read in a poll that 60% of fundamentalist Christians had never READ the Sermon on the Mount. Also read Rabbi Michael Lerner's observations in Tikkum Magazine where he asks, “Why Can't Obama Convince the Dems?”.

Those opposed to health care reform continue to beat the drum of high costs. The cost is surely much less than our ongoing and highly questionable wars, of our bloated defense budget. Monica Sanchez writes in Campaign For America's Future that the House’s health Reform Bill would produce a $6 Billion surplus. This bill, of course, includes a public option. Better still, if not too late, would be reconsideration of HR 676 which could actually reduce the costs of health care nationally by 30%.

In any event, how to raise the money? It is immoral not to undo the 2001 Bush tax cuts for the wealthy, and that could go a long way toward financing a program. And since the taxpayer, in reality, is now subsidizing employer provided health insurance -- since the employee pays no tax, and it is essentially earned income -- I see no objection to a reasonable federal surtax on such insurance. In the long run a true national health insurance plan would more than compensate in savings to the individual, and would provide in return peace of mind regarding health care for his or her family.

The moneyed interests in this country have denied us universal health care since it was first suggested by Theodore Roosevelt nearly a hundred years ago. Remember, as well, that French national health care began its evolution in the late 19th century under a conservative Third Republic; that German care originated at the suggestion of Otto von Bismark , a Royalist, in the late 19th century, and that it originated in the U.K. under Winston Churchill, a Conservative, after World War II.

The only truly "socialized medicine” I am familiar with is at the Veterans Administration, and in military hospitals here in the USA. The Scandinavian nations have social-democratic governments, but their health care gives absolutely free choice of physician (not “provider” as doctors are called here), hospital, specialist, and pharmacy. With certain rare exclusions the physician has free choice of treatment and the management of care. Care is not rationed on ability to pay as it is by the insurance industry in the United States.

One last thought. There’s a fraudulent television ad about a lady who came to the United States for treatment of a "brain tumor" which had not immediately been taken care of in Canada. I have learned that she did not have cancer, let alone a tumor per se. She had a fluid filled cyst near the pituitary gland and optic nerve, which in due time could cause problems with sight. It called for a procedure performed by only certain neurosurgeons, and would have required some time to schedule since it was not an emergency. It was apparently the individual’s decision to opt for immediate surgery and that was the reason for here coming to the Mayo Clinic.

It reminds me of a fine chap I played golf with some years ago who had an atrial fibrillation that could be cured by an ablation procedure done by a cardiologist per catheter. He could have had it done locally within 48 hours, but he opted for a specific cardiologist at an out of town clinic and that resulted in a two month delay. Certain decisions are those of the patient and not of the system.

[Dr. Stephen R. Keister lives in Erie, PA. He is a retired physician who is active in health care reform. His previous articles on The Rag Blog can be found here.]

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Obama Must Fight for Public Option, Real Health Care Reform

President Obama addresses the American Medical Association, June 15, 2009. Photo by Charles Rex Arbogast / AP.

In some way the message must get through to the Senate Democratic leadership that they were elected to represent THE PEOPLE and were not brought to Washington to be prostituted to various amoral monied interests.

By Dr. Stephen R. Keister / The Rag Blog / June 22, 2009

Webster's Universal College Dictionary defines "prostitute" in various ways; however, the most telling is: "A person who willingly uses his or her talent or ability in a base and unworthy way, usu.for money."

Enter the United States Senate. The latest reports from The Center for Responsive Politics as reported by The Lee Newspapers State Bureau showed that the campaign of Sen. Max Baucus and his Glacier PAC, which raises money and distributes it to other candidates, received 23% of their $14.8 million from health care and insurance interests. The $3.4 million from these sectors includes $853,000 from pharmaceutical and health products; 851,000 from health professionals; $467,000 from hospitals and nursing homes; $466,000 from health-service and HMO interests; and $784,000 from insurance. This is the Senator leads the way in the Senate concerning health care reform This is the Senator who had proponents of single payer, universal care arrested in handcuffs when they attempted to speak at his hearings.

Senator Baucus is not alone in his complicity with the insurance industry. He is joined by six or seven other turncoat Democratic Senators who are beholden to the monied interests in the insurance, pharmaceutical and health care industries. These were the same insurance companies whose executives testified before Congress, as reported in The L.A. Times, and when asked if they'll stop dropping customers except where they can show “intentional fraud.” All said "No.”

Executives of three of the nation's largest health insurers told lawmakers in Washington this past Tuesday that they would continue canceling medical coverage for some sick policyholders, despite withering criticism from Republican and Democratic members of Congress who decided the practices as unfair and abusive.

An investigation by the House Subcommittee on Oversight and Investigations showed that health insurers WellPoint Inc., UnitedHealth Group and Assurant, Inc. cancelled the coverage of more than 20,000 people, allowing the companies to avoid paying more than $300 million in medical claims over a five-year period.

It also found that policyholders with breast cancer, lymphoma and more than 1,000 other conditions were targeted for recission and that employees were praised in performance reviews for terminating the policies of customers with expensive illnesses.

Thus we can easily understand the public’s responses in a Harris Health Care poll in January, 2009, which showed the following results. When asked, "How much do you trust each of the following to do the right thing for the health care of those whom they have a responsibility for?” Answers were broken down into several categories: A Lot; Some; Not Much; Not At All; Not Sure.

Those responding "A Lot": Nurses 65%; Doctors 61%; Dentists 56%; Pharmacies 49%; Hospitals 44%; Pharmaceutical Companies 14%; Employers 12%; Managed care companies 9%; Health Insurance Companies 8%.

Another category of questions : "And how much do you trust each of the following to do the right thing FOR YOU and your health care?" Those responding "a Lot". Your doctor or doctors 63%; Nurses who treat you 60%; Your dentist 58%; The pharmacy or pharmacies you use 50%; The last hospital you visited 47%; The prescription drugs you take 44% ; Your employer 16%; Your health insurance company 15%; Your managed care company 9%..

In some way the message must get through to the Senate Democratic leadership that they were elected to represent THE PEOPLE and were not brought to Washington to be prostituted to various amoral monied interests.

Happily, The House of Representatives has provided us with a discussion draft of a program that provides affordable health care for all Americans and controls health care cost growth. This was made available on June 19, 2009. Thus, we have here a small step in the correct direction.

There is little or no hope for "bipartisanship.” It’s either a pipe dream or a cop-out. The Republicans continue to reduce the discussion to absurdity, still claiming that single-payer or public option will lead to "government rationing" of health coverage. As Dan Lipsher points out in the Summit Daily, "Guess what: Private insurance companies already ration health care, but instead of the law determining what to cover and how much to pay, it's an insurance company making these decisions. Rather than being motivated by what's best for the patient, these insurance company employees are compensated on the basis of how much money they can save their employers/stockholders.” Ever wonder why "usual and customary" coverage is never enough to pay your full medical or dental bill? That’s because treatment cannot realistically be found at the price the insurance company arbitrarily sets.

A government plan, on the other hand, can be required by law to pay 100% of the cost of necessary treatment. No more aftercare bills for hundreds or thousands of dollars because the cost of a CAT scan or chemo session exceeded the "usual and customary" allowance authorized by a nameless, faceless middle manager at Aetna or Blue Cross/Blue Shield. A government plan can also set maximum charges for treatments, reducing or eliminating overcharges by hospitals and other providers looking to maximize profits and making patients pay for months or years to satisfy their hospital bills -- and reducing personal bankruptcies by a significant percentage as well.

Republicans claim that private insurance companies will not be able to compete with a government-sponsored health plan. Yet private insurance profits are so excessive that they have agreed to voluntarily cut costs by $2 trillion over 10 years -- that's $200 billion a year. In other words, private insurers have been gouging businesses and consumers to the tune of $667 per person per year. We hear a lot about “letting the market dictate price,” but clearly the fix is in when it comes to insurance premiums, deductibles, and pay-outs.

Where is the White House in all of this discussion? President Obama seems to have held his own in his speech to the AMA; however, the President, like much of the public, appeared to have only a vague idea of the nature of the AMA. The AMA is not and never has been an organization representative of American physicians. The AMA membership probably represents 30% of the physicians in the United States, and possibly one half of those are retired. The AMA is basically a marketing organization, largely sponsored by the insurance and pharmaceutical industries. It has no disciplinary function. The educational function is limited -- most doctors keep abreast of their ongoing education through their speciality societies and journals.

The AMA traditionally has represented right wing politicians and opposed social change, i.e. Social Security and Medicare. It has imbued in the practicing physician the thought that high malpractice premiums are solely the fault of the "trial lawyers," disregarding the fact that the doctor’s own negligence, lack of caring, and failure to communicate with the patient or other attending physicians are indeed part of the problem. Further, when the malpractice insurance companies are losing in their investment portfolios they increase premiums, to maintain profits, and blame the increase on the trial lawyers.

Time becomes of the essence; hence, the President must speak out to the Senate, as he did to the Congress on the recent War Appropriations bill. He must schedule an address to the American people where he unequivocally fulfills his campaign promises to provide decent health care, as is available in the majority of the free world. I would think that President Obama is as ashamed as I am of seeing the United States ranked #32 worldwide in health care delivery, a notch above Slovenia. Obama must make his own decision and not accept the council of the duplicitous Rahm Emanuel.

One admires the President’s insight and knowledge in taking a reasonable, sensible, and enlightened stand as regards the present civil conflict in Iran; one trusts that he will show like courage in facing down the Senate regarding health care and, if necessary, request the Senate to enact the "nuclear option" to bypass the Republican obstructionism and the Democratic acceptance of health insurance industry bribery

I had hoped to further address the legalization of cannabis; however, space is limited. I would suggest that anyone interested in the subject, as well as in the "war on drugs" obtain the July-August issue of Mother Jones, as much of the magazine is devoted to those topics, including an excellent historical review.

[Dr. Stephen R. Keister, a retired physician who is active in health care reform, lives in Erie, PA. His previous articles on The Rag Blog can be found here.]

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Single Payer: The Republican Perspective

Thanks to Diane Stirling-Stevens / The Rag Blog

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Health Care Reform : Our Last Stand

Health Care for America Now

This effort, in my opinion, represents our last stand to effectively combat the forces that would deny Americans decent health care merely to increase the profits of the insurance and pharmaceutical cartels.

By Dr. Stephen R. Keister / The Rag Blog / May 28, 2009

As I watch the proposals for a national health program, and the well financed opposition in Congress, I am reminded of a warning sounded by Eric Hoffer in 1951. Hoffer wrote, and this surely applies to the increasing roar of the opposition, that

"Charlatanism of some degree is indispensable to effective leadership. There can be no mass movement without some deliberate misrepresentation of facts. No solid, tangible advantage can hold a following and make it zealous and loyal unto death. The leader has to be practical and a realist, yet must talk the language of the visionary and the idealist."

The two most recent organizations created by the insurance and pharmaceutical industries -- which they hope the American public will accept as bona fide entitles -- are Patients United Now and Americans For Prosperity. These creations exemplify charlatanism at its finest; their appeal is to the naive and ill-informed. The really dirty stuff is just beginning.

I attended a local meeting of Health Care for America Now (HCAN) and would strongly suggest that all readers of The Rag Blog take advantage of the organization’s web site. This effort, in my opinion, represents our last stand to effectively combat the forces that would deny Americans decent health care merely to increase the profits of the insurance and pharmaceutical cartels. I entered this contest as a strong backer of single payer/universal health care as outlined by Physicians for a National Health Program (PNHP); however, as a pragmatist one must make concessions, as I did to Dr. Marc Stier, the energetic, intelligent, and dedicated leader of the Pennsylvania chapter of HCAN.

I continue to feel that single payer is the program of choice; however, the realities that we face in the United States Senate (we can almost visualize the wire transfers to Switzerland and Liechtenstein while we watch the Finance Committee prostrate itself before the insurance and pharmaceutical giants) alone illustrates the seeming futility of facing any significant legislation. The Lehigh Valley News has a thoughtful discussion of why single payer is in trouble in an article titled "Why Is Single Payer Care Off the Table" by Rev. Sandra L. Strauss, who is director of public advocacy for the Pennsylvania Council of Churches.

The HCAN meeting I attended convened with an eight person panel, including Dr. Stier. Brief -- but the statements given by representatives of the two U.S. Senators, and our local Congress-lady rang hollow. There is, however, some encouraging news regarding Sen. Robert P. Casey of Pennsylvania. According to an article from The Hill, distributed by truthout, Sen. Casey, a member of the Senate Health care Committee, will follow Sen. Edward’s Kennedy's lead. It also appears that Senators Durbin, Gillibrand, Harkin, Inouye, Kaufman, Levin, Merkley, Reed, Rockefeller, Schumer, Stabenow, Whitehouse, Webb, and Sanders are on board as well.

I would guess that there were 50-60 individuals present at the gathering. Some, including Dr. Stier, speaking to a generally well-informed audience, clarified the plans and intents of HCAN. There were several handouts; one was titled "A public Health Insurance Plan Option -- What Is It?" This was concise and to the point; however, one clause gave me pause: "May hire insurance companies, where efficient and appropriate, to handle administrative functions such as paying claims.” Shades of "Medicare Advantage,” the Bush administration’s attempt, still ongoing, to privatize Medicare.

It was noted that HCAN is planning a march on Washington in June, and is hoping for 20-30,000 participants. This calls to mind a "march" some years ago, the "one million man march" which was organized, in essence, to prove the participants’ masculinity. This brings to mind a thought that occurred to me during the meeting: "Where ARE the uninsured; where are the folks that we are representing?" Will any of these people come to the June gathering in Washington? Which brings to mind more words of Eric Hoffer from The True Believer>:

"The poor on the borderline of starvation live purposeful lives. To be engaged in a desperate struggle for food and shelter is to be wholly free from a sense of futility. The goals are concrete and immediate. Every meal is a fulfillment; to go to sleep on a full stomach is a triumph; and every windfall a miracle. What need could they have for ‘an inspiring super-individual goal which would give meaning and dignity to their lives?’ They are immune to the appeal of a mass movement."

I would suggest that all progressives, at this time of feelings of ambivalence regarding President Obama, review Hoffer's thinking. To me he is more relevant than he was in 1951.

President Obama, speaking on C-SPAN on May 24, reportedly vowed that his health care plan will provide "basic coverage" to all Americans. He gave no specifics but repeated the mantra that his plan "will invest more in prevention and wellness programs" as including as a move to increase electronic data-keeping. Once again, a cop-out! The anxious mother with a feverish child wants a physician at the bedside and does not give a hoot about wellness programs. The husband, sitting in an intensive care unit with his wife in a diabetic coma, wants a competent endocrinologist in charge and does not give a tinker’s damn about electronic data keeping. "Basic coverage?”

Are we discussing something akin to Medicaid ? Medicaid, a half-way measure in the search of health car?. A fraud in many instances which provides "care" on paper but in the real world provides nothing in the way of first class medical attention.

To make the situation even more frightening, an AP story carried in the Erie Times News reports that “a major health insurer says that the government can save more than $500 billion in Medicare spending by sending patients to less expensive, more efficient doctors, reducing hospital visits by the elderly, and cutting down on unnecessary care.” The 'health insurer' consulted by some idiot in Washington is the United Health Group, the largest participant in the Bush administration’s "Medicare Advantage,” a company that pays its CEO some $30-plus million per year. Nowhere does the “consultant” suggest doing away with Medicare Advantage plans, which are draining the Medicare trust fund by billions of dollars per year. One wonders who the demented individual in Washington was that provoked this "consultation" which is rather akin to asking the Godfather to review the business practices of the family industries to which the Mafia sells protection. Not really a fair comparison since the Costa Nostra never had it as good as the United health Group.

The other concern regarding "basic coverage" is that it will require, by law (probably unconstitutional) that everyone purchase private insurance. Of course, the policies of the less fortunate will have something like a $5,000 yearly deductible, high co-insurance payments, and numerous exclusions. For instance, they will state that they will pay for "management of diabetes,” but in the very, very small print will exclude payment for "diabetic complications.” This all dovetails nicely with a report from the Philadelphia Inquirer that says that the cost of insurance from Independence Blue Cross, for a family of four, non-group subscribers, would rise from $1,069.15 per month to $1,634, a 52.8% increase. Of course, there are cheaper plans, but here again we find the large deductibles, the co-insurance, and the exclusions.

And as far as Blue Cross is concerned, these folks are politically active, as Paul Krugman points out in the May 22 New York Times ("The Blue Double Cross"). On the Monday following the White House photo-op, The Washington Post reported that Blue Cross of North Carolina was preparing a series of ads attacking a public option insurance. The insurance industry will not be satisfied with merely doing away with single payer/universal care, but will stoop to all manner of deceit to persuade the gullible public that a public option plan is not in its interest. Not only will our elected representatives receive baksheesh, but we will see contrived ads about how bad health care is in other countries, how freedom of choice will be disallowed by a public plan, and we will be told that the “government will choose your doctor” and that there will be waiting periods of weeks to obtain care, etc. All hogwash, lies, and misrepresentations.

Two final thoughts:

We who support health care for all must, as well, support The Employee Free choice Act. These programs, in my opinion, are joined at the hip. And, we must support the American College of Physicians PAC in its efforts 1) to ensure that all Americans have access to affordable care; 2) to pilot test new Medicare payment models that realign incentives to support effective, efficient, patient-centered, coordinated care; 3) to improve Medicare fee for service payments to make primary care competitive with other specialties; and 4) to establish a national workforce policy to ensure sufficient numbers of primary care and other physicians.

Since we are writing from Erie, Pa., the site of ex-President Bush's “coming-out” speech on June 17, we will try to keep you informed of an occasion that The Erie Times News, a good companion newspaper to the Washington Times or Greensburg Tribune, will turn into a memorable, earth shattering, event.

[Dr. Stephen R. Keister, a regular contributor to The Rag Blog, lives in Erie, PA. He is a retired physician who is active in health care reform. His previous articles on The Rag Blog can be found here.]

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Congressional Health Care Hearings : Pure Flim-Flam

Dr. FlimFlam's Miracle Cream, as sold by Sen. Max Baucus and the gang. Image of Dr. Zoidberg from Futurama Wiki.

These hearings are pure flim-flam and the Senate will support a 'health care plan' largely dictated by the insurance and pharmaceutical industries.

Dr. Stephen R. Keister / The Rag Blog / May 20, 2009

In a country well governed poverty is something to be ashamed of, In a country badly governed wealth is something to be ashamed of. -- Confucius, 500 B.C.

This morning I encountered two seemingly unrelated bits of information that reflect on the current health care debate.

The first item was an AP dispatch from Geneva: the World Health Organization urged drug makers to reserve some of their pandemic swine-flu vaccine for poor countries, but received few concrete offers. The global body wants companies to donate at least 10% of their production or offer reduced prices for poor countries that would otherwise be left without vaccines should there be a sudden surge in demand. But some of the pharmaceutical companies are skeptical about what such a commitment could mean for their business (read: profits).

Second, while reading Bill Moyers’ Moyers on Democracy and came across the following:

"It was just a couple of years ago that controversy erupted over the so-called date-rape drug, Rohynol. Rapists were found to be using it to drug and sedate their victims before exploiting them. Sparked by public indignation, members of Congress moved to designate the drug as a controlled substance, which would have meant stiff penalties for its abuse. Lobbyists for the pharmaceutical industry, which obviously does not condone rape but does oppose regulation that might interfere with its astronomical profits, killed the effort. They smothered it to death with money, big contributions to Republicans and Democrats alike. The money talked and the politicians shut up."

From this we gain further insight into the workings of both the large corporations and the U.S. Senate. While watching the hearings on health care in Sen. Max Baucus’ committee, I am prone to flashbacks to the days of Huey Long, Boss Tweed, E.H.Crump and James Pendergast. As we have noted in previous articles, these hearings are pure flim-flam and the Senate will support a "health care plan" largely dictated by the insurance and pharmaceutical industries. Unhappily the President seems to be of like mind; at last week’s White House press conference he stood with the enemies of decent health care behind him and spoke out in favor of their totally absurd suggestions, appearing just as sad a figure as Neville Chamberlain appeared at Munich in 1938 when he announced "peace in our time.”

One misunderstanding that needs to be cleared up: both the Senate and White House séances claim that doctors are represented in their proceedings. They refer to the American Medical Association. In reality the AMA is a political lobby which has little to do with the practice of medicine or the conduct of physicians. In the 1930s the Journal of The American Medical Association was one of two publications in this country that published articles written in Germany that espoused the "science of eugenics” -- of hereditary racial superiority. In my early days of practice one Dr. Morris Fishbein was the leader of the AMA and a mouthpiece for the most reactionary political causes including the activities of the House Un-American Activities Committee.

As a rule, over the years fewer than 50% of American physicians have been AMA members. The AMA helped bury universal health care as an adjunct to President Roosevelt's social security program, and opposed health care for all at the time of the founding of Medicare. The AMA even opposed physicians entering into the social security program.

Both the Senate and the White House have excluded the true representative physician’s organizations from their discussions, such as the American College of Physicians/American Society of Internal Medicine and Physicians for a National Health Program (PNHP). The only other organization as disingenuous is the AARP, which is a massive purveyor of health insurance.

In the June 1, 2009 edition of The Nation, Vincent Navarro, M.D., PhD, professor of health policy at The Johns Hopkins Medical Institution, writes:

"Without a clear mobilization in the country, such as we saw in the civil rights era, we are not going to see true health care reform. Recommendations to give more money for technology and research and to subsidize premiums for those who cannot pay are extremely unambitious. They do not come even close to the root of the problem: the enormous power of the insurance-industrial complex."

Time is of the essence, and where is the public outcry? We have seen no spectacular marches, no public gatherings involving those denied decent health care. We have seen small conclaves of those dedicated idealistically to health care for all, the organizers, the workers. Where are the people? Where is the movement reflecting the masses that do not have health care? I do not expect torch carrying multitudes singing "Arise you prisoners of starvation, arise you wretched of the earth," but it would be helpful to see some of the kind of activity suggested by Dr. Navarro as we stand even now upon the bank of the Rubicon. We have a very short summer in which to succeed.

I fear that there is an American cultural predisposition to accept the status quo. I am reminded of an old motion picture, Charles Dickens’ "Tale of Two Cities,” where in the opening scene a child is run down by an aristocrat's horse drawn carriage. The situation was accepted as part of life by the peasants standing by. This, in the 1890s was a carryover from the Lord of the Manor/serf oriented society of the 13th Century, where the vassals accepted the Lord's whims without question. The Lord was supported by the king, the Dominicans and the flagellate friars. Are we faced by a like situation where the disenfranchised, those without health insurance, accept the rule of our corporate society, augmented by the U.S. Senate and the megachurch leaders in Fort Lauderdale, Virginia Beach, and Colorado Springs? Tell me it is not so.

Robert Reich expresses his fear that we are on the verge of losing the battle. Dr. Reich indicates that the President may well have caved in, even on his compromise of "Medicare For All,” in the face of the pressure from the pharmaceutical/insurance/medical supply manufacturers. And David Sirota devotes an article to "Health Care's Enigma in Chief,” as he refers to President Obama. Obama, it appears, in spite of his earlier pronouncements, has become a health care mystery, struggling to muster consistent positions on the issue.

Meanwhile the general public continues to be flooded by a multibillion dollar avalanche of misinformation relative to health care in Canada and the countries of the European Union. Unfortunately, if critical thinking is informed by what we see on Fox News and CNN, the corporate sponsors of the disinformation may well be way ahead of us, the underfunded folks who try to speak the truth. After all, we are opposed by CRC Public Relations, whose chairman is Lief Noren, a major player in the Swiftboat organization. Perhaps if all the readers of these words were to check out an article from The National Post by Diane Francis entitled “U.S. Health Care Lies About Canada, Greed, U.S.Politics, Dysfunction,” we could do a bit of reeducation among our friends and relatives.

I for one had been hoping that the House of Representatives would seriously consider Universal Single Payer Health care; however, Ralph Nader quotes House Speaker Nancy Pelosi, who responds to a question about health care reform with these revealing and exasperating words: "Over and over again, we hear single payer, single payer, single payer. Well, it's not going to be single payer.” Mr. Nader fears that the Speaker’s connections to Aetna are showing.

Of course the least expensive program for the U.S. taxpayer is universal single payer coverage. This is graphically pointed out in the April 23 testimony of Dr. David Himmelstein of PNHP, at a hearing on "Ways to Reduce the Cost of Health Care Insurance for Employers, Employees, and Their Families,” before the Health, Labor, and Pensions subcommittee.

As it takes up health care reform the Congress should consider a program of mandated, paid, sick days as is present in every other industrialized nation. The United States is the only nation that fails to provide for an individual who stays home to prevent spread of a contagious illness, and is penalized financially for doing the correct thing. This becomes imperative in view of the potential pandemic of swine flu this coming winter. This is especially important since the United States is probably the least prepared of the Western nations to deal with such a pandemic. Forty million citizens are without a family doctor and our public health systems have been largely neglected since 2001, save for the stockpiling of a far from adequate supply of antiviral drugs.

[Dr. Stephen R. Keister, a regular contributor to The Rag Blog, lives in Erie, PA. He is a retired physician who is active in health care reform. His previous articles on The Rag Blog can be found here.]

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Single Payer Health Insurance: Ending a Parade of Preventable Misery

Dr. Claudia Fegan.
Single-payer health insurance is way to go
By Don Terry / May 14, 2009

An army of lawyers and lobbyists is gathering along the Potomac.

The upcoming battle in Washington over national health care reform is going to be fierce.

Billions of dollars are at stake.

There will be blood.

So, I called a doctor.

About 70 percent of the patients who Dr. Claudia Fegan treats at her South Side clinic don't have health insurance -- like the housekeeper whose breasts were purple and rock-hard from cancer.

"She was just waiting at home to die," Fegan says. "She didn't have insurance. She didn't know what to do. Her daughter finally brought her in."

Fegan, past president of Physicians for a National Health Program, has seen cases like that again and again. A parade of preventable misery. That's why she supports a single-payer system that would essentially expand Medicare coverage to include every American, regardless of age.

Under such a plan, the government would pay the health-care bills of all Americans. Advocates say the somewhat higher taxes that result would be offset by massive savings in administrative costs rung up by the scores of private insurance companies that dominate the current system.

Yet health-care services would remain private. People would still get their choice of doctors and hospitals -- which isn't always permitted under some of today's insurance plans.

A single-payer system is not socialism, as its wackier opponents contend. But the S-word has become the far right's boogey- man of the moment.

No wonder. Big money is at stake. America spends more on health care than any country in the world, about $7,200 a year for every man, woman and child.

France, Germany and Switzerland rank higher than the U.S. in overall health care yet spend only about $3,400 per capita. Like most of the developed world, those countries have single-payer health-care systems.

Under a single-payer system, the private insurance industry would be largely out of the health-care business. That's what's keeping them up at night -- and at the White House just the other day, when they made sketchy promises to help cut costs.

A single-payer system would do it for them. Fegan says the program would save the country $400 billion a year in administrative costs and other waste. That's a lot of foreclosed homes and jobs that could be saved.

"The current system,'' she says, "allows insurance companies to dictate who gets care and what kind of care they get. We shouldn't allow the insurance companies to practice medicine without a license.''

Before Barack Obama went to Washington, he supported a single-payer system. He has since backed off that position.

He has proposed a somewhat vague public/private system that would keep the insurance companies in the game -- and in the money. That's the most politically feasible option, he contends.

He barely gives single-payer advocates the time of day and begrudgingly included them at a recent White House health-care reform conference.

"I'm sorry to say, like many before him, Obama is worried about the awesome clout of the insurance industry,'' says Dr. Quentin Young, a Hyde Park neighbor of Obama and a physician for more than 50 years. "The fix is in.''

"The economy can't tolerate this market-based system. There's a growing awareness that single-payer is the way to go," says Young, national coordinator for Physicians for a National Health Program.

Fegan says more pressure has to be put on Obama and other officials to support a single-payer plan. "We have to create a movement. . . . He's still making politically feasible arguments instead of doing what he knows to be right. Issues of social justice are never politically feasible.''

Fegan makes a lot of sense.

Remember, electing a black man from the South Side of Chicago president wasn't politically feasible, either.

Source / Chicago Sun Times

Thanks to Jeffrey Segal / The Rag Blog

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Health Care Profiteers : This Won't Hurt a Bit

Graphic from ISIPS.
The fight for real health care reform

We are being outspent by billions of dollars by the amalgam of well heeled interest groups that will benefit financially from maintaining the status quo.

By Dr. Stephen R. Keister / The Rag Blog / May 14, 2009

In Webster's Universal College dictionary there are four definitions, but one applies. Prostitute: "A person who willingly uses his or her talent or ability in a base or unworthy way, usu, for money.”

I have studied several photographs of President Obama taken this past Monday with the representatives of the health insurance industry and their shills. Try as I may I cannot get a similar photograph out of my mind, of negotiations which took place in September 1938. Here is Prime Minister Neville Chamberlain in Munich amid a group of glowing contemporaries happily announcing "we have achieved peace in our time.”

Concurrently, Sen. Max Baucus continues to create a chimera in his Senate committee, inviting those to testify who have created the present health care crises and having those who honestly and sincerely desire decent health care escorted out of the chamber in handcuffs. It is really mind-boggling that the needs for health care for all Americans would descend into such a farcical morass.

Each day I come across reports of more unions that have endorsed HR 676. Each time I want to cry out in frustration. I have not reached the depths of cynicism felt by Alan L. Maki as expressed in his excellent comment appended to my Rag Blog article of May 8; however, I can share his frustration. I further appreciate his listing of the financial contributions by the insurance and related industries to the members of the Senate.

It is my understanding that Congress will not finally vote on a health care bill until September, so we have some time to work for HR 676, S 703, or the compromise suggestion of an alternative, i.e. a public, subsidized, public health care plan for all similar to that presently available for those over the age of 65 as Medicare. According to a survey published by The Commonwealth Fund, only 8% of the folks covered by Medicare rated their coverage as "fair or poor,” while 18% of individuals with employer based insurance were dissatisfied.

M.S. Bellows, Jr. has an excellent piece that was distributed by Common Dreams: "Is Obama Naive about the For-Profit Industry’s Commitment to Real Reform?” What was promised? A coalition of health insurance, hospital, pharmaceutical company and physician trade groups, plus a major union, are promising the President that they will reduce the rate of future growth in the cost of health care by 1.5% per year for the next decade! The reason sited by the group -- including Big Pharma, the health insurance lobby, the American Medical Association (which represents the pharmaceutical industry and has done so for years), and hospital industry groups -- is that they are "Americans.” To anyone with any insight at all this is patently absurd and has absolutely nothing to do with the establishment of a universal health care system in the United States. How stupid do these folks think we are?

Yet, I fear that they have something very strong in their favor, and that is the cultural detachment in the United States. I am taken back to an episode during the 2004 presidential campaign when on a rare occasion I was watching TV – CNN as I recall. The correspondent was interviewing an underprivileged lady somewhere in the Midwest. Her husband was unemployed, they had lost their health insurance, two children were ill, their house was in foreclosure. The interviewer asked the lady who she was voting for, and without hesitation she answered: "For President Bush, of course, he is against gay-marriage."

In recent weeks numerous new organizations have entered the fight for decent health care, including Single Payer Action and Doctors for America. These join the Physicians for a National Health Care Program, Center for American Progress, Campaign for America’s Future, Health Care for America Now, and others. Yet, in spite of the positive work done by all of these dedicated folk, we are being outspent by billions of dollars by the amalgam of well heeled interest groups that will benefit financially from maintaining the status quo. Their lies and misrepresentations are everywhere: that European or Canadian health care is inferior to ours, that folks die of cancer in the UK because of neglect, that it takes weeks to get seen by a doctor in the Netherlands, that the government in Germany chooses one’s physician. Happily, a bit of light is being brought by The Ed Show on MSNBC, and a few well done TV appeals to support the cause of decent health care.

At near age 88 I hate to surrender; however, I feel that the only answer to achieve anything constructive -- and I will, with hesitation, settle for "Medicare for all” -- is to mobilize an action akin to the civil rights movement, taking to the streets, the public squares, and our elected representatives’ local offices. This must remain nonviolent, for the forces behind denying health care will only be too glad to take advantage of what they see as civil disobedience. They control the "authorities" and the seats of power. There may be three months to overcome the pandering of the lobbyists to our elected officials. Remember the Jacobins did not initiate the events of 1889, the movement originated with The Third Estate, the middle class.

Don't miss "The Secret Right-Wing Strategy on Health Care is Exposed," an article by Bernie Horn published by Campaign For America's Future. To effectively counter the manipulation of our representatives and the mainstream media, we must stay informed.

Further, do not be distracted by the calls for computerized records as the sine qua non of health care. The right wing seems to feel that this, along with "wellness programs,” and further tax breaks for the well-to-do, will suffice. Granted computerized records would once again open up communications, hopefully, among our various attending physicians, but they would also have the unhappy result of opening up our health care records to the insurance industry and give them further opportunity to fish for reasons to disqualify our rightful claims.

We must educate any and all of our friends. Medicare, for instance, is an example of government run insurance, as is the Veterans Administration (which the Bush administration grossly underfunded). For instance, with a national health program the “bureaucrats” will not select your doctor or hospital for you. You will have free choice of physicians as is the case in Europe. The lies and fabrications of long waits for care in the EU or Canada are essentially just that: lies and fabrications. Yes, in Canada, just as in the United States, you might have to wait for an especially popular physician at a major clinic, but that is the exception, not the rule.

The opponents of universal care will, however, cite it as the rule. You might have to wait for a new and expensive cancer drug in the UK; however, you probably won’t get it at all in this country -- without the best insurance. Here’s a statistic to remember: single payer, universal care as proposed in HR 676 will cost the citizen approximately 40% of present costs.

Health Insurance Company Profits in 2007 (thanks to the Wonkroom at Think Progress):

1. UnitedHealth Group -- $4.654 billion (Oxford, PacifiCare, IBA,AmerChoice, Evercare, Ovations, MAMSI and Ingenix)
2. Well Point -- $3.345 billion (Various BLUES across the U.S.)
3. Aetna Inc. -- $1.831 billion
4. CIGNA Corp. -- $1.115 billion
5. Humana Inc. -- $834 million
6. Coventry Health Care -- $626 million
7. Health Net -- $194 million

Much work lies ahead. We must unite and give it a good try, for if we do not succeed we will encounter an even worse health care situation than has been foisted upon us by the health insurance industry for the past 30 or more years.

[Dr. Stephen R. Keister, a regular contributor to The Rag Blog, lives in Erie, PA. He is a retired physician who is active in health care reform. His previous articles on The Rag Blog can be found here.]

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Health Care Reform : Private Companies Just in it for the Money

Graphic from lamiavitafolle.

We have an opportunity to make real and substantial changes to fix America's health care. A few promises and some band-aids on our current system are not nearly enough.

By Ted McLaughlin / The Rag Blog / May 10, 2009

According to CNN, "President Obama will announce Monday that he has secured the commitment of several industry groups to do their part to rein in the growth in health care costs. This pledge from the private sector could reduce the growth in health care spending by 1.5 percentage points a year, for a savings of $2 trillion over 10 years. Overall, it could amount to a 20% reduction in the growth of health care spending."

The commitment has been agreed to by six trade associations representing unions, hospitals, insurers and the drug industry. The administration is treating this as good news, and says it shows these private companies are on board with health reform. I'm not at all sure I agree.

These companies, especially the insurance companies, know that a large majority of the American people are unhappy with our health care system as it is. This sounds more like the opening salvo in a public relations campaign to convince the American people that these companies are not really such bad guys after all.

The fact is that we are spending more money on health care per patient than any other industrialized nation and getting less for it. The climate is ripe for real reform, and that is scaring the hell out of the insurers and health care providers. They are making obscene profits from the current system, and are afraid of substantial reform -- afraid it will interfere with those profits.

Notice that they didn't agree to actually cut any costs -- only the rate of growth of the costs. If you'll re-read the first paragraph, you'll see they are only promising a 20% cut in the "growth" of health care costs. Frankly, that's not nearly good enough.

It's time to take the obscene profits out of health care. Providers need to be paid fairly, but that is not the problem in the current system. The problem is that the insurance providers and big pharmaceutical companies are in charge -- not the doctors, clinics and hospitals.

The last time health care reform was proposed, these companies ran ads saying it would deny patients the right to choose their own doctor, and keep the doctors from determining what care was needed and should be provided. This campaign was a big lie, because consumers who have private insurance do not currently have those rights.

Consumers cannot choose their own doctor and hospital. Both must be chosen from a list provided by the insurance company. If a doctor or hospital is not on the list, then the consumer cannot choose them (or must pay thousands of extra dollars out of their own pockets if they do choose them).

And doctors are not currently in charge of your health care -- an insurance company employee is. Doctors can only provide the care that the insurance company will pay for, and if that care is expensive, the company will probably not pay for it. After all, they make bigger profits if they don't pay, and for an insurance company profit is the name of the game.

The only way to actually cut costs and cover all of our citizens is to institute a government-run single-payer health care system. This would instantly cut out the obscene profits of the insurance companies. It would also allow the government to control the costs of medications.

And it would allow each patient to choose his own doctor and hospital, and put the doctors back in charge of health care decisions. This is true in Canada, Great Britain, France and most other industrialized nations with government-run health insurance system, so there is no reason it cannot be done here.

So, don't fall for this announcement that the private companies are going to cut costs. They aren't -- only the growth of costs. Don't let them fool you into believing a public health care insurance plan is not needed. It most certainly is needed.

We have an opportunity to make real and substantial changes to fix America's health care. A few promises and some band-aids on our current system are not nearly enough. Decent and affordable health care should be the right of every American -- not just the rich.

[Rag Blog contributor Ted McLaughlin also posts at jobsanger, an excellent Texas political blog.]

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