This article was posted at the Physicians for a National Health Plan web-site, where you can find daily updates of press and letters to the editor about the single payer health care issue.

The U.S. should adopt its northern neighbor’s system of state-paid medical care for all its citizens. Pro or con?

Pro: Follow the Maple Leaf

by James Clancy, National Union of Public & General Employees (Ottawa)
Business Week

I find Top 10 lists are a useful way to quickly distill large and complicated issues down to the bare essentials. So here are my Top 10 reasons the U.S. should adopt Canada’s single-payer health-care system.

1. All Americans would have health insurance. This is the right thing to do because it reflects and promotes core values and notions of citizenship: equality, compassion, and social solidarity. Sickness doesn’t discriminate. Neither should health care.

2. Health would improve. On almost every critical measure (life expectancy, infant mortality, etc.), Canada rates higher than the U.S., and we’re among the best in the world.

3. It would cost less. Canada spends 9.8% of GDP on health care, while the U.S. spends more than 15%. A single-payer system is the less expensive way to go.

4. Patients would have more choice. In Canada, patients can choose whatever doctor, specialist, and hospital they want. Treatment decisions are left to patients and their doctors. No insurance companies meddle in our choices.

5. Quality of service would improve. In Canada, health providers never have to choose between their wealth and a patient’s health. Our system forbids that choice. The vast majority of Canadians are highly satisfied with the quality of care they receive. In Canada, patients rarely sue physicians.

6. It would reduce the bureaucracy. Patients in Canada show their health card and get care. Health providers bill the government directly and get paid. It’s that simple.

7. Fewer Americans would go bankrupt because of health-care costs. This is a major problem for many U.S. families. It rarely happens in Canada.

8. It would benefit business. Companies in Canada have a competitive advantage because they don’t have to provide basic health-care coverage for their workers.

9. It would diminish labor strife. Health care is incidental in labor negotiations in Canada. It’s a large and growing pitfall in contract negotiations in the U.S.

10. It would serve democracy. Most Americans want major, not incremental, health-care reform. Many Americans support a single-payer system. It is about responding to the wishes of the people.

Ignoring ‘mandate’ plans’ record of failure

By Roger Bybee
Fair & Accuracy in Reporting
Extra!
May/June 2008

In the 2008 Democratic primary campaign between Barack Obama and Hillary Clinton, each is offering a slightly different variant of individual mandate-based healthcare plans relying on the private insurance industry. Media coverage has magnified the slight variations while almost entirely ignoring the big picture: Both health plans are based on a model that has consistently failed to get off the ground in numerous states.

Most media analysis has focused on the political advantage provided by each proposal, rather than on the evidence that either plan would actually deliver quality, affordable care to all Americans.

Obama proposes that parents be mandated to buy private insurance for their children, with an individual mandate for adults to be imposed once “cost controls” drive down the cost of insurance—a highly optimistic scenario, given that he is not addressing insurers’ extremely high administrative costs. For her part, Clinton insists on an immediate and universal mandate for all to purchase private insurance. “As a practical matter, the difference between Senator Clinton’s and Senator Obama’s approaches comes down to timing and sequencing,” stated former Clinton Labor Secretary Robert Reich (American Prospect, 1/10/08).

Some health policy experts trace the roots of the Democratic candidates’ insurance-centered, mandate-based healthcare plans to Republican President Richard Nixon, who recognized the need for health reform but sought to protect private insurers and other powerful interests. In 1971, Nixon proposed mandating employers to cover their employees and requiring poorer Americans to pay reduced insurance premiums in an expanded Medicaid program. Over time, Nixon’s concept has devolved into an approach with less stress on employer payments and more emphasis on individual mandates to purchase private insurance.

The individual mandate essentially requires citizens to buy private insurance that is unaffordable for tens of millions. Consequently, it has been the rock upon which one “universal” state plan after another has crashed and splintered, as noted in a New York Times op-ed (12/15/07) by Harvard Medical School doctors Steffie Woolhandler and David Himmelstein.

Much-heralded plans passed in the late 1980s and early 1990s in Massachusetts, Oregon, Minnesota, Tennessee, Vermont and Washington all promised to provide universal coverage, most often based on a combination of employer and individual mandates. In each case, the mandate-based approach has failed to deliver any decreases in the number of uninsured; in several states there were substantial increases, as Himmelstein and Woolhandler detail.

The most recent experiment with mandates in Massachusetts appears to be sinking fast. The plan, signed into law in 2006 by Republican Gov. Mitt Romney, charges employers just $295 per year while forcing families earning as little as $29,400 a year to buy insurance without any subsidy, backed up with penalties as high as $4,000. While state officials claim progress, “according to the Census Bureau, the new sign-ups amount to less than one-quarter of the uninsured,” noted Himmelstein and Woolhandler (Boston Globe op-ed, 9/17/07). They pointed out that “244,000 of the Massachusetts uninsured get zero assistance—just a stiff fine if they don’t buy coverage.”

Essentially, healthcare plans have been configured to prevent a showdown with private health insurers over their unaffordable premiums, driven by astronomical U.S. administrative costs. As Woolhandler and Himmelstein observed in their New York Times op-ed (12/15/07):

The “mandate model” for healthcare rests on impeccable political logic: avoiding challenging insurance firms’ stranglehold on healthcare. But it is economic nonsense. The reliance on private insurers makes universal coverage unaffordable.

With an estimated excess administrative burden of $350 billion to $400 billion annually, it is impossible to envision effective cost controls under a system dominated by private insurance, at a time when per-person healthcare costs have reached $7,400 in the U.S. (New York Times, 3/3/08), virtually twice the cost of any other advanced nation.

Even when the individual mandate/private insurance approach is coupled with an option to choose a public insurance plan, as both Obama and Clinton have proposed, only a small portion of the excess insurance overhead can be eliminated, because providers and patients must contend with multiple insurers seeking to maximize profit. While some Democrats, like former candidate John Edwards, envisioned the public plan as the incubator for an evolving single-payer system (New York Times, 1/25/08), such an alternative system might also be transformed into the insurers’ dumping ground for patients who would likely diminish their profits by requiring more care.

The individual mandate approach is also weighed down by an unappealing political message, a point rarely mentioned in mainstream media. Rather than focusing on the benefits a new government program would confer on all Americans, the individual mandate puts the spotlight on the immediate burden of buying often-unaffordable insurance. As economist Robert Kuttner put it (American Prospect online, 1/30/08): “Universal social insurance signals government help. A mandate signals government coercion.”

Typifying the media analysis were New York Times reporter Kevin Sack’s pieces on the healthcare policy debate (12/25/07, 2/23/08). Sack pointed out (12/25/07) that the number of uninsured grew to 47 million in 2006, over 2 million more than the year before, and that employer-provided coverage now reaches only 60 percent of Americans, compared with 64 percent in 2000. Despite these mounting indicators of an increasingly crisis-wracked healthcare system, none of the “sweeping plans to restructure healthcare” in California, Illinois or Pennsylvania “will finish 2007 with a bill passed and signed.”

By way of explanation, Sack wrote, “In each state, the initiatives confronted entrenched opposition from insurance and other business lobbies that made it far more difficult to build a consensus than in the small New England states that acted in recent years.”

Such a statement is most notable for what it fails to illuminate. For one thing, the failures of the various New England mandate plans went unmentioned.

The candidates’ promised means of lowering insurance premiums also escaped any serious examination. “The difference is that Obama insists he will be able to lure all of the uninsured simply by dangling the carrot of low premiums; Mrs. Clinton believes there will always be some free riders who respond only to a government stick,” Sack wrote (New York Times, 2/23/08). While Sack cited cost-cutting proposals by Obama and Clinton for electronic record-keeping, preventive care and chronic disease management, he ignored the elephant in the room: the huge excess administrative costs in the U.S. imposed by private insurers. Overall, such costs account for 31 cents out of every U.S. dollar spent on healthcare (New England Journal of Medicine, 8/21/03; Health Affairs, 11-12/05).

Like much of the major media, Sack’s articles spotlighted relatively trivial procedural differences between Obama and Clinton while overlooking proven models of healthcare financing that deliver both universal coverage and effective cost controls through negotiations between provincial governments and providers. For example, neighboring Canada provides healthcare to every citizen for 52 percent of U.S. per-person costs, allows free choice of doctors, and produces far better health outcomes in terms of infant mortality, life expectancy and many other key indicators (Health Affairs, 1-2/08).

Yet many key policymakers and media commentators have utterly disqualified the single-payer plan from serious consideration. “If you want to get to universal coverage, then you have to do the individual mandate,” Urban Institute economist Joe Holahan told the Washington Post (2/24/08). “You can do it with a single-payer system, under which one entity, the government, would finance all healthcare,” he said. “But assuming that’s [politically] off the charts, then I think it [the individual mandate] is the only way to go.”

In the same vein, leading pundits like Ron Brownstein have pronounced (L.A. Times, 7/1/07):

For all the passion it evokes, the single-payer idea remains at the fringe of political viability. Though the cause energizes the left, the idea of the federal government completely replacing the private health insurance industry is so far outside the American experience that even the vast majority of health reform advocates consider it politically dead on arrival for the foreseeable future.

This viewpoint, while widely held among Washington, D.C. political and media insiders, overlooks the largely positive experience of over 40 million Americans with the Medicare and Veterans Administration systems that operate on a single-payer model.

Moreover, this exclusion reflects a vast gulf between Democratic leaders and the party’s constituency, as 70 percent of Democratic primary voters support a single-payer model of reform (Greenberg Quinlan Rosner Research, 5/4/07). This level of sentiment among Democratic voters was only slightly higher than that found among samples of all American citizens, as when CBS (9/14-16/07) found that 55 percent preferred “having one health insurance program covering all Americans that would be administered by the government and paid for by taxpayers,” vs. 29 percent who chose “keeping the current system where many people get their insurance from private employers and some have no insurance.”

But this overwhelming popular support for a single-payer system (both among the general public and increasingly doctors as well—Annals of Internal Medicine, 4/1/08) has rarely been found worthy of mention in influential media like the New York Times or Washington Post, where a search showed no record of articles on such polling over the last three years.

Meanwhile, a widely quoted New York Times poll (3/2/07) failed to even raise the single-payer issue, instead asking a much less revealing question about support for universal healthcare, a general goal supported by “nearly 8 in 10.” However, the ambiguous phrasing of possible alternatives—a list from which single-payer was omitted—produced predictably ambiguous responses from the public. Consequently, the accompanying story concluded by citing a Harvard expert predicting that public divisions would probably generate a “train wreck,” once more blocking reform. Such coverage reinforces the dubious notions that Americans resist large-scale healthcare reform and have no preferences on specific alternatives to the status quo.

Two Letters from the New York Times. These were posted at the Physicians for a National Health Plan web-site and collected by Joe Kane.

The New York Times
Letters
Published: June 19, 2008

To the Editor:

Re “The Massachusetts Model” (editorial, June 16):

As a Massachusetts primary care physician, I dearly wish that your optimism for our state’s health care plan were well placed. My fear, however, is that any plan that does not eliminate the colossal waste of multiple competing private health insurers is doomed to failure.

Costs can never be contained while supporting bloated private bureaucracies and for-profit medicine. Most physicians now support single-payer, national health insurance (“Medicare for all”).

Alan Meyers
Boston, June 16, 2008
The writer is associate professor of pediatrics at Boston University School of Medicine and a founding member, Physicians for a National Health Program.

To the Editor:

You hail Massachusetts health reform as a promising model for the nation. But within the last year both the State Senate president and the executive director of the agency implementing the new law have publicly recognized that it will collapse if health care costs continue to rise by double digits, which they have.

No effective cost-control legislation is in sight. In Massachusetts we see history repeating itself: a large expansion of Medicaid in the mid-1990s added more than 300,000 residents to the rolls, cutting the uninsured population almost by half. A few short years of rising costs, however, were enough to erase those gains and place the state back to where it started.

Similar fates have befallen many “universal” state reforms hailed as models for the nation. Without eliminating the waste inherent in commercial health care systems and making comprehensive coverage a right, no country has ever been able to achieve universal health care.

We need a single-payer health care system that will be there for our children, not another unsustainable experiment with obvious math problems that won’t be there just a few years from now.

Benjamin Day
Executive Director
Mass-Care: The Massachusetts Campaign for Single Payer Health Care
Boston, June 17, 2008

The three major party candidates for President–John McCain, Hillary Clinton and Barack Obama–all have the same flaw in their approach to our national disgrace of 47 million uninsured, mostly working Americans, in the richest country in the world. They are oblivious to the mathematics involved.

They favor so called choice of PLANS, when what we need is only one choice. Complete coverage for all sickness.

The so called choice of plans means that the affluent will buy the best coverage, and the less than affluent will have to settle for less coverage. Premiums are based on the quality of coverage, which is based on the actuarial tables of the for profit insurance companies.

That means you can’t achieve universal care from private for profit insurance.

The solution is simple: Follow the cardinal rule of economically sound insurance known to the industry as “Spread the Risk”. The more people in one insurance pool, especially a non-profit pool, the lowest cost per person is achieved. The mechanism to do this has been with us for over 40 years. It’s called Medicare.

Why not expand it to cover non seniors as Harry Truman reportedly said at the signing of the Medicare Bill in 1965: “I would have preferred if it covered everybody, not just the seniors.”?

The Birth of Sicko: An Educational Tale
from the January 2008  LICNHP  Newsletter

Our organization is concerned about the role our media play in preventing the public from getting honest information about our health care mess, or about the single payer alternative.

Recently, Michale Moore was on Amy Goodman’s program, Democracy Now. He was asked what gave him the idea to make “Sicko.” His story tells us what we’re up against:

I had a TV show on back in the 90’s called TV Nation, and one day I just - I thought it would be interesting to have like a race. So we sent a camera crew to an emergency room in Fort Lauderdale, a camera crew to an emergency room in Toronto, and then one to Havana. And, they would each wait until someone came in with a broken arm or a broken leg. And, then they were going to follow that person through and see the Health Care Olympics.

And so, it was a race between the US, Canada and Cuba. And to make a long story short, Cuba won. They had the fastest care, the best care, and it cost nothing.

We turn the show in to NBC that week, and we get a call from a censor. They’re not called “the censor”, they’re called Standards and Practices. And so, this woman calls. She’s the head of S&P - Dr. Somebody, she had a “Dr.” before her name, but I forget her last name. But she calls, and she says, “Mike, Cuba can’t win.”

I said, “What? Cuba can’t win? They won.”

“No, we can’t say that on NBC. We can’t say that Cuba won.”

“Well, yeah, but they won! They provided the fastest care. They were the cheapest. And, the patient was happy, and the bone got fixed. No it’s not against regulations here.”, I said. “Oh well, I’m not changing it.”

Well, they changed it. Two days later, when it aired, they changed it so that Canada almost won, but they charged the guy $15 for some crutches.

Independent Voice

The Myth That Will Not Die
by Joe Kane
March 6, 2003 [with updates for 2008]

What do Senators Trent Lott, Orrin Hatch, John Kerry, Ted Kennedy, and all the members of congress have in common? They are all beneficiaries of the Federal Employees Health Benefits plan known as FEHB, an elitist health insurance program that has a grossly misunderstood myth built around it.

I call it elitist, because it can only work for some at the expense of others, never for the whole country. And yet, for more than a decade, some politician is on occasion saying that the FEHB is the model for solving the problem of millions of Americans being without health care coverage.

Of course it never comes to pass as it is a myth, and the number of uninsured keeps increasing, while our health care system stays on its course to collapse. Now once again the myth of the FEHB as a model to solve our growing health care crisis and “reform” Medicare, is being touted again, and tragically by two of my favorite well meaning
Senators, Ted Kennedy and John Kerry, as well as President Bush and Senator Frist. (In 2008, Hillary Clinton has gotten on board too.)

Trying to understand FEHB started for me with a famous weekly talk show back in the early 90s, during the debate on Clinton’s Health Plan. Washington reporter Lisa Meyers on Meet The Press, questioned Newt Gingrich about his health insurance. He said he paid about $400 a month. The following night she pointed out: “He pays only $104 a month and the Government pays $404 a month! When asked why he misrepresented the facts, his answer was that he made a mistake.

Duh! Possibly a deliberate lie?

That was my eye opener, so I called the Office of Management and Budget in Washington, and a gentleman named Doug McCormick explained that the Government subsidizes all Federal employee premiums an average of 72%. That there is also a bureaucracy called the Office of Personnel Management, that employs 153 people to administer all the different insurance plans.

Needles to say these insurance companies are all in business for profit, not for the health of the patient. So what we have here, is all of us taxpayers, which includes the 42 million (47 million in 2008) uninsured, are having our hard earned dollars giving corporate welfare to the private for profit insurance industry(HMOs), to protect their profit margins. An industry that to this day has failed to produce affordable quality health care coverage for everyone. The same failed industry that spends millions of their profit dollars lobbying congress to fool us into believing, that our great Democratic government, which has given our parents and grandparents Social Security and Medicare, is incapable of handling decent coverage for all Americans. The Yiddish word for that is called Chutzpah!

Here is the undeniable arithmetic, which will destroy the myth once and for all. I feel like I’m Toto pulling back the Curtain in the Wizard of Oz. A cheap limited coverage policy of $5000 a year, multiplied by 42 million to cover the uninsured, costs $210 billion. 72%
of that is $151 billion. Where in hell can they get that kind of money? (Updating the numbers to 2008 - a $7000 premium for 47 million uninsured gives us $329 billion, times 72% gives us 236,880 billion.) On top of which the OPM of 153 employees would have to be increased by hundreds of new employees to handle another 47 million private plans. A huge additional expense. The whole idea would be dead on arrival.

If we dare to consider 20 million underinsured getting subsidized, the money going
to the additional corporate welfare becomes more outrageous.President Bush and Senator Frist are now pushing for more corporate welfare for the managed care industry, under the guise of “Modernizing Medicare” and “Choices” for seniors, to force seniors to leave Medicare for some prescription drug coverage. This is the surest way to utterly destroy the whole Medicare program, as it fractures the insurance pool we call Medicare. The cardinal rule of fiscally sound insurance known to actuaries as “Spread The Risk,” is the immutable law that cannot be broken without weakening the sound financial structure of insurance. Simple mathematical logic: The bigger the pool, the lower the cost for everyone.

In 1993 the Executive Editor of the New England Journal of Medicine, and in the NY Times on 10/13/02, Dr. Marcia Angell offered the logical solution. Extend the time tested Medicare program to the non-seniors. That would cover all Americans, who can then choose their own doctor, and permanently assure the solvency of Medicare, because it’s based on that basic economic law.

The most fascinating fact is that Medicare’s track record on costs for non-medical administration is only a shade over 2%, so there would be a SAVINGS of over $250 billion dollars by eliminating the systemic wastage of the HMOs. They have by their very nature a 25% cost ratio because of sales commissions, advertising budgets, stockholder dividends and huge CEO multi-million dollar salaries and golden parachutes. Because they offer so many different plans, they create massive amounts of costs for processing the paperwork, that any doctor will tell you is killing them.

Only one plan is needed. Everybody is covered for everything when they’re all in one non-profit insurance pool. The savings would allow us to cover prescription drugs, long term care, deductibles and co-payments.The phoniness of President Bush’s words in his
State of the Union speech betrays how unaware or cruel he is. I quote: “Instead we must work toward a system in which all Americans have a good insurance policy, choose their own doctors and seniors and low-income Americans receive help they need. Instead of bureaucrats and trial lawyers and HMOs, we must put doctors and nurses and patients back in charge of American Medicine.” (emphasis mine)

So what is his solution for prescription drugs for seniors? Give taxpayer money to those same HMOs to offer seniors prescription drugs, wherein they can continue to stop doctors
and nurses and patients from being in charge of American Medicine. Mr. Compassionate Conservative: Why not eliminate those middlemen and save the money, by giving the funding directly to Medicare?

Take heed America, before the system collapses!

Joe Kane is an Executive Board member of the LI Coalition For A National Health Plan. He can be reached at kanekohn@yahoo.com

The health care debate can be won by forcing the focus of the health care debate on phrases such as:

• Saving the Free Enterprise System of the doctors
• Spread the risk - Medicare is a restricted insurance pool of only old people, the highest risk. Basic rule of sensible insurance must be applied to secure its future. Expand Medicare insurance to non-seniors.
• Cost efficiency of non-profit Medicare - 2% to 3% as opposed to 20% to 30% wastage from middleman private for-profit HMOs.
• Savings of over $300 billion a year could cover prescription drugs and long term care, while covering everyone.
• Restoring precious choice of one’s own doctor.

Medicare for All results in shrinking the size of government, so:

No more need for following Federal Bureaucracies:

• Medicaid
• Tri Care
• Kidney DialysisFund
• Tuberculosis Fund
• Aids Fund
• Breast Cancer Fund
• Native American Health Care
• Expanded in home services for elderly(EISEP) QMB, SLIMB, and QI-1 for low income people (who are not poor enough for Medicaid)

No more need for the following NY State programs:

• Epic (Drug assistance for some over 65 years old)
• Child Health Plus
• Family Health Plus
• S Chip

Also:

• Workmens Compensation and Auto Insurance costs will drop as all medical payments are covered in the new system.
• Veterans would now have choice of family doctors and other hospitals
• We can also eliminate the 72% Government subsidy of Government Employees Insurance(FEHBP), plus the Office Of Personnel Management’s 153 full time employees who administer the private plans, each with the 20%-30% wastage

A Single Payer Medicare for All health care plan would have the backing of the 14,000 member Physicians For A National Health Plan(PNHP), New England Journal of Medicine, Thousands of Doctors from the American College of Physicians, American College of Surgeons and many other medical organizations. (The American Medical Association only represents 32% of all Physicians). The new generation of doctors favors a new health care system.
This summary created by:

Joe Kane,
Associate Publisher of Long Beach Independent Voice
Executive Board, LI Coalition For A National Health Plan

and

Dr. James Bernstein,
Past President, LICNHP
Former Professor of Internal Medicine at Einstein College of Medicine
Former President of Long Island Gastroenterological Association at SUNY Stonybroook.

From a flier explaining Conyers Bill - HR 676:

National Health Insurance with Conyers Bill - HR 676

The essential points are:

1. The for-profit insurance companies are out of the picture, saving us at least 25% of costs.

2. Everyone is covered, and 95% will pay far less.

3. We’ll be healthier!

How would a “Medicare for All” Health System Work?

Every American would receive a National Health Insurance Card. This card could be presented to any doctor or hospital for a full range of benefits. Patients would pay nothing out of pocket, and they would receive no medical bills. Doctors and hospitals would be paid out of a single national health fund instead of a wasteful patchwork of insurance companies. The paperwork savings would be enough to provide coverage for all without spending any more.

Welcome to the new website for Long Island Coalition for a National Health Plan