Healthcare Is A Human Right Rally
12:30 pm, Cedar Creek Room, Statehouse, Montpelier
Join the Vermont Workers’ Center to deliver thousands of petition signatures collected by the Healthcare Is A Human Right Campaign calling on Vermont to move forward with the design for a new healthcare system with single-payer financing and based on human rights principles.
People’s Movement Assembly
1pm - 3pm, Pavilion Auditorium, 109 State St, Montpelier
The VWC believes the struggle for healthcare and workers’ rights is directly connected to many of critical issues facing working and low-income families in Vermont. Join us to discuss strategies of uniting across movements, including:
♦ A healthcare system that works for everyone
♦ Livable wage jobs, paid sick days and safe working conditions
♦ Quality early education and affordable childcare
♦ Disability rights and protecting important social programs
♦ Safe and affordable housing and ending homelessness
♦ Fighting racism and all forms of oppression
♦ Climate justice and healthy environment
Sunday, December 26, 2010
Thursday, December 23, 2010
Millions of Americans Face Poverty and Hardship During the Holiday Season
Center on Budget and Policy Priorities
The holidays are a time when Americans come together with family and friends to share the blessings of life. Unfortunately, millions of Americans are having trouble affording basic necessities. Below are the most current figures available in five important areas.
*1.6 million people were homeless in 2009 and spent at least part of the year in a shelter; nearly 325,000 of them were children.
*15 million people were unemployed as of November, 6 million of whom had been looking for work for more than half a year.
*44 million people were poor in 2009, 19 million of whom had incomes below half of the poverty line (half of the poverty line corresponds to an income of $5,478 for an individual and $10,977 for a family of four).
*50 million people lived in households that lacked access to adequate food at some point in 2009 because they didn’t have enough money for groceries. Nearly 18 million people lived in households where one or more people had to skip meals or take other steps to reduce their food intake because of lack of resources.
*51 million people lacked health coverage in 2009.
The holidays are a time when Americans come together with family and friends to share the blessings of life. Unfortunately, millions of Americans are having trouble affording basic necessities. Below are the most current figures available in five important areas.
*1.6 million people were homeless in 2009 and spent at least part of the year in a shelter; nearly 325,000 of them were children.
*15 million people were unemployed as of November, 6 million of whom had been looking for work for more than half a year.
*44 million people were poor in 2009, 19 million of whom had incomes below half of the poverty line (half of the poverty line corresponds to an income of $5,478 for an individual and $10,977 for a family of four).
*50 million people lived in households that lacked access to adequate food at some point in 2009 because they didn’t have enough money for groceries. Nearly 18 million people lived in households where one or more people had to skip meals or take other steps to reduce their food intake because of lack of resources.
*51 million people lacked health coverage in 2009.
Tuesday, December 14, 2010
Ezra Klein on the constitutional single payer path
Health reform advocates have little to fear from judge's ruling
By Washington Post Staff Writer (Ezra Klein, per Wonkbook)
The Washington Post
December 14, 2010
U.S. District Judge Henry E. Hudson, a George W. Bush appointee (and part-owner of a Republican campaign-consulting firm that fought the health-care overhaul legislation), has, as expected, ruled the individual mandate unconstitutional. So why are reform advocates so unexpectedly pleased?
The individual mandate began life as a Republican idea. Its earliest appearances in legislation were in the Republican alternatives to the Clinton health-care bill, where it was co-sponsored by such GOP stalwarts as Bob Dole, Orrin G. Hatch and Charles E. Grassley. Later on, it was the centerpiece of then-Gov. Mitt Romney's health-reform plan in Massachusetts, and then it was included in the Wyden-Bennett bill, which many Republicans signed on to.
It was only when the individual mandate appeared in President Obama's legislation that it became so polarizing on the right. The political logic was clear enough: The individual mandate was the most unpopular piece of the bill (you might remember that Obama's 2008 campaign plan omitted it, and he frequently attacked Hillary Clinton for endorsing it in her proposal). But as a policy choice, it might prove disastrous.
The individual mandate was created by conservatives who realized that it was the only way to get universal coverage into the private market. Otherwise, insurers turn away the sick, public anger rises, and, eventually, you get some kind of government-run, single-payer system, much as they did in Europe, and much as we have with Medicare.
If Republicans succeed in taking it off the table, they may sign the death warrant for private insurers in America: Eventually, rising cost pressures will force more aggressive reforms than even Obama has proposed, and if conservative judges have made the private market unfixable by removing the most effective way to deal with adverse selection problems, the only alternative will be the very constitutional, but decidedly non-conservative, single-payer path.
Comment:
By Don McCanne, MD
It would be gratifying poetic irony if conservative legislators and conservative judges pushed us into single payer reform by either repealing or ruling unconstitutional the individual mandate.
As I said on KPFA/KPFK yesterday, "Nobody is going to argue that Medicare is unconstitutional.. We should fix it so it works better and then provide it to everyone."
By Washington Post Staff Writer (Ezra Klein, per Wonkbook)
The Washington Post
December 14, 2010
U.S. District Judge Henry E. Hudson, a George W. Bush appointee (and part-owner of a Republican campaign-consulting firm that fought the health-care overhaul legislation), has, as expected, ruled the individual mandate unconstitutional. So why are reform advocates so unexpectedly pleased?
The individual mandate began life as a Republican idea. Its earliest appearances in legislation were in the Republican alternatives to the Clinton health-care bill, where it was co-sponsored by such GOP stalwarts as Bob Dole, Orrin G. Hatch and Charles E. Grassley. Later on, it was the centerpiece of then-Gov. Mitt Romney's health-reform plan in Massachusetts, and then it was included in the Wyden-Bennett bill, which many Republicans signed on to.
It was only when the individual mandate appeared in President Obama's legislation that it became so polarizing on the right. The political logic was clear enough: The individual mandate was the most unpopular piece of the bill (you might remember that Obama's 2008 campaign plan omitted it, and he frequently attacked Hillary Clinton for endorsing it in her proposal). But as a policy choice, it might prove disastrous.
The individual mandate was created by conservatives who realized that it was the only way to get universal coverage into the private market. Otherwise, insurers turn away the sick, public anger rises, and, eventually, you get some kind of government-run, single-payer system, much as they did in Europe, and much as we have with Medicare.
If Republicans succeed in taking it off the table, they may sign the death warrant for private insurers in America: Eventually, rising cost pressures will force more aggressive reforms than even Obama has proposed, and if conservative judges have made the private market unfixable by removing the most effective way to deal with adverse selection problems, the only alternative will be the very constitutional, but decidedly non-conservative, single-payer path.
Comment:
By Don McCanne, MD
It would be gratifying poetic irony if conservative legislators and conservative judges pushed us into single payer reform by either repealing or ruling unconstitutional the individual mandate.
As I said on KPFA/KPFK yesterday, "Nobody is going to argue that Medicare is unconstitutional.. We should fix it so it works better and then provide it to everyone."
Wednesday, December 8, 2010
Healthcare-NOW! Talks with Drs. Himmelstein and Woolhandler
Join Healthcare-NOW! members and supporters for a special evening of discussion with the founders of the leading national single-payer advocacy group, Physicians for a National Health Program, Drs. Steffie Woolhandler and David Himmelstein.
As 2010 comes to a close, what have we learned in our advocacy for single-payer healthcare? Join us for an analysis of the new health law, and why so many choose to continue to advocate for single-payer national healthcare.
When: Monday, December 13th, 8pm (EST)
Featuring: Steffie Woolhandler, MD, MPH, FACP – internal medicine, New York/Boston and David U. Himmelstein, MD, FACP – internal medicine, New York/Boston
Moderator: Katie Robbins, National Organizer, Healthcare-NOW!
Questions will be facilitated by Katie Robbins. If you have a specific question for discussion, please email Katie in advance of the call at katie@healthcare-now.org.
As 2010 comes to a close, what have we learned in our advocacy for single-payer healthcare? Join us for an analysis of the new health law, and why so many choose to continue to advocate for single-payer national healthcare.
When: Monday, December 13th, 8pm (EST)
Featuring: Steffie Woolhandler, MD, MPH, FACP – internal medicine, New York/Boston and David U. Himmelstein, MD, FACP – internal medicine, New York/Boston
Moderator: Katie Robbins, National Organizer, Healthcare-NOW!
Questions will be facilitated by Katie Robbins. If you have a specific question for discussion, please email Katie in advance of the call at katie@healthcare-now.org.
Sunday, December 5, 2010
Single-Payer Health Insurance for Oregon
Obviously, getting to single payer is a long-term project. It's not just about moving a piece of legislation; it's a movement.
There are many good things we can say about health care reform at the state and federal level. Here in Oregon we passed the Healthy Kids Act, extending coverage to all of Oregon’s uninsured children, a really remarkable achievement. As a result of the federal reforms, children all over the country can no longer be denied coverage because of pre-existing conditions, and in a few years that will extend to everyone. Young adults can stay on their parents’ coverage until they are 26. Seniors see an end to the donut-hole in their prescription drug coverage. If things stay on track, an insurance exchange for individuals and small businesses is coming, and perhaps even some kind of public option for Oregon.
Despite these points of progress, though, many gaps will still remain in these plans. I see three problems in particular:
■First, there will still be people who will be left out, and that’s going to continue to drive up the cost of coverage for the rest of us.
■Second, for most people insurance is still going to be tied to employment. So if you lose your job, change your job, or drop below full-time at your job, you’re going to have to change your coverage or even worse--you’re going to lose your coverage entirely.
■Third, for the most part our system will still rely on private insurance companies, who charge very high administrative fees, and whose primary interest is their own profits.
At best, what we’re going to continue to have is a patchwork system. There’s a real danger that people are going to fall through the cracks, middle-class families are going to pay more, and small businesses are going to continue to be hammered.
Fortunately, one of the best things that federal health insurance reform did was open the door to further experimentation by the states. Thanks in large part to work done by Senator Wyden, states can try out their own solutions, as long as they are expanding access to quality healthcare to more people more affordably.
I believe that the best solution to the three problems that I mentioned above will be a “single payer” system. This would be a system like Medicare, but extended to all. Everyone would pay into the system in a progressive manner, and it would relieve the burden on Oregon’s small businesses. Initial projections show that we could create a system that in total would cost no more than we are currently paying as individuals, businesses, and the state—but everyone would be covered, would have access to quality care by the provider of their choice, and the rise in costs could be contained.
One of the real problems with the Federal reform process was that advocates of single payer were never allowed a seat at the table. For reasons of politics and influence and strategy it was ruled out before it was even considered. That’s wrong, it’s bad government, and we need to try to make it right.
I would like to see Oregon taking steps to move in this direction. So I’ve partnered with a coalition of single payer advocates--Health Care for All Oregon, Physicians for a National Health Program, Jobs with Justice, and the Oregon League of Women Voters—to develop The Affordable Health Care for All Oregonians Act for the 2011 legislative session. To see the concepts behind the bill, go to the Health Care for All Oregon (HCAO) website. Senator Chip Shields has committed to introduce the bill on the Senate side, and a number of my legislative colleagues have indicated interest in co-sponsoring.
Obviously, getting to single payer is a long-term project. It's not just about moving a piece of legislation; it's a movement. It's going to require ongoing commitment, an enormous amount of effort, organizing, and education. It's a movement that needs to reach beyond the usual confines of the mainstream media. Are you willing to help.
There are many good things we can say about health care reform at the state and federal level. Here in Oregon we passed the Healthy Kids Act, extending coverage to all of Oregon’s uninsured children, a really remarkable achievement. As a result of the federal reforms, children all over the country can no longer be denied coverage because of pre-existing conditions, and in a few years that will extend to everyone. Young adults can stay on their parents’ coverage until they are 26. Seniors see an end to the donut-hole in their prescription drug coverage. If things stay on track, an insurance exchange for individuals and small businesses is coming, and perhaps even some kind of public option for Oregon.
Despite these points of progress, though, many gaps will still remain in these plans. I see three problems in particular:
■First, there will still be people who will be left out, and that’s going to continue to drive up the cost of coverage for the rest of us.
■Second, for most people insurance is still going to be tied to employment. So if you lose your job, change your job, or drop below full-time at your job, you’re going to have to change your coverage or even worse--you’re going to lose your coverage entirely.
■Third, for the most part our system will still rely on private insurance companies, who charge very high administrative fees, and whose primary interest is their own profits.
At best, what we’re going to continue to have is a patchwork system. There’s a real danger that people are going to fall through the cracks, middle-class families are going to pay more, and small businesses are going to continue to be hammered.
Fortunately, one of the best things that federal health insurance reform did was open the door to further experimentation by the states. Thanks in large part to work done by Senator Wyden, states can try out their own solutions, as long as they are expanding access to quality healthcare to more people more affordably.
I believe that the best solution to the three problems that I mentioned above will be a “single payer” system. This would be a system like Medicare, but extended to all. Everyone would pay into the system in a progressive manner, and it would relieve the burden on Oregon’s small businesses. Initial projections show that we could create a system that in total would cost no more than we are currently paying as individuals, businesses, and the state—but everyone would be covered, would have access to quality care by the provider of their choice, and the rise in costs could be contained.
One of the real problems with the Federal reform process was that advocates of single payer were never allowed a seat at the table. For reasons of politics and influence and strategy it was ruled out before it was even considered. That’s wrong, it’s bad government, and we need to try to make it right.
I would like to see Oregon taking steps to move in this direction. So I’ve partnered with a coalition of single payer advocates--Health Care for All Oregon, Physicians for a National Health Program, Jobs with Justice, and the Oregon League of Women Voters—to develop The Affordable Health Care for All Oregonians Act for the 2011 legislative session. To see the concepts behind the bill, go to the Health Care for All Oregon (HCAO) website. Senator Chip Shields has committed to introduce the bill on the Senate side, and a number of my legislative colleagues have indicated interest in co-sponsoring.
Obviously, getting to single payer is a long-term project. It's not just about moving a piece of legislation; it's a movement. It's going to require ongoing commitment, an enormous amount of effort, organizing, and education. It's a movement that needs to reach beyond the usual confines of the mainstream media. Are you willing to help.
Saturday, December 4, 2010
Dr. Margaret Flowers: New health care law fails to make the grade
The Capital Times
When it comes to health insurance coverage, Wisconsin receives a B in comparison to other states, but only because it’s graded on a curve. The state’s 9.5 percent uninsured rate falls considerably below the national average of 16.7, but that’s not much consolation to residents who remain uninsured or who are covered by skimpy policies with big deductibles and co-pays.
The Census Bureau reports that the number of uninsured in the U.S. jumped 10 percent to 51 million people in 2009. This is the greatest jump since data have been collected. The jump would have been more than 20 percent if not for public programs like BadgerCare.
No other rich nation experiences such high levels of people without access to health care and the resultant suffering and death. For example, a study in the American Journal of Public Health shows that in the United States nearly 45,000 deaths annually can be linked to lack of health insurance. That’s over 120 preventable deaths every day.
Even those who have health insurance are unprotected. A growing number of people have insurance policies that require high co-pays, deductibles and other out-of-pocket expenses. These “cost-sharing” measures are serious obstacles to getting care. The majority of people who go bankrupt from medical bills have insurance when they get sick. Private health insurance is like an umbrella that melts in the rain -it may not be there when you need it most.
Sadly, the new federal health law fails to make the grade. Even the Congressional Budget Office estimates that 23 million people will still lack coverage in 2019 after the health legislation is fully implemented. The Centers for Medicare and Medicaid Services reports that health care costs will rise more quickly under the new law than if there had been no health bill.
A potent example of what to expect occurred when the recent provision preventing health insurers from denying new policies to children with pre-existing conditions kicked in. The day before this protection went into effect, insurers like WellPoint, UnitedHealth Group, Aetna, Cigna and Humana announced that they would no longer offer new policies to individual children.
What can we conclude about the new legislation? It further enriches and empowers the very industries which are at the heart of the problem. As long as private insurers occupy a commanding role in our health system, we will never achieve universal or affordable care. Insurers make money by enrolling the healthy, screening out the sick, denying claims and raising premiums.
There is a solution that receives top marks: a single-payer national health insurance program, commonly referred to as improved Medicare for all. Single-payer means that our health care dollars are pooled in a single public fund that pays for a universal health care system. This is estimated to save $400 billion, which would cover those who need care. Surveys show this approach is supported by two-thirds of the population.
Improved Medicare for all means every person living in the United States would be guaranteed high-quality care from birth to death. Coverage would be comprehensive, including dental care, vision care, mental health services and prescriptions. And the working and middle class would pay less for health care because of the increased efficiency of a single-payer system.
Patients would choose their physician and health facility, and decisions about treatment would be made by patients and their health professionals without interference by insurance company bureaucrats.
While the health care crisis may not be obvious in Madison, the effects are felt in Wisconsin and across the nation. We must work with renewed energy and commitment for a national health program that addresses our fundamental problems. Everybody in, nobody out.
Dr. Margaret Flowers, who spoke recently in Madison, resides in Baltimore and serves as congressional fellow for Physicians for a National Health Program. She is also a board member of Healthcare-Now.
When it comes to health insurance coverage, Wisconsin receives a B in comparison to other states, but only because it’s graded on a curve. The state’s 9.5 percent uninsured rate falls considerably below the national average of 16.7, but that’s not much consolation to residents who remain uninsured or who are covered by skimpy policies with big deductibles and co-pays.
The Census Bureau reports that the number of uninsured in the U.S. jumped 10 percent to 51 million people in 2009. This is the greatest jump since data have been collected. The jump would have been more than 20 percent if not for public programs like BadgerCare.
No other rich nation experiences such high levels of people without access to health care and the resultant suffering and death. For example, a study in the American Journal of Public Health shows that in the United States nearly 45,000 deaths annually can be linked to lack of health insurance. That’s over 120 preventable deaths every day.
Even those who have health insurance are unprotected. A growing number of people have insurance policies that require high co-pays, deductibles and other out-of-pocket expenses. These “cost-sharing” measures are serious obstacles to getting care. The majority of people who go bankrupt from medical bills have insurance when they get sick. Private health insurance is like an umbrella that melts in the rain -it may not be there when you need it most.
Sadly, the new federal health law fails to make the grade. Even the Congressional Budget Office estimates that 23 million people will still lack coverage in 2019 after the health legislation is fully implemented. The Centers for Medicare and Medicaid Services reports that health care costs will rise more quickly under the new law than if there had been no health bill.
A potent example of what to expect occurred when the recent provision preventing health insurers from denying new policies to children with pre-existing conditions kicked in. The day before this protection went into effect, insurers like WellPoint, UnitedHealth Group, Aetna, Cigna and Humana announced that they would no longer offer new policies to individual children.
What can we conclude about the new legislation? It further enriches and empowers the very industries which are at the heart of the problem. As long as private insurers occupy a commanding role in our health system, we will never achieve universal or affordable care. Insurers make money by enrolling the healthy, screening out the sick, denying claims and raising premiums.
There is a solution that receives top marks: a single-payer national health insurance program, commonly referred to as improved Medicare for all. Single-payer means that our health care dollars are pooled in a single public fund that pays for a universal health care system. This is estimated to save $400 billion, which would cover those who need care. Surveys show this approach is supported by two-thirds of the population.
Improved Medicare for all means every person living in the United States would be guaranteed high-quality care from birth to death. Coverage would be comprehensive, including dental care, vision care, mental health services and prescriptions. And the working and middle class would pay less for health care because of the increased efficiency of a single-payer system.
Patients would choose their physician and health facility, and decisions about treatment would be made by patients and their health professionals without interference by insurance company bureaucrats.
While the health care crisis may not be obvious in Madison, the effects are felt in Wisconsin and across the nation. We must work with renewed energy and commitment for a national health program that addresses our fundamental problems. Everybody in, nobody out.
Dr. Margaret Flowers, who spoke recently in Madison, resides in Baltimore and serves as congressional fellow for Physicians for a National Health Program. She is also a board member of Healthcare-Now.
Will the Wyden/Brown state waiver enable single payer?
By Don McCanne MD
The initial reaction to S. 3958, The Empowering States to Innovate Act, sponsored by Sen. Ron Wyden (D-OR) and Sen. Scott Brown (R-MA), is that the bill will enable states to bypass the requirements of the Patient Protection and Affordable Care Act (PPACA) and set up their own state-based programs, even single payer should the states prefer. But what does the bill actually say?
PPACA already authorizes a program for state waivers, but not until 2017. The Wyden/Brown bill does only one thing. It moves the state waiver program forward to 2014, the same year that the individual mandate and insurance exchanges go into effect. It does not change the waiver in any other way.
For those states that wish to establish their own programs, advancing the eligibility date removes the very burdensome task of complying with the insurance exchanges, mandates and other requirements for an interval of only three years, and then facing the additional costs and burdens of transitioning to their own programs. If you agree with the policy that states should be able to set up their own programs, then this is a very wise move.
Massachusetts already has a program similar to PPACA. Sen. Brown would much rather modify what they have by complying with the waiver than to have to comply with all details of PPACA for the first three years. For Sen. Wyden, his preferred model of reform was rejected by Congress, but he would still like to experiment with his model, as much as possible, within the state of Oregon, while protecting what innovative programs they already have.
So just how much leeway does the PPACA state waiver allow? It does allow innovations as long as coverage is at least as comprehensive, cost sharing is at least as affordable, at least as many residents would be covered, and as long as the federal deficit would not be increased. It also passes through to the state the funds that would have been used for premium tax credits, cost-sharing reductions, and small business credits. Is that enough funding to establish a single payer system?
What about the funds for Medicare? Medicaid? CHIP? Taft-Hartley plans? What about ERISA requirements? What about the multitude of other funding requirements such as the VA system, academic institutions, safety-net institutions, community health centers, the Indian Health Service, the U.S. Public Health Service, and the many others?
There is no authorization in the Wyden/Brown bill, PPACA, nor any other existing law or regulation to fold many or all of these programs into one single payer system. Think of trying to run a partial single payer system (an oxymoron) while still having to deal with the massive Medicare and Medicaid programs. The point is, don’t let up on your advocacy, thinking that Wyden/Brown is our entry to single payer. We would still have a highly fragmented financing system.
Our best option remains enacting a national single payer bill such as HR 676, which will be re-introduced in the next session of Congress. In lieu of that, we should continue with our efforts to enact single payer systems on the state level. Just don’t be fooled into thinking that a bill such as Wyden/Brown is the ticket. The enabling federal legislation that would be required for state programs would be as complicated, if not more so, than a bill establishing a national single payer program – an improved Medicare for everyone.
Vermont is a test. Without enabling comprehensive federal legislation, I’m already apprehensive.
The initial reaction to S. 3958, The Empowering States to Innovate Act, sponsored by Sen. Ron Wyden (D-OR) and Sen. Scott Brown (R-MA), is that the bill will enable states to bypass the requirements of the Patient Protection and Affordable Care Act (PPACA) and set up their own state-based programs, even single payer should the states prefer. But what does the bill actually say?
PPACA already authorizes a program for state waivers, but not until 2017. The Wyden/Brown bill does only one thing. It moves the state waiver program forward to 2014, the same year that the individual mandate and insurance exchanges go into effect. It does not change the waiver in any other way.
For those states that wish to establish their own programs, advancing the eligibility date removes the very burdensome task of complying with the insurance exchanges, mandates and other requirements for an interval of only three years, and then facing the additional costs and burdens of transitioning to their own programs. If you agree with the policy that states should be able to set up their own programs, then this is a very wise move.
Massachusetts already has a program similar to PPACA. Sen. Brown would much rather modify what they have by complying with the waiver than to have to comply with all details of PPACA for the first three years. For Sen. Wyden, his preferred model of reform was rejected by Congress, but he would still like to experiment with his model, as much as possible, within the state of Oregon, while protecting what innovative programs they already have.
So just how much leeway does the PPACA state waiver allow? It does allow innovations as long as coverage is at least as comprehensive, cost sharing is at least as affordable, at least as many residents would be covered, and as long as the federal deficit would not be increased. It also passes through to the state the funds that would have been used for premium tax credits, cost-sharing reductions, and small business credits. Is that enough funding to establish a single payer system?
What about the funds for Medicare? Medicaid? CHIP? Taft-Hartley plans? What about ERISA requirements? What about the multitude of other funding requirements such as the VA system, academic institutions, safety-net institutions, community health centers, the Indian Health Service, the U.S. Public Health Service, and the many others?
There is no authorization in the Wyden/Brown bill, PPACA, nor any other existing law or regulation to fold many or all of these programs into one single payer system. Think of trying to run a partial single payer system (an oxymoron) while still having to deal with the massive Medicare and Medicaid programs. The point is, don’t let up on your advocacy, thinking that Wyden/Brown is our entry to single payer. We would still have a highly fragmented financing system.
Our best option remains enacting a national single payer bill such as HR 676, which will be re-introduced in the next session of Congress. In lieu of that, we should continue with our efforts to enact single payer systems on the state level. Just don’t be fooled into thinking that a bill such as Wyden/Brown is the ticket. The enabling federal legislation that would be required for state programs would be as complicated, if not more so, than a bill establishing a national single payer program – an improved Medicare for everyone.
Vermont is a test. Without enabling comprehensive federal legislation, I’m already apprehensive.
Vermont Gov-Elect Shumlin Already Lobbying President Obama On Health Care
Vermont Public Radio News
(Host) Governor-elect Peter Shumlin says he's optimistic that he can persuade the Obama administration to grant Vermont a special waiver to implement a single payer health care system.
Shumlin says he's already raised this issue with the president, and he'll do it again when he visits the White House early next month.
VPR's Bob Kinzel reports.
(Kinzel) The possibility of Vermont winning a federal waiver to put a single payer health care system in place was a top issue in the gubernatorial campaign.
Republican candidate Brian Dubie said that 2014 is the earliest a waiver could be issued under the new national health care reform law.
But Democrat Peter Shumlin argued that Vermont's congressional delegation could petition the Obama administration to make it happen sooner.
Speaking on VPR's Vermont Edition, Shumlin says he's already spoken to the president about this issue.
(Shumlin) "I had the privilege of talking to the President of the United States earlier today. He called me from Air Force One. A lot of bizarre things have happened to me in the last five days, but that's one of them. You know, you pick up the phone and there's the president at the end of the line. It was a real honor."
(Kinzel) And Shumlin says he doesn't think getting a federal waiver will be the toughest part of implementing a single payer system in Vermont.
(Shumlin) "The waivers is the easy part. The hard part is designing a single payer health care system that works and that delivers quality health care, gets insurers off our providers' backs, has a reimbursement system that makes sense. ... I believe if we design that system, we can sell it."
(Kinzel) The Legislature is expected to receive a special study this winter that will outline several different health care reform plans. One of them will be a single payer approach.
Once that report has been released, Shumlin says he wants to bring together a diverse group of businesspeople, health care providers and consumers to hammer out a workable plan. The governor-elect says it should have 4 specific goals.
(Shumlin) "Delivers quality health care to all Vermonters, where health care is right and not a privilege. Second, is affordable. The current system is going to drown us and will bankrupt us. We can't spend a million dollars more a day than we did the day before. Third, provide outcomes-based medicine so that providers are reimbursed for keeping us healthy, not the number of tests they put us through. And finally, fourth, and perhaps most important, using technology."
(Kinzel) Shumlin admits that making major changes to the state's health care system isn't going to happen overnight. But he's hopeful that significant progress can be made during his first term in office.
For VPR News, I'm Bob Kinzel in Montpelier
(Host) Governor-elect Peter Shumlin says he's optimistic that he can persuade the Obama administration to grant Vermont a special waiver to implement a single payer health care system.
Shumlin says he's already raised this issue with the president, and he'll do it again when he visits the White House early next month.
VPR's Bob Kinzel reports.
(Kinzel) The possibility of Vermont winning a federal waiver to put a single payer health care system in place was a top issue in the gubernatorial campaign.
Republican candidate Brian Dubie said that 2014 is the earliest a waiver could be issued under the new national health care reform law.
But Democrat Peter Shumlin argued that Vermont's congressional delegation could petition the Obama administration to make it happen sooner.
Speaking on VPR's Vermont Edition, Shumlin says he's already spoken to the president about this issue.
(Shumlin) "I had the privilege of talking to the President of the United States earlier today. He called me from Air Force One. A lot of bizarre things have happened to me in the last five days, but that's one of them. You know, you pick up the phone and there's the president at the end of the line. It was a real honor."
(Kinzel) And Shumlin says he doesn't think getting a federal waiver will be the toughest part of implementing a single payer system in Vermont.
(Shumlin) "The waivers is the easy part. The hard part is designing a single payer health care system that works and that delivers quality health care, gets insurers off our providers' backs, has a reimbursement system that makes sense. ... I believe if we design that system, we can sell it."
(Kinzel) The Legislature is expected to receive a special study this winter that will outline several different health care reform plans. One of them will be a single payer approach.
Once that report has been released, Shumlin says he wants to bring together a diverse group of businesspeople, health care providers and consumers to hammer out a workable plan. The governor-elect says it should have 4 specific goals.
(Shumlin) "Delivers quality health care to all Vermonters, where health care is right and not a privilege. Second, is affordable. The current system is going to drown us and will bankrupt us. We can't spend a million dollars more a day than we did the day before. Third, provide outcomes-based medicine so that providers are reimbursed for keeping us healthy, not the number of tests they put us through. And finally, fourth, and perhaps most important, using technology."
(Kinzel) Shumlin admits that making major changes to the state's health care system isn't going to happen overnight. But he's hopeful that significant progress can be made during his first term in office.
For VPR News, I'm Bob Kinzel in Montpelier
Massachusetts Voters Appear Ready to Embrace Single Payer
By FireDogLake's Jon Walker
Massachusetts is considered one of the most liberal states in the country. It has already adopted a private insurance-based, near-universal health insurance system under Republican Governor Mitt Romney. Given that, it should come as no surprise that, in a large swath of the state, voters signaled their willingness to adopt a universal single-payer health care system, similar to “Medicare for all.”
Massachusetts allows for citizens to place non-binding, local “public policy questions” on the ballot. In precincts containing around 10 percent of the state’s population, the Massachusetts Campaign for Health Care Justice put on the ballot a question asking voters whether or not to instruct their local representative to “support legislation establishing health care as a human right regardless of age, state of health, or employment status, by creating a single-payer health insurance system like Medicare that is comprehensive, cost effective, and publicly provided to all residents of Massachusetts?” As of today, in the precincts reporting 62 percent voted yes.
How would this 62 percent support in these local precincts translate to the level of support statewide?
As done previously for the marijuana legalization public policy question, I did, where possible, a town-by-town analysis comparing the results for the single-payer question to the results of the 2010 governor’s race and the 2008 presidential contest. (Note: precincts not fully reported, and a few towns that are split between two state House districts, had to be dropped from the analysis.)
In the towns compared, the voters were only very slightly more liberal-leaning than the entire state. This year, in the towns examined, the liberal-leaning gubernatorial candidates, Democrat Deval Patrick and Green Jill Stein, combined for a total that was roughly only three percentage points higher than their share of the vote statewide. Compared to the 2008 presidential election, the towns examined only supported Barack Obama and the liberal third-party candidates by roughly two percentage points compared to voters statewide.
A projected 59 percent support for single payer
By comparing the samples, I conclude that the towns I examined in my analysis are fairly representative, and if the single-payer question had appeared on the ballot across the whole state this year, it would have received a Yes vote of roughly 59 percent, just slightly less than it did in the local precincts.
That is a strong majority for a state single payer system, especially given that this midterm election saw a big Republican wave with unusually high conservative turnout.
I did the same analysis based on the results of a near-identical single-payer public policy question placed on the ballot in several districts in 2008. While the districts where it was on the ballot were significantly more liberal than the state as a whole, my analysis leads me to believe that roughly 69 percent of the 2008 electorate supported single payer. 2008, of course, was a Democratic wave year, and showed unusually high liberal and youth turnout.
This swing on a liberal issue is similar to the generic ballot swing from Democrat to Republican that we saw in the last two elections. I suspect in a more normal election, with a more normal turnout, demographic support would fall somewhere in between.
Conclusion
It appears the voters of Massachusetts are open to embracing universal single-payer health insurance, which would be substantially more progressive and cost effective than their current private-insurance-based system. With the state struggling to pay for their inefficient, subsidized private system It is a reform the state should seriously consider.
I would hope to see that if there were broad support among the electorate for single payer, the Democrat-dominated Massachusetts state government would choose to implement this better policy. Unfortunately, as we have seen at the national level, the health care industry has a powerful ability to crush smart reform. If the elected officials refuse to act, single-payer activists should keep in mind that there is at least potential majority support for taking the issue directly to the voters through the initiative process. Something the state of Massachusetts allows.
Some Caveats– Most of the caveats of my marijuana legalization analysis also apply. There is a fair amount of vote drop-off down the ballot. For example, it is likely supporters of single payer were slightly more likely to indicate their support for this non-binding question, while those mildly opposed chose to just skip it.
Most importantly with an issue like this: details are critical. Many of those who in general support single payer might oppose a specific proposal based on how it is paid for and how it affects their current insurance. If single payer activists do try to advance the issue through a binding initiative, getting the details right politically and policy-wise could prove a very complicated task.
Massachusetts is considered one of the most liberal states in the country. It has already adopted a private insurance-based, near-universal health insurance system under Republican Governor Mitt Romney. Given that, it should come as no surprise that, in a large swath of the state, voters signaled their willingness to adopt a universal single-payer health care system, similar to “Medicare for all.”
Massachusetts allows for citizens to place non-binding, local “public policy questions” on the ballot. In precincts containing around 10 percent of the state’s population, the Massachusetts Campaign for Health Care Justice put on the ballot a question asking voters whether or not to instruct their local representative to “support legislation establishing health care as a human right regardless of age, state of health, or employment status, by creating a single-payer health insurance system like Medicare that is comprehensive, cost effective, and publicly provided to all residents of Massachusetts?” As of today, in the precincts reporting 62 percent voted yes.
How would this 62 percent support in these local precincts translate to the level of support statewide?
As done previously for the marijuana legalization public policy question, I did, where possible, a town-by-town analysis comparing the results for the single-payer question to the results of the 2010 governor’s race and the 2008 presidential contest. (Note: precincts not fully reported, and a few towns that are split between two state House districts, had to be dropped from the analysis.)
In the towns compared, the voters were only very slightly more liberal-leaning than the entire state. This year, in the towns examined, the liberal-leaning gubernatorial candidates, Democrat Deval Patrick and Green Jill Stein, combined for a total that was roughly only three percentage points higher than their share of the vote statewide. Compared to the 2008 presidential election, the towns examined only supported Barack Obama and the liberal third-party candidates by roughly two percentage points compared to voters statewide.
A projected 59 percent support for single payer
By comparing the samples, I conclude that the towns I examined in my analysis are fairly representative, and if the single-payer question had appeared on the ballot across the whole state this year, it would have received a Yes vote of roughly 59 percent, just slightly less than it did in the local precincts.
That is a strong majority for a state single payer system, especially given that this midterm election saw a big Republican wave with unusually high conservative turnout.
I did the same analysis based on the results of a near-identical single-payer public policy question placed on the ballot in several districts in 2008. While the districts where it was on the ballot were significantly more liberal than the state as a whole, my analysis leads me to believe that roughly 69 percent of the 2008 electorate supported single payer. 2008, of course, was a Democratic wave year, and showed unusually high liberal and youth turnout.
This swing on a liberal issue is similar to the generic ballot swing from Democrat to Republican that we saw in the last two elections. I suspect in a more normal election, with a more normal turnout, demographic support would fall somewhere in between.
Conclusion
It appears the voters of Massachusetts are open to embracing universal single-payer health insurance, which would be substantially more progressive and cost effective than their current private-insurance-based system. With the state struggling to pay for their inefficient, subsidized private system It is a reform the state should seriously consider.
I would hope to see that if there were broad support among the electorate for single payer, the Democrat-dominated Massachusetts state government would choose to implement this better policy. Unfortunately, as we have seen at the national level, the health care industry has a powerful ability to crush smart reform. If the elected officials refuse to act, single-payer activists should keep in mind that there is at least potential majority support for taking the issue directly to the voters through the initiative process. Something the state of Massachusetts allows.
Some Caveats– Most of the caveats of my marijuana legalization analysis also apply. There is a fair amount of vote drop-off down the ballot. For example, it is likely supporters of single payer were slightly more likely to indicate their support for this non-binding question, while those mildly opposed chose to just skip it.
Most importantly with an issue like this: details are critical. Many of those who in general support single payer might oppose a specific proposal based on how it is paid for and how it affects their current insurance. If single payer activists do try to advance the issue through a binding initiative, getting the details right politically and policy-wise could prove a very complicated task.
Health Care is a Human Rights Issue
By Ronald W. Pies, MD
Some see health care as a political or economic issue. They are correct, of course, on one level. But I believe that health care is fundamentally a moral issue; indeed, a matter of basic human rights. I do not believe that a nation as rich as ours (albeit with most wealth concentrated among the upper income levels) can shirk its moral responsibilities in the matter of providing basic health care for all its citizens. This doesn't mean that everybody who wants a face-lift should get one on the taxpayer's dime: I am talking about providing all citizens with the most basic health care, required to sustain life and limb. And, yes: I believe this is a right that any citizen may claim, particularly in a country purporting to be “civilized.”
I am hardly alone in this view, nor is my position new. In 1948, the General Assembly of the United Nations adopted The Universal Declaration of Human Rights, article 25 of which states:
“Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.”
I don't pretend to be an expert on health care economics, and I am aware of significant logistical problems in some countries that provide health care to all their citizens; e.g., very long waiting lists for elective procedures. I am not advocating the infamous “government takeover” of health care that has been so much a part of recent political diatribes from some quarters. Rather, I favor a single-payer national health insurance system. One ambitious proposal describes this as
“...a system in which a single public or quasi-public agency organizes health financing, but delivery of care remains largely private. Under a single-payer system, all Americans would be covered for all medically necessary services, including: doctor, hospital, preventive, long-term care, mental health, reproductive health care, dental, vision, prescription drug and medical supply costs. Patients would [retain] free choice of doctor and hospital, and doctors would [retain] autonomy over patient care.” —Source: Physicians for a National Health Program
I would urge all psychiatrists to read over the FAQ section of this website. The PNHP site also notes the following:
“A number of studies (notably a General Accounting Office report in 1991 and a Congressional Budget Office report in 1993) show that there is more than enough money in our health care system to serve everyone if it were spent wisely. Administrative costs are at 31% of U.S. health spending, far higher than in other countries' systems. These inflated costs are due to our failure to have a publicly financed, universal health care system. We spend about twice as much per person as Canada or most European nations, and still deny health care to many in need. A national health program could save enough on administration to assure access to care for all Americans, without rationing.” —Source: Physicians for a National Health Program
On the specific issue of mental health care, we have a long way to go as a nation. For example, many patients with depression—particularly some minority groups—are not being provided adequate care. Contrary to the much-ballyhooed claim that “depression is over-treated” in this country, a recent study1 suggests that many Americans with clinical depression are not getting any kind of care at all. As the lead author, Hector Gonzalez, MD, put it in an interview with the Wall Street Journal, ““Few Americans with depression actually get any kind of care, and even fewer get care consistent with the [best practice] standards of care.” Gonzalez and colleagues found, in particular, that Mexican American and African American individuals meeting 12-month major depression criteria “…consistently and significantly had lower odds for any depression therapy and guideline-concordant therapies.”
In this country, according to a 2002 study by the Institute of Medicine, 18,000 Americans die every year because they don't have health insurance.3 Almost certainly, some of these individuals die by their own hand, owing to untreated major depression. This is simply unconscionable, particularly in the nation with the highest GDP in the world. Recent changes in health care coverage will improve things for many thousands of Americans,4, but much more must be done. A publicly financed, universal health care system, while not without its own costs and problems, is worth trying—and is surely preferable to our current health care debacle. It is also the right thing to do.
Some see health care as a political or economic issue. They are correct, of course, on one level. But I believe that health care is fundamentally a moral issue; indeed, a matter of basic human rights. I do not believe that a nation as rich as ours (albeit with most wealth concentrated among the upper income levels) can shirk its moral responsibilities in the matter of providing basic health care for all its citizens. This doesn't mean that everybody who wants a face-lift should get one on the taxpayer's dime: I am talking about providing all citizens with the most basic health care, required to sustain life and limb. And, yes: I believe this is a right that any citizen may claim, particularly in a country purporting to be “civilized.”
I am hardly alone in this view, nor is my position new. In 1948, the General Assembly of the United Nations adopted The Universal Declaration of Human Rights, article 25 of which states:
“Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.”
I don't pretend to be an expert on health care economics, and I am aware of significant logistical problems in some countries that provide health care to all their citizens; e.g., very long waiting lists for elective procedures. I am not advocating the infamous “government takeover” of health care that has been so much a part of recent political diatribes from some quarters. Rather, I favor a single-payer national health insurance system. One ambitious proposal describes this as
“...a system in which a single public or quasi-public agency organizes health financing, but delivery of care remains largely private. Under a single-payer system, all Americans would be covered for all medically necessary services, including: doctor, hospital, preventive, long-term care, mental health, reproductive health care, dental, vision, prescription drug and medical supply costs. Patients would [retain] free choice of doctor and hospital, and doctors would [retain] autonomy over patient care.” —Source: Physicians for a National Health Program
I would urge all psychiatrists to read over the FAQ section of this website. The PNHP site also notes the following:
“A number of studies (notably a General Accounting Office report in 1991 and a Congressional Budget Office report in 1993) show that there is more than enough money in our health care system to serve everyone if it were spent wisely. Administrative costs are at 31% of U.S. health spending, far higher than in other countries' systems. These inflated costs are due to our failure to have a publicly financed, universal health care system. We spend about twice as much per person as Canada or most European nations, and still deny health care to many in need. A national health program could save enough on administration to assure access to care for all Americans, without rationing.” —Source: Physicians for a National Health Program
On the specific issue of mental health care, we have a long way to go as a nation. For example, many patients with depression—particularly some minority groups—are not being provided adequate care. Contrary to the much-ballyhooed claim that “depression is over-treated” in this country, a recent study1 suggests that many Americans with clinical depression are not getting any kind of care at all. As the lead author, Hector Gonzalez, MD, put it in an interview with the Wall Street Journal, ““Few Americans with depression actually get any kind of care, and even fewer get care consistent with the [best practice] standards of care.” Gonzalez and colleagues found, in particular, that Mexican American and African American individuals meeting 12-month major depression criteria “…consistently and significantly had lower odds for any depression therapy and guideline-concordant therapies.”
In this country, according to a 2002 study by the Institute of Medicine, 18,000 Americans die every year because they don't have health insurance.3 Almost certainly, some of these individuals die by their own hand, owing to untreated major depression. This is simply unconscionable, particularly in the nation with the highest GDP in the world. Recent changes in health care coverage will improve things for many thousands of Americans,4, but much more must be done. A publicly financed, universal health care system, while not without its own costs and problems, is worth trying—and is surely preferable to our current health care debacle. It is also the right thing to do.
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