Harold,

This is excellent. You make the key point that reform is a process not a single event. We must fight for what we can get and keep moving forward. A single payer is the end point not the beginning.

Your analysis seems to echo the perspective of the Progressive Caucus. In a letter to Nancy Pelosi and Harry Reid, this group made clear that while most of their members preferred a single payer, they also viewed "the inclusion of a public option plan" as a necessity
( http://tiny.cc/KU7Cz ). The authors (Representatives Woolsey and Grijalva) concluded that they looked forward to "working...to insure inclusion of a public option plan and the successful passage of healthcare legislation that will provide a choice of quality healthcare for all Americans."

"Reformers need allies, and they must be committed and smart practitioners of coalition politics. Rustin excoriated moderates who refused to support genuine reforms. He also chastised reformers who adopt a militant posture, yet who fail to be effective allies or who fail to step up for allies when they are most needed."  

Harold:

Thank you for so clearly laying out the obstacles and high stakes that lie right before us.  As mentioned previously, our most important task right now is to pull together all of our common interests in facilitating meaningful health care reform.  We cannot let "perfect" doom "good" at this crucial stage.

Right now is the time for practical politics. President Obama is pursuing the right overall strategy to ensure that we achieve an ambitious, if imperfect health reform.

Everyone in, nobody out, seems eminently practical to me.

What is "the right overall strategy"?  Announcing in advance your willingness to negotiate before anything is on the table? That's not smart negotiating strategy.  Backtracking from campaign promises under the guise of pragmatism?

The more allies he has, the more people stand up to be counted, the stronger this bill will be.

What bill?  There is no bill yet.  Why should anyone sign on to support a non-existent piece of legislation?

We can do some of that through innovations such as pay-for-performance, improved electronic medical records, and comparative effectiveness research.

I refer you to this article in the Annals of Internal Medicine, which looked at these strategies and more, and found them wanting.

Some single-payer supporters are sitting on their hands, because they believe President Obama's proposed reforms are too limited.

Really? And who would they be? Or is this a strawman argument? 

This whole piece is an argument for compromise when no legislation has been drafted yet.  I see no details about how this would work. Single payer is the only long term solution yet it is left out of the discussion in Washington about how to fix our health care crisis.

Their coalition's statement was very clear and it was their "line in the sand". If they don't think that the legislation will lead to single payer, they will then vote against it, period. The letter is a protest, period. Please don't read anything into their statement other than that or else you will become very confused before the real debate even begins.

Given Harold's commentary and Joseph's call that we shouldn't let the perfect be the enemy of the good, it's pretty hard not to see the Administration sacrifice morality for political expedience.

It's very simple: Everybody in, nobody out. 

And if private insurers think they're that great, then they'd have no problem withstanding competition from a public plan.  But they're not that great, which is why they're fighting the concept tooth and nail with senators like Evan Bayh on their side.

I won't be subtle either: imagine if no reform takes place this year.  The set back would be terrible.  We can move in any direction we need to support once viable legislation is created.  I don't know which groups are winning, but I know it won't be perfect.  This is not the end point of health care reform, it is the beginning and could continue to be perfected.  So many people are unemployed and losing homes and pensions, that a failure to help them obtain health care and health insurance by some system would be tragic.

France is doing pretty well these days. With the top rating from the World Health Organization for its plunge into Universal Health Care with a private option, France has arguably the best relative model for us to take a serious look at in our own reform.

Let's be honest. If nothing else, Americans like to have a choice. Regardless of our income, lifestyle choices, or interests, we all have an affinity for different things. Whatever these decisions may be, we all feel comfortable (or we hope to feel comfortable) making decisions for our own lives. For me, a recent graduate, an avid snow boarder, and an overall active person who has had gaps in health care coverage in the past year, it would certainly be nice to be able to choose a public health care. But would I feel comfortable making that decision for someone else? No.

I stand with Dr. Dean not only because the French health care system, which offers a public option but allows citizens to choose private care if they so wish, is so successful, but because it offers a choice to individuals. I would feel uncomfortable making intimate decisions for my neighbors, and I understand personal health to be an intimate matter.

I stand with Dr. Dean because we need a system where people can make their own choices. If we have a universally available public option, paired with the ability for each individual to opt for private insurance, we effectively leave the decision on personal health up to each individual, but never leave anyone without coverage, no matter what.

Standing with Dr. Dean means that each individual can make his or her own choice AND that the choice is between two different health care options, not between having health care, and not having it at all.

Sens. Baucus & Kennedy publicly committed today that their respective Senate committees would vote on health care legislation by early June.  That's only 6 weeks from now -- clearly now is the time to get involved.  

Also notable in the Baucus and Kennedy letter was their promise to work together and produce substantially similar legislation that could easily be combined into one bill.  This means that it's likely that either both drafts will include a public plan (as Kennedy clearly supports), or that the public option will be used as a bargaining chip and traded away (as seems to be Baucus's plan).  So -- as Harold said in his thoughtful post -- now is the time to register our opinion on that issue.  

In case you missed, the following pertain to our share objectives, common opponents, and the fierce urgency of now. In the coming days and weeks, the final outcome of a successful reform for a healthy people and better nation, could be achieved...

President Obama has said: "So let there be no doubt: healthcare reform cannot wait, it must not wait, and it will not wait another year." It is up to us all, in joint efforts.

Stayin' alive
http://www.tnr.com/politics/story.html?id=4de1ca9d-6334-484f-a311-1c6c3d4998f7&k=8514

A Public Plan for Health Insurance?
http://www.nytimes.com/2009/04/07/opinion/07tue1.html

The First Showdown on Health Care
http://www.nytimes.com/2009/04/12/opinion/12sun1.html

The End of Private Health Insurance.
http://online.wsj.com/article/SB123958544583612437.html

The President Has Become a Divisive Figure
http://online.wsj.com/article/SB123923500880003227.html

Sick in the head: Why America won't get the health-care system it needs
http://harpers.org/archive/2009/02/0082380

A debate: Can Healthcare Reform Finally Happen?

Former U.S. Senate majority leader Tom Daschle; former U.S Secretary Health and Human Services Michael Leavitt, moderated Judy Woodruff PBS

http://www.c-spanarchives.org/library/index.php?main_page=product_video_info&products_id=284957-1

Harold - thank you for your thoughtful post.

As I read the comments I'm trying to tease apart those issues on which people tend to agree, and the areas that generate disagreement. I get the sense that there is actually considerably more agreement than disagreement. To echo Helen Halpin's comment, everyone seems to want universal coverage that is not dependent upon one's health status or economic fortunes. I'm sure that everyone wants that care to be above a certain standard of quality (although we may differ in how that is defined). And, I'm going to guess that everyone accepts that health care costs must come down to make all of this sustainable. This is a good start and these are really the key issues of principle.

The disagreement appears to be mostly about tactics - how do we get there from here? Some of us are concerned that if we advocate solely for a single payer system, no reform will happen at all. Others worry that "showing one's hand" gives up too much before the negotiation has started.

In Ury and Fischer's wonderful book on negotiation, Getting To Yes, they talk about the difference between "position-based" negotiation and "principle-based" negotiation. They argue that locking in too early on positions leads to polarization that rarely results in a settlement that maximizes what all parties are looking for. In contrast, focusing on principles (or interests) allows for more creative solutions that meet more of everyone's needs. Letting go of a position is not a sign of weakness; it can actually be a demonstration of strength.

This past week, President Obama shook the hand and exchanged pleasantries with Venezuelan President Hugo Chavez. The right-wing cable hosts screamed that this showed weakness and will encourage Chavez or others to take advantage of the U.S. They are stuck in their position that says "we don't talk to people who don't like us." However, Obama understands that our two countries share many interests in common, and he is secure enough to cast aside this polarizing position, offer his hand and try to find common ground. All he has given away is a handshake. This is a show of strength, not weakness, particularly if it leads to improved relations between our hemispheres.

So, too, in the health care debate. I believe we will be much more successful this time around if we frame the debate about what needs to be present in a reformed health care system (e.g., universal coverage with quality care and cost control) rather than exactly how that system will be structured (e.g., public plan vs. single payer).

DFA Coalition Groups (since 2004 and before)

Physicians for a Democratic Majority

3201 Mission Streeet, San Francisco, CA  94110

Read the DemDocs "Roadmap to Universal Healthcare"

DNC Chair Dr. Howard Dean called the DemDocs plan "The best idea for healthcare I've heard in 30 years, including my own."

 

...publicly funded healthcare through the implementation of these Three Steps to Medicare for All, the private insurance industry would dwindle to a size where it would no longer have the political clout to shape legislation to its liking. Private health insurance companies could also continue to act as fiscal intermediaries for Medicare, as they do under the current system, within the 2.6% budget that Medicare allocates for such expenses.

 

What would a national “Medicare for All” plan ultimately look like? Every American would be enrolled from birth through the end of life, with all medically necessary care provided by the largest network of providers in the country, with each person being able to choose doctors and hospitals from the largest panel in the country. Government would be the payer, but providers would not be government employers and this plan would not create “socialized medicine.” Many options would continue to exist for receiving care through Medicare, including individual hospitals and doctors’ offices, group practices, large systems such as Kaiser (which could continue to exist as they currently do, but with all funding provided through Medicare), and the continued existence of specialized programs such as the Veterans Administration system, the Indian Health Service, and the military. Patients would continue to have reasonable copays and deductibles, and the private system could continue to exist for cosmetic procedures and other non-covered benefits. [...]

the full doc.

<!--StartFragment-->

President Obama supports the public plan.  Dr. Howard Dean, Dr. Snyderman and Dr. Studer on MSNBC panel discuss the cost of healthcare:

  http://www.msnbc.msn.com/id/21134540/vp/30227447#30227447 

Let us join this virtual panel discussion so that we move From protest to coalition.

Thank you Harold

A panel discusses how the problem of the 46 million Americans who do not have health care can be solved amid rising health care costs.

http://www.msnbc.msn.com/id/21134540/vp/30227479#30227479

to those of us who believe in standing your ground - at least until the battle is well underway.

Sorry Harold, Joseph, et al.

I support Medicare For All HR 676 because that's where the effiencies and equality of care have the best chance of working for those who need it most. That segment of the population is WAY bigger than the 46 million uninsured.

You have to give relief to those underinsured AND those who are hopelessly stuck in plans that keep them one week/month from being broke due to uncovered costs. When there is just no cash for those events one soon is unproductive or has attendance problems. BAM, there goes your job AND insurance coverage with it.

Kinda wondering here if the 'surrender monkies' here wouold like to divulge their insurance assurance so we can all understand how they don't understand our point of veiw, coz

... they obviously do NOT. Sadly.

Whether we like it or not, legislation that has any chance of making it to the President's desk will be drafted in committee without very much direct input from people outside of Washington DC.  Committee members will have their antennae out gaguing public opinion, but by the time we see actual legislation, many compromises will be irrevocably cast in stone (at least for this legislative session).  Some changes will occur as additional agreements and compromises are reached, but on many issues the choice will be "take it or leave it."  Each of us will have to decide whether to support the legislation actively, sit on our hands, or oppose the legislation because it is not good enough or is a step in the wrong direction.

Principle-based negotiation is a very powerful tool.  All too often I've watched position-based negotiators fail to reach a deal they both wanted because they never were able to find the common ground they both knew was there.  Setting a "reservation price" too high often gets you less, not more.  Being sympathetic to the other side's point of view (even when you think they are being totally unreasonable) sometimes gets you a lot more than vilification and character assassination.  Setting an absolute bottom line is critical to preserving one's principles, and one certainly shouldn't compromise away one's prinicples or give up things unnecessarily by "bargaining against oneself."  But in a rapidly moving negotiation, it is important for each of us to decide in advance what prinicples are absolute deal-breakers and what positions we are prepared to compromise to advance the principles we hold dear.  We needn't let anyone know where we will draw that line, but we had better have thought this through pretty carefully by the time the rubber hits the road.

For the record, I like a single payer option and would happily support it if the House and Senate leadership moved it forward.  However, single payer is not a panecea.  Insurance always brings with it a degree of what Kenneth Arrow described as "moral hazard," and univeral single payer health insurance comes with a particularly high level of moral hazard. 

For example, on Saturday evening a friend experienced a brief dysrhythmia and called her not particular dedicated family physician who sent her to an emergency room.  The emergency room physician covered his hindquarters by admitting her to the hospital.  The dysrhythmia vanished as mysteriously as it had appeared and she was discharged, fortunately not much the worse for wear.  I'm sure the bill to whatever third-party is insuring her will be considerable. 

This story is quite consistent with what Dr. Arnold Milstein learned when he studied high-quality cost-effective medical practices on a grant from the Robert Wood Johnson Foundation.  One thing most of them had in common was that they went to great lengths to keep people out of the hospital.  He told me he discovered that about 8 our of every 10 patients who would have been admitted to a hospital by an emergency room physician were seen and sent home without subsequent harm by family physicians from these high performing practices.  But it is easier for family physicians to send patients to emergency rooms (I've been shocked by how many times I've called family physicians off-hours on behalf of friends and been advised by an answering machine to call 911 or wait until regular hours).  It is easier for emergency room physicians to admit patients they've never seen before than to run the risk of missing something because they have no baseline comparative data or personal experience with the patient.  And the hospital is pleased to fill a bed and collect its fees.  Many patients, if they don't have to pay much of the bill, feel this is good care, although some, like my friend, feel they've been ripped off.  This type of behavior is an important component in what is driving our health care costs sky high without improving anyone's health.

I don't have much hope that the legislation that will be considered in Congress will do much to address this and many other critical structural problems in our health care system, but that won't keep me from working hard to pass any legislation that makes our health care system work better for all Americans.  I don't think single payer will do much to address the problem of inappropriate care either, but I would be interested in knowing how it would, if it would.  I know the British recently implemented a pay-for-performance program for family physicians which did not work out quite as expected.  Their experience does provide some interesting insights into the difference between deciding who pays and deciding how people get paid.

Senators Set Timetable for Health Care Bills

The chairmen of two Senate committees told President Obama today that by early June they would finish writing legislation on health care to “provide coverage to all Americans.”

The commitment came from Senator Max Baucus, the Montana Democrat who is chairman of the Finance Committee, and Senator Edward M. Kennedy, the Massachusetts Democrat who is chairman of the Committee on Health, Education, Labor and Pensions.

They set forth their plans in a letter to Mr. Obama, in an apparent effort to create a sense of momentum without disclosing the specifics of their proposals.

[...]

White House officials said they would not prescribe the details of comprehensive health legislation, as President Bill Clinton tried to do in 1993-94. Obama aides said they would provide technical assistance to Congress on request.

[...]

The Finance Committee has broad authority over taxes, Medicare and Medicaid. Mr. Baucus has proposed expanding Medicare and Medicaid and has expressed interest in the idea of taxing some employer-provided health benefits to help finance coverage for the uninsured.

[...]

Chairmen of three House committees and their aides have also been working closely on what they hope will be a single bill to remake the nation’s health care system.

The lawmakers, all Democrats, are Representatives Charles B. Rangel of New York, chairman of the Ways and Means Committee; Henry A. Waxman of California, chairman of the Energy and Commerce Committee; and George Miller of California, chairman of the Education and Labor Committee. They have a combined total of more than 100 years of service in the House.

 

The full text of the letter is below:

April 20, 2009

The President
The White House
1600 Pennsylvania Avenue, NW
Washington, DC 20500

Dear Mr. President:

For nearly a year, we have been working together toward the shared goal of significant reforms to our health care system. We must act swiftly, because the cost of inaction is too high for individuals, families, businesses, state and federal governments. Comprehensive health care reform legislation will responsibly contain costs, improve quality, enhance disease prevention, and provide coverage to all Americans. We are committed to working with you, and with our colleagues in Congress, to enact legislation to achieve these long-overdue reforms without delay. We are writing to you today to let you know of the schedule for committee action that we intend to follow to meet this goal.

Since our committees share jurisdiction over health care reform legislation in the Senate, we have jointly laid out an aggressive schedule to accomplish our goal. Both committees plan to mark-up legislation in early June. Our intention is for that legislation to be very similar, and to reflect a shared approach to reform, so that the measures that our two committees report can be quickly merged into a single bill for consideration on the Senate floor.

The unprecedented level of funding devoted to health care reform in your budget this year leaves no doubt about your commitment to the goals of expanding coverage, reducing costs, and improving health and health care. We have a moral duty to ensure that every American can get quality health care. We must act to contain the growth of health care costs to ensure our economic stability; to help American businesses deal with the health care challenge; and to make sure that we are getting our money’s worth. With your continued leadership and commitment, and working together, we remain certain that our goal of enacting comprehensive health care reform can be accomplished with the urgency that the American people rightly demand.

Respectfully yours,

Senator Max Baucus                Senator Edward M. Kennedy
Chairman                               Chairman
Senate Finance Committee       Senate HELP Committee

http://www.nytimes.com/2009/04/23/us/politics/23health.html

Read this piece by E.J. Dionne today in the Washington Post called "A Different Health Care Debate". It says pretty much everything we have been saying but to a much broader audience.
http://www.realclearpolitics.com/articles/2009/04/23/on_health_care_stop_thinking_about_yesterday_96123.html

Single-Payer Expert Testifies in Congress

Dr. David Himmelstein, co-founder of PNHP, an associate professor of medicine at Harvard Medical School and a primary care doctor at Cambridge Hospital in Cambridge, Massachusetts tells the House Subcommittee on Health, Employment, Labor and Pensions that only a major overhaul of the existing system, one which replaces the wasteful, for-profit, private insurance industry with a publicly financed, single-payer program similar to Medicare, can rein in costs while guaranteeing universal, comprehensive coverage.
http://edlabor.house.gov/documents/111/pdf/testimony/20090423DavidHimmelsteinTestimony.pdf

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Mike Ferrell stars in single-payer PSA

TV spots have been put together by Clark Newhall starring Mike Ferrell advocating for single-payer.  Help raise funds to get these on the air!  Also, consider using these on local public access stations that take submissions from local residents.  Thanks for getting the word out!
http://www.1payer.net/videos/medicare-for-all.html

 

-----------

Round Tables on health in Senate Finance Committee, Max Baucus, Chair

The first Round Table discussion already occurred this week, and no single-payer experts were included. 

 

Two more round tables are slated for May.:

May 5: Roundtable Discussion #2 on expanding health care to  all Americans-focus on uninsured

May 14: Roundtable Discussion #3 on financing health care reform
 

June: Senate Finance Committee will begin to mark up legislation

The roundtable series will be open to the public and web cast on the Finance Committee website, www.finance.senate.gov . You can also see them on CSPAN who often repeats them at night

If you are a constituent in a state with a Senator who serves on the Finance Committee, consider calling and urging local coalition members to call and ask them to include Single-Payer experts in these Hearings.  
 
Here is a link to the Press Release from Senate Finance Committee with information on Hearings - http://finance.senate.gov/press/Gpress/2009/prg041509.pdf
 
Here is a list of Senate Finance Committee Members - http://finance.senate.gov/sitepages/committee.htm

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Elderly Used as Front in Letter Writing Scam - AHIP behind it.

Background info: Obama is looking for ways to cut money from the budget. He has said that he wants to eliminate the fed. subsidy that the insurance companies' Medicare Advantage Plans currently get (Kaiser has it for seniors).  It was announced last week that AHIP(Ins. Plans) would be holding 90 meetings across the country in an attempt to block this effort(they have made bundles off of these). The problem is that seniors who have them have better benefits than traditional Medicare because the plans are subsidized so they can afford to offer these. This article shows fradulent activity by the insurance companies sending false letters with seniors names on them claiming they don't want their MA plan dropped. They are really desperate!
 
http://www.eagletribune.com/punews/local_story_103032149.html 

------------

Colorado State Bill short 1 vote on final House vote - report back from Michele Swenson

Believing we have to work at both state and federal levels, Health Care for All Colorado wrote a single-payer bill this year, a year after the CO Blue Ribbon Commission for Health Care Reform buried the Single Payer proposal in its final report - even though the SP proposal evaluated by the Lewin Group was the only one demonstrating net savings for the state of $1.4 billion and comprehensive coverage for all. With support from one of our congressional reps, 2 previous federal bills introduced to support state pilot projects for reform, and even Pres. Obama's statement before the election endorsing state pilot health care reform projects, our CO Guaranteed Health Care Act (HB 1273) was guided by supportive legislators through 2 House commitees and a voice vote on the House floor. It was short 1 vote on final House vote, so was tabled.

We are planning to ask friendly legislators to introduce a joint Resolution in support of HR 676 like that recently passed by both houses of the Maine legislature - see   

Several of our counties have passed similar resolutions.

What if a number of states and cities did so? 

Michele Swenson
Denver

-----------

Healthcare-NOW! and Leadership Conference for Guaranteed Health Care Nationwide Day of Action being planned in over 20 cities around May 30th
 
Great events are being planned around the country!  Please submit logistics for your events so we can help promote them.  Check out the May 30th web page here: http://www.healthcare-now.org/campaigns/may-30th-day-of-action/ 

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Direct Actions for Single Payer

Single-payer activists are planning more direct actions to bring the single-payer message to Members of Congress.   Check out these great ideas!

Belly Dance for Single Payer - http://www.singlepayeraction.org/index.php

We Aren't Covered!  - http://www.healthcare-now.org/2009/04/report-from-demo-at-rep-rangels-office/

----------------

From Healthcare-Now! comes the following analysis detailing the key differences between the recently introduced Senate single-payer bill and HR 676:

With the introduction of Senate Bill 703, the single-payer movement is gearing up to support a Senate strategy.  We applaud Senator Sanders [VT] for introducing S703 "the American Health Security Act," a comprehensive single-payer bill, though not a direct companion bill to HR 676. Differences between the bills are noted in the attached document created by Dr. Len Rodberg, PNHP. 

Healthcare-NOW! recognizes that HR 676 has aspects that are preferable to S703.  For example, HR 676 builds on the existing structure of Medicare, which should allow for an easier, quicker, and less expensive transition to universal single-payer.  Also, the taxing structure set up in 676 is preferable--a more equitable split between employer and employee, plus the higher tax on the wealthiest 5% and the small transfer tax on stocks and bonds transfers helps to address the huge gap between the rich and working class & poor.   HR 676 legislation is more inclusive of ALL residents, which emphasizes our mission of implementing a health care system that respects health as a human right.
S703 also has preferable points to HR 676. S703 stresses the need for community health centers to be fully funded, giving the 60 million Americans now living in rural and underserved areas access to care.  It also addresses the critical shortage of primary care physicians and dentists, the bill provides resources for the National Health Service Corps to train an additional 24,000 health professionals. 

We urge you to look over the differences and prepare to support S703 to bring single-payer into the dialogue of the Senate.  In the coming months, Healthcare-NOW! and allied organizations encourage you to lobby your Representatives to continue support and cosponsorship of HR 676 as well as your Senators to cosponsor S703.  There are currently no cosponsors of S703, so we challenge you to bring the first Senator on board!

Physicians for a National Health Program has submitted highlights of S703:

• Patients go to any doctor or hospital of their choice.

• The program is paid for by combining current sources of government health spending into a single fund with modest new taxes amounting to less than what people now pay for insurance premiums and out-of-pocket expenses.

• Comprehensive benefits, including coverage for dental, mental health, and prescription drugs.

• While federally funded, the program is to be administered by the states.

• By eliminating the high overhead and profits of the private, investor-owned insurance industry, along with the burdensome paperwork imposed on physicians, hospitals and other providers, the plan saves at least $400 billion annually - enough money to provide comprehensive, quality care to all.

• Community health centers are fully funded, giving the 60 million Americans now living in rural and underserved areas access to care.

• To address the critical shortage of primary care physicians and dentists, the bill provides resources for the National Health Service Corps to train an additional 24,000 health professionals.

Sanders, who serves on the Senate Committee on Health, Education, Labor, and Pensions, is a longtime advocate of fundamental health care reform. His new bill draws heavily upon the single-payer legislation introduced by the late Sen. Paul Wellstone (D-Minn.) in 1993, S. 491, and closely parallels similar legislation pending before the House, H.R. 1200, introduced by Rep. Jim McDermott (D-Wash.).

There is no summary available yet, but the full text of legislation is found here: http://pnhp.org/PDF_files/American-Health-Security-Act-single-payer.pdf

------------

Video: California State Senate Health hearing last week in Sacramento

Worth noting:

 

1) Parker Duncan, AMSA, Amer. Med. Students Assn. and CaPA(PNHP Calif. chapter) fellow taking a year off to educate med. students all over Calif. about Single Payer. 

2) Malinda Markowitz, CNA Director, from San Jose about why nurses support Single Payer

3) The long line of supporters which include new organizations!

http://www.calchannel.com/channel/viewvideo/263

A report on all that is happening in health care reform debate right now except the Single Payer perspective.

What the Senate and House are planning on reform and if the public option is still on the table.

http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=58124

http://www.huffingtonpost.com/jason-rosenbaum/republicans-cave-on-major_b_191071.html

We are moving closer to health reform.  

Have a nice weekend

http://www.washingtonpost.com/wp-dyn/content/article/2009/04/24/AR2009042401178.html?hpid=artslot

Getting the insurance companies to care about the people whom they cover or the providers who deliver the care is a dream. No one here has had to spend hours on the phone trying to get an insurance company to pay a legitimate bill. It took me one year for someone to address a riduculously low payment which meant that I was providing charity work for people who paid good money for their healthcare while the insurance company kept the profit. What sense does this make? Keeping the insurance companies in the mix will only guarantee that more physicians will flee medicine. I wopuld rather deal with Medicare and the federalk government than any insurance company. The feds at least answer the phone and publish a fee schedule that they don't change on a whim. Single payer isn't on the table because we don't have the courage to do the right thing for all Americans! Too bad that our exceptionalism doesn't include any courage.

The private health insurance industry proposes to reduce health care spend and slow rate increases over the next 10 years to provide $2 trillion in “savings”?

Total 2009 US health care annual spend is widely accepted to be US $2.5 trillion.

Today, 1200 US private health insurance companies make up the US private health insurance industry that insures 60% of the US population, or 180 million Americans.

Approximately 180 million Americans are covered by private health insurance.   At an estimate of $10,000 per person per year, total US private health insurance annual spend is about $1.8 trillion for these 180 million privately insured Americans.

At $1.8 trillion annually, the private health insurance industry administers 70% of the total $2.5 trillion US health care annual spend.

The private health insurance industry is extremely profitable. In fact, of the $1.8 trillion private health insurance industry, 31% goes directly to administrative costs and profit.  So, for every US health care dollar spent by privately insured Americans, an average of 31 cents goes to the US private health insurers' administration and profit, or $580 billion annually.

If the private health insurance industry continues to administer 70% of the total US health care $1.8 trillion annually over the next 10 years, the total private health insurance industry would be $18 trillion at current US health insurance industry premiums and health care costs.

If the private health industry continues a 31% administrative costs and profit at $580 billion annually over the next 10 years, the health insurance industry would receive $5.8 trillion for administrative costs and profit at current US health insurance industry premiums and health care costs.

However, the US health care industry is estimated to grow as much as 60% or to a total of $40 trillion over the next 10 years.

If the private health insurance industry continues to administer 70% of the total US health care annual spend over the next 10 years, total private health insurance industry would be $24 trillion. 

And if the private health insurance industry maintains a 31% overhead over the next 10 years, a total of over $7.7 trillion would go directly to private health insurance industry operational costs and profit. 

Over the next 10 years, the private health insurance industry could potentially see $24 trillion industry that includes $7.7 trillion operational costs and profit?  

Does it really cost $7.7 trillion to write policies and process health care bills?  

With a potential total industry of nearly $24 trillion over the next 10 years, I am not surprised that the private health insurance industry offered $2 trillion in reduced spending and slower premium increases.

How does the private health insurance industry achieve a 31% overhead today?

The 180 million Americans with private health insurance are statistically healthier, wealthier, and have less costly medical conditions (e.g. not terminally ill like a larger segment of those on Medicare, etc.). This is where a 31% overhead is available for administrative costs and profits for the private health insurance industry, insuring the young, healthy, and wealthy.

How does private health insurance industry overhead compare to Medicare and Medicaid/SCHIP?

Medicare covers 45 million seniors or 15 percent of the US population. At an estimate of $10,000 per person per year, that amounts to $450 billion annually (including unfortunately $60 billion in fraud annually), with an overhead of only 3% or $13.5 billion annually due to no profits or excessive administrative costs and salaries. 

Medicare is not the most thorough and efficiently run operation.   Also, seniors statistically are not the healthiest segment of the US population, while many require more expensive long term health care, especially the terminally ill.  The fact that this segment of the US population is growing the fastest will make matters even more complicated. 

Medicaid/SCHIP costs are $300 billion annually for 30 million US children and welfare recipients, or 10 percent of the US population.  At an estimate of $10,000 per person per year, that amounts to $300 billion annually, with an overhead of only 3% or $9 billion annually due to no profits or excessive administrative costs and salaries. 

Medicaid/SCHIP is also not the most thorough and efficiently run operation.  Additionally, the impoverished are statistically not the healthiest or most intellectual segment of any population, and administering health care coverage and treatment can be more challenging.   Unfortunately, this segment of the US population is also growing.