Professor Jacob Hacker originally defined the concept of an ideal 'public option' as part of health care reform a decade ago. He evaluates current health care proposals in his recent report Public Plan Choice in Congressional Health Plans: the Good, the Not-so-good, and the Ugly. On page 20 Hacker includes a chart comparing 4 of the current federal proposals based on 5 criteria against his definition of the ideal public plan.

Hacker writes, "The simplest public option is to let people without employer-provided health insurance to buy into Medicare, or a similar program, at cost."

Democrats started with a compromise position, failing to make the best case for health care reform as key to economic recovery -- a single public-payer model with full choice of private providers (unlike private insurances that limit provider access). Instead, Democrats have promoted a largely undefined 'public option,' and permitted the political right to define the terms of the debate using distortion and distraction.

As Hacker notes, a strong public plan at the very least must be built on Medicare's existing provider network and payment methods, and not weakened by requiring the plan to create a provider network from scratch, or to negotiate rates individually with each provider across the nation. Access to a 'public plan' should not be restricted to only the smallest firms.

The best way for President Obama and Democrats to reclaim the issue is by making their 'public option' an optional Medicare buy-in for anyone. Medicare is known and liked by most people, and not so easily distorted. Medicare has low overhead costs for built-in cost containment, and its structure is in place -- it could be up and running relatively quickly, with no need to create a whole new program at additional cost. Enlarging Medicare's risk pool by permitting younger people to buy in on a sliding scale would improve its financial stability.

Additional improvements to Medicare would encompass eliminating costly high subsidies to privatized Medicare Advantage plans, and permitting negotiation of drug prices as is done in other countries, while improving provider reimbursement. See also: 'Public Option' a Shadow of Its Original Intent - Dr. Marcia Angell Advises Optional Medicare Buy-In

STATE & LOCAL SAVINGS WITH SINGLE PAYER
Share with legislators the 6-page Summary of State and Local Savings of Single Payer in the 2007 Lewin Report as a remedy to strained local and state budgets. Some public policy people are beginning to consider these savings as states become more distressed.

NUMBERS OF UNINSURED AND UNDERINSURED IN COLORADO
A Denver Post editorial recently repeated the error of attributing all unpaid medical bills to the uninsured. "If we only insure the uninsured, runs the thinking, cost-shifting in the form of rising premiums for the insured will be ended" -- completely ignoring the link between growing numbers of underinsured and the increased unpaid medical costs over the past decade.

In addition to denial or delay of care, insurance companies make money by shifting more costs to families and individuals by moving them to "catastrophic" or "consumer-driven" health plans with less coverage and high out-of-pocket costs.

A 2008 Study  by doctors at the University of Colorado School of Medicine revealed that of those with insurance for a full year, <b>36.3% were underinsured</b> -- that is, they reported the delay or omission of recommended care because of their inability to afford it; half felt that their health suffered because they could not afford recommended care.

A 2009 Study by Families USA reported that <b>32.4% of Coloradans were uninsured</b> - nearly 1 out of 3 people under age 65 had no health insurance all or part of the 2-year period 2007-2008. 

Combined, the numbers indicate that at any point in time, as many as 68.5% of Coloradans may be under- or uninsured.

RESOLUTIONS IN SUPPORT OF SINGLE PAYER
Denver Democrats Executive Committee voted 44-4 for a resolution urging our state and federal legislators to support single payer health care reform. Read about it . Other Colorado county Democrats have also expressed support of a single-payer system, including Montrose, Boulder, Costilla, Hinsdale, La Plata, Arapahoe counties, and recently Jeffco. The nation's mayors passed a Resolution in support of single payer, HR 676, at their gathering last summer.

Another small window of opportunity for a congressional debate and vote on the single payer bill (HR 676) will open next month. In response to Rep. Anthony Wiener's (D-NY) proposed amendment for HR 676 in the House Energy & Commerce Committee, Speaker Pelosi agreed to have a debate and a vote on the single payer bill on the House floor after Congress reconvenes in the Fall. Please urge your representatives to support the single payer proposal - more suggested talking points below. The "public option" has been diluted from its original intent - see piece below.

Fearmongering around "government-controlled" health care has been used to distract from our Wall-St. controlled health care. See The Tyranny of Wall St.-Run Health Care: No CEO Left Behind. 

Genesis of the Public Option & Its Dilution
The "public option" has been diluted – testament to the influence of the monied lobbies. It is a rule of negotiation not to start with compromise, and, instead to make the best case for reform upfront. The best case for comprehensive coverage and cost containment is a single public payer model with full free choice of private providers -- from that position, compromise would at least be a stronger "public option."

The Public Option feature of health care reform was conceived by political science professor Jacob Hacker, whose most recent iteration in 2007 is named the "Health Care for America Plan." Hacker envisioned it as a "Medicare-like" program that would sell health insurance to the non-elderly in competition with the 1,000 to 1,500 health insurance companies that sell insurance today.

Kip Sullivan, member of Minnesota Physicians for a National Health Program, recently evaluated the "public option" features of House and Senate Democratic proposals, and concluded that they are faint shadows of Hacker’s original proposal. Read the full piece about the genesis of the public option & its dilution.

The 5 original criteria that Hacker and the Lewin Group (which evaluated it) said are critical to the success of the "public option":

•• The Public Option had to be pre-populated with tens of millions of people, that is, it had to begin like Medicare did representing a large pool of people the day it commenced operations (Hacker proposed shifting all or most uninsured people as well as Medicaid and SCHIP enrollees into his public program);
•• Subsidies to individuals to buy insurance would be substantial, and only Public Option enrollees could get subsidies (people who chose to buy insurance from insurance companies could not get subsidies);
•• The Public Option and its subsidies had to be available to all nonelderly Americans (not just the uninsured and employees of small employers);
•• The Public Option had to be given authority to use Medicare’s provider reimbursement rates; and
•• The insurance industry had to be required to offer the same minimum level of benefits the Public Option had to offer.

Concluded Sullivan, of Hacker’s five criteria, only one is met by the Democrats’ proposed bills – i.e., both proposals require the insurance industry to cover the same benefits the "public option" must cover. None of the other four criteria are met.

As Robert Kuttner writes (Faint Praise): "...the likelihood is that whatever finally makes it through this session of Congress will reinforce and further bloat the current disaster of a health insurance system rather than fundamentally changing it. And if the decent elements of the plan are blocked, Obama should have the courage to pull the bill and take his case to the people....The satisfaction of a Rose Garden signing ceremony is not worth it, if the plan is more thorn than rose."

Talking Points to take to Legislators

Legislators need to hear from constituents in order to counter the $1.4 million/day spent by insurance, PHRMA & other special interests steering the health care reform debate to benefit their bottom lines.

Some things we might tell our senators/represenatives:

Eliminate For-Profit Insurances – The U.S. is the only country that continues to build its health insurance system around for-profit insurances. Most other industrialized nations prohibit for-profit insurance for primary health care; private insurance is reserved for supplemental coverage (e.g., private hospital room with TV, cosmetic surgeries, etc.). Underwriting should be eliminated, and true universal coverage provided.

Extend Medicare to All – As Dr. Marcia Angel says, the simplest way to expand health coverage to all (even in stages) is to expand Medicare coverage to all. It can be expanded by decade - lower the qualifying age to 50, then 40, etc. The infrastructure for Medicare billing, etc. is in place; it only needs to be improved, e.g., to permit negotiation of bulk drug and medical equipment costs; and the more costly privatized Medicare plans eliminated.

Support the amendment offered by Rep. Anthony Weiner (D-NY), which would effectively replace the entire existing health plan with the text of H.R. 676, Rep. John Conyers' single-payer legislation. Speaker Pelosi has agreed to permit debate and a vote on Weiner's Single Payer Amendment sometime after the House reconvenes in September.

A True Public Option – must include the 5 main criteria listed by Hacker above. The "Public Option" won’t save much money, but it may provide the competition to keep private insurances "more honest."

CBO Report of Single Payer Savings – The Congressional Budget Office should report the cost savings of the single-payer proposals (HR676 & SB703) side-by-side with the cost analysis of every other proposal. Over 20 federal and state studies since 1990 show considerable cost savings with the single-payer model. If the Blue Dog Democrats are serious about cost containment, they should demand the full CBO Report – see Blue Dogs Should Demand CBO Report of Single Payer Savings

Means-testing for subsidies adds a high "non-benefit" cost. It is less costly to simply cover everyone (like Medicare) instead of making folks jump through hoops to prove eligibility (for subsidies, etc). Read the comments of Merton C. Bernstein, leading health insurance expert and law professor emeritus at Washington University, who notes that private health insurance non-benefit costs range from about 12% to as much as 30% of outlays – compared to Medicare overhead of 3%.

Kucinich Amendment in Support of State Single Payer – Urge our senators and representatives to assure that the Kucinich Amendment is part of any health bill that passes, to help states pass single payer reform without federal ERISA challenges. At least 10 states have written single payer proposals thus far.

Two-hundred and fifty people gathered on the steps of the Colorado Capitol Saturday, May 30 as part of a "National Day of Action" to advocate for a single-payer model of health care reform. People came from Colorado Springs, Buena Vista and Ft. Collins as well as metro Denver to share stories and data about the utter failure of U.S. health care, which has become a profit-center for multi-payer insurances and hospitals at the expense of health care access for the people of Colorado.

Roya, a rally organizer from Health Care for All Colorado, related the story of a friend, repeatedly denied health care due to a "pre-existing" condition of cancer, until she died. Mike, a leader of ArapaHope Community Team, another rally organizer, told of continuous denial of health care coverage since he had a mild heart attack 14 years ago.

Fort Collins physician, Dr. Cory Carroll expressed the frustration of primary care providers whose care for patients is often complicated or obstructed by for-profit private insurances that assume the right to deny or delay claims.

Sen. Morgan Carroll observed that insurance companies make their profit by over-charging premiums, which rose 98% from 2000-2007, and by denying necessary health care. In Colorado, unlicensed and unqualified insurance industry folks deny necessary medical treatment. Asking "Where are our priorities?" Sen. Carroll noted that we have spent billions more on wall street bailouts than it would cost to provide health care to every single American for decades. Read more of Sen. Carroll's remarks.

Single-Payer has been declared "off the table" by Sen. Baucus and others in Washington. When Gov. Howard Dean visited Denver last week to promote a parallel public health care option, he drew gasps from his progressive audience when he suggested that Medicare Part D was "good" reform --perhaps a mark of the insularity of Washington culture, and a disconnect  on the part of some of our leaders.

Rep. John Kefalas has done a stellar job of shepherding the Colorado Guaranteed Health Care Act (HB 1273) through two committees - Business Affairs & Labor and Appropriations - and a second reading in the House. The bill is scheduled for 3rd reading and final vote in the House on Monday, April 13, where it now has 32 votes. One more vote is needed or it will die.

Six Democrats have yet to indicate they will vote affirmatively.

Please call and email each of the following representatives before 9 a.m. on Monday morning.

Speaker Terrence Carroll 303-866-2909 terrance.carroll.house@state.co.us

Rep. Kathleen Curry 303-866-2945 kathleencurry@montrose.net

Rep. Wesley McKinley 303-866-2398 mckinley@cowboywes.com

Rep. Karen Middleton 303-866-3911 karen@karenmiddleton.com

Rep. Jim Riesberg 303-866-2929 jim.riesberg.house@state.co.us

Rep. Christine Scanlan 303-866-2952 christine.scanlan.house@state.co.us


The Board of Directors of the Health District of Northern Larimer County wrote a 6-page objective analysis of HB 1273, and voted unaminously to endorse the bill - one of more than 60 group endorsers. Read their Analysis.

The Northern Colorado Business Report, which has remained out in front in reporting on health care reform, on March 13 printed an editorial endorsement of HB 1273. Read their Endorsement.

Opponents of HB 1273 have predictably focused on "free market" arguments invoking "competition" and "choice", though, honestly, people want a choice of health care providers, not minimum-benefit insurances that leave them at risk. Rep. Kefalas has consistently maintained that to move to a quality-centered health care system, competition should occur among providers, not among for-profit insurances. Kefalas rightly notes that we need a new health care paradigm that also permits greater transparency in order to facilitate determination of best practices and health care outcomes. Currently, thousands of different insurers each maintain secrecy around their own proprietary data.

One of the oft-used arguments to foreclose debate of HB 1273 - used by Republicans and by the governor’s office - has been the notion that the 208 Commission studied the single payer proposal in depth and rejected it. Nevertheless, we who were present at most of the 208 Commission meetings witnessed the almost immediate dismissal of any consideration of the Single Payer model. There was true disbelief expressed by Commission Chair Bill Lindsay (among others) - "That can’t be!" - when the Lewin Group reported the cost savings of single payer. It was the only one of 5 proposals that showed cost savings for providers, businesses, families, hospitals, and a net savings for the state of $1.4 billion, as well as the ability to provide comprehensive coverage for all.

There was never any attempt by the Commission to follow up with study of  the Single Payer model - rather, they dismissed it in 4 cursory sentences in their Final Report to the legislature, calling it "politically unfeasible." The Commission devoted most of their time to writing their own proposal of incremental reforms based on the Massachusetts model of a mandate for private insurances.

So, debate around the Single Payer model has been consistently short-circuited at all levels, with an effective media blackout among the large Denver-area print media. It bears repeating that throughout the 208 Commission process, the Denver Post and The Rocky Mountain News rejected pieces related to the Single Payer model, preferring instead pieces by "free-market" advocates. The business editor of the News informed me that he did not want "to confuse his readers" with information about single payer. By comparision, the Ft. Collins and Pueblo newspapers excelled at presenting pros and cons of all aspects of the health care reform debate.

We have yet to have a thorough honest debate of the Single Payer model of health care that has not been distorted by opponents’ framing, too often with capitulation from some of our Democratic leaders. As recently as April 7 when Rep. Diana DeGette gave her signature health care reform speech before the City Club of Denver, she conceded the issue by using opponents’ framing of health care reform. Promising "strong doctor-patient relationships - free from government interference...," DeGette disregarded the fact that only a single-payer model offers full choice of providers; nor did she mention the $20 billion annual interference of private insurance plans that daily breach patient-doctor relationships, gaming the system using "Denial Management" to deny, delay and renege on insurance claims. "...let there be no doubt: ‘socialized medicine’ is not coming to America," promised DeGette. Again, our Democratic leaders too often fail to define issues and inform people, but rather fall into the trap of letting Republicans and corporate interests define the terms of every debate.

For the first time since Rep. Kefalas introduced the Colorado Guaranteed Health Care Act (HB 1273) this legislative session, on Monday April 6 there was a relatively brief (1-1/2 hour) window for debate about the issue of single payer on the House floor. It was a powerful experience to witness  Democrats stepping up to present the case for a sytemic health care reform, countering the specious arguments presented by the opposition. I will summarize the April 6 HB 1273 House floor debate in a subsequent post.

A May 2005 Pew Poll revealed that 65 percent agreed government should guarantee health coverage for every American "even if it means raising taxes." In a 2009 Lake Research Partners survey, nearly 7 in 10 voters expressed a desire for complete overhaul or major reform of the health care system. The April 2008 Annals of Internal Medicine reported that 59 percent of U.S. doctors supported "government legislation to establish national health insurance," an increase of 10 percent of doctors over 5 years.

The debate continues to be short-circuited, an effective blackout in some media markets since the convening of the Colorado 208 Commission on Health Care Reform. Though the CHS single-payer proposal was the only 1 of 5 proposals demonstrating state cost savings of $1.4 billion and comprehensive coverage for all, it was buried in the Commission’s final report and dismissed as ‘politically unfeasible.’

Throughout the 208 Commission process, the Denver Post and The Rocky Mountain News printed only health care reform pieces by ‘free-market’ advocates. The News business editor, Rob Reuteman backed out of his promise to give equal time to single-payer, saying that it is "pie-in-the-sky" and "I don’t want to confuse the readers." Media marginalization continues.

The Colorado Guaranteed Health Care Act (HB 1273) moved out of the Business Affairs Committee on March 18, with at least 100 supporters, many providers and small business owners testifying about the need to address the declining primary care infrastructure and the rising cost that make coverage prohibitive. It was noted that Massachusetts reform is a trainwreck, marked by taxpayer-subsidized private insurance and growing numbers on Medicaid rolls, doubliing Massachusetts health spending, from $630 million in 2007 to an estimated $1.3 billion in 2009.

HCPF director and the governor’s spokesperson, Joan Henneberry spoke against HB 1273, calling it a "a new bureaucracy." In fact, the bill intends to address the unsustainable private and public health care bureaucracies. Multi-payer insurances are paper-intensive with high overhead costs; and the Colorado Medicaid bureaucracy maintains about 20 different categories of Medicaid, each with different means testing and annual reauthorizations that erect barriers to health care access and exponentially increase administrative costs.

On March 27 Colorado State of Mind (ch 6) invited panelists to speak about Colorado health care reform, but failed to include anyone who could speak to the specious arguments raised against HB 1273. Pediatrician Larry Wolk asserted that single payer denies ‘choice,’ and that it represents ‘one-size-fits-all’ -- variations on the ‘free-market’ theme holding that people want a choice of insurances, rather than a choice of health care providers. A choice of minimum-benefit and catastrophic coverage is no choice at all - something employees are discovering as costs rise and more are moved into reduced-benefit policies with high out-of-pocket costs.

Pediatric cardiologist Dr. Reginald Washington noted that even if more people have public or private insurance, there are not enough primary care providers in Colorado to care for everybody. In fact, more primary care providers are leaving private practice, overwhelmed by the burden of dealing with multi-payer networks, copious paperwork, preauthorizations and claims denials that take away valuable time from patients, and require them to hire extra staff.

The Colorado Guaranteed Health Care Act (HB1273) provides the structure for a long-term, systemic solution – simplified billing, quality-centered health care, and full choice of providers and hospitals. It addresses our degraded primary care system with investment in education to address provider shortages; and requires transparency for determining best practices, and incentives for improved health outcomes and costs containment.

The bill passed out of Appropriatiions April 3 and will probably be heard in the full House the week of April 6. All of our legislators and the governor need to hear that there is grassroots support for HB1273. Appropriations members are below. Identify your legislators at www.vote-smart.org . Write an email to the governor at http://www.chcpf.state.co.us/governor/contact.html.

To those who ask why we do this at the state level, there have been federal bills (which may be re-introduced this session) to fund state pilot projects for health care reform. At least one of our congressional delegation is willing to help us at the federal level, and we need to be ready. If you think comprehensive health care reform will happen quickly at the federal level, please read the following piece I wrote for Huffington Post:  Dems & Repubs on Health Care: 'Love a Lobbyist' - we need to urge our federal senators and representatives to work for meaningful reform.

HB 09-1273 - the Colorado Guaranteed Health Care Act - defines the structure for meaningful health care reform. It is the only current proposed systemic health care reform that addresses the crisis of health care financing and delivery. Read Bill Description & Summary.

It is popular to say that single, public-payer health insurance with full choice of providers is the solution, but it is "not politically feasible" - which has become an expression of the lack of political will to do the right thing. Fifty-nine percent of doctors (historically conservative) in a recent poll supported the single-payer model of health care reform.

A friend's doctor is one who no longer processes health insurance claims - he requires payment from his patients, whom he advises to file their own claims with their insurance companies. Similarly, some hospitals have been reported to require up-front payment from patients who have "catastrophic" insurances with high-out-of-pocket expenses (underinsurance), which notoriously result in unpaid medical bills. 

Thus far, HB 09-1273 has 15 House and 3 Senate cosponsors. Urge your legislators to sign on as cosponsor. HB 09-1273 could become a significant contributor to economic recovery.

The Following Groups have endorsed the the Colorado Guaranteed Health Care Act. If your group would like to endorse, contact info@healthcareforallcolorado.org.

• Colorado Nurses Association
• Colorado Medical Society
• National Association of Social Workers, Colorado Chapter
• Rocky Mountain Farmers Union
• Colorado Education Association
• League of Women Voters (Colorado)
• Junior League of Denver
• Colorado Cross Disability Coalition
• Autism Society of Colorado
• Colorado Social Legislation Committee
• Hunger for Justice Lutheran Advocacy Ministry of Colorado
• The Rocky Mountain Conference of The United Methodist Church
• Balanced Choice Health Care, Inc.
• Colorado Alliance for Retired Americans
• Be the Change USA
• Justice and Peace Ministry Team of the Rocky Mountain Conference of the United Church of Christ
• Arapahope Community Team
• LARASA (Latin American Research And Service Agency)

Attend the hearing for HR 1273 currently scheduled on March 18 at 1:30 pm in the Capitol Old Supreme Court Chambers, 2nd floor. 

Journalist T.R. Reid contrasts U.S. health care with that in 5 other industrialized nations in his documentary ‘Sick Around the World.’ None of the 5 countries he visited – Germany, Switzerland, Japan, Taiwan and Great Britain – utilizes for-profit insurance; all pay on average half as much per capita for health care as the U.S., and all have better health care outcomes, longer lives, etc.

Rather than a quality-centered health care system, the U.S. profit-centered model of health care has compromised our primary care infrastructure. At least one hundred overburdened U.S. emergency rooms have closed their doors over the past decade. It was recently reported that University Hospital became the 8th area facility to close its psychiatric unit; at the same time, it maintains a new 6-story building on the Fitzsimmons campus dedicated solely to billing, processing more than 1,000 different forms for over 1,000 different insurers.

Over 20 federal and state studies, including the Colorado Lewin Group study in 2007, have demonstrated billions of dollars of savings in health care spending, as well as the ability to provide comprehensive health care for all, utilizing a single-risk-pool publicly financed and privately delivered health care system.

The Colorado Guaranteed Health Care Act, HB09-1273, has been introduced to create the structure for comprehensive reform that guarantees health care for all Coloradans. In addition to streamlining administrative health costs, HB09-1273 stipulates annual negotiation of fair reimbursement to all providers; negotiation of prescription drug and medical equipment costs; support for education to address primary care, nursing and other provider shortages; and prioritization of retraining for displaced workers.

In the place of inadequate private insurances that have seen premium increases of more than 100% since 2000, the single public-payer model of health insurance separates health coverage from employment, establishes a sliding-scale premium based on income, and permits full choice of health care providers. Read more about the proposed bill at www.HealthCareforAllColorado.org, then urge your legislators to support HB09-1273, comprehensive health care for all Coloradans.

Following is a summary of the Colorado Guaranteed Health Care Act, setting up the framework for true universal health care in Colorado. It has been assigned to the House Business Affairs & Labor Committee, which meets on Tuesdays and Wednesdays (members listed below). Rep. Kefalas introduced HB09-1273 with fifteen House cosponsors (Representatives Gwen Green, Jerry Frangas, Lois Court, Randy Fischer, Dickey Lee Hullinghorst, Jeanne Labuda, Claire Levy, Joe Miklosi, Sal Pace, Edward Vigil, Dennis Apuan, Beth McCann, Anne McGihon, Su Ryden, and Sue Schafer). Senator Joyce Foster will introduce the bill in the Senate; presently, there are two cosponsors: Senators Morgan Carroll and Bob Bacon. Thank your legislators if they are cosponsoring the bill.

See Summary of Bill HB 09-1273 & Full 13-page Bill

John Geyman, M.D. (Do Not Resuscitate: Why the Health Insurance Industry is Dying, and How We Must Replace It) reports that administrative costs for the U.S. multi-payer health insurance bureaucracy is 5 to 9 times greater than that for not-for-profit traditional Medicare -- 20-26% vs. 3%; and that U.S. health insurance premiums have risen more than 100% since 2000, and are projected to consume all of household income by 2025. Furthermore, taxpayers are subsidizing private health insurance, e.g., privatized Medicare Advantage Plans, is 13% more costly than traditional Medicare.

A Harvard Study (7-9-02) reported that government's share of health expenditures nearly doubled since 1965, totaling almost 60% of total health costs in 1999. Government health costs include spending for Medicare, Medicaid, veterans and military, private insurance for public employees (members of Congress, firemen and school teachers, etc.), and tax-subsidized private coverage (e.g., tax credits for businesses’ coverage of employees).

T.R. Reid's documentary "Sick Around the World" draws a contrast between the higher cost and poorer outcomes of U.S. health care, with health care in 5 other capitalist countries. None of the 5 countries would tolerate conditions that result in medical bankruptcy (now 50% of U.S. personal bankruptcies). All of the 5 countries cover health care with some form of social insurance paid for on a sliding scale. None have for-profit insurances (except for certain supplemental policies). Following are 2 pages of notes made at the time Reid showed his documentary to state legislators and responded to follow-up questions.

"Sick Around the World," Documentary by Journalist T.R. Reid
Presented to a Joint Session of the Colorado House & Senate HHS Committees 1-8-09

For his documentary evaluating health care around the world, T.R. Reid visited 5 capitalist countries - Great Britain, Japan, Germany, Taiwan and Switzerland. He previously lived in Japan and Great Britain (x5 years), where he said his family received very good care from a doctor who lived on the block and made house calls.

The national insurance of most of these countries is covered by a sliding-scale tax or social insurance payment. None risk personal bankruptcy. The poor are subsidized. All countries spend roughly half as much on health care as the U.S. and have better outcomes. In all of the countries except Britain, medical education is free. Some profit for providers is accepted, however insurance profit for general medically necessary health care is not. Reid contrasts the five other capitalist countries with the U.S., with its "army of underwriters" practicing risk selection. In other countries claims are paid quickly, within 2 weeks. Great Britain has a public entity that makes decisions about coverage, e.g., cutoff for some procedures, such as kidney dialysis for the terminally ill. "They cover eveybody, not everything."

Reid reports that most capitalist countries don’t trust the unfettered free market and, thus, enact serious controls. He observes that universal care in the U.S. could begin at the state or federal level. If one state created a model, others would likely follow, as in Canada, where national health care started in one province (Saskatchewan, where insurers did not want to insure rural folks), covered by taxes. One by one, other provinces demanded the same.

Health care systems in all of the countries he visited share the following characteristics:

1) Insurance companies accept everyone (no exclusions) and do not profit from basic necessary coverage – even when coverage is accomplished through a number of private insurers. E.g., Germany has over 200 private insurers, who make an end-of-year financial report. To equalize risk among insurances, those that end the year in the black, share their income with those who end the year in the red.

2) There is a mandate for all to buy into the public social insurnace system, and government subsidizes the poor.

3) Doctors and hospitals negotiate annually for fixed-rate payment, whether they negotiate with a quasi-government or government entity, or with private insurers as a unit, as in Germany. There is no widening gap between numbers of primary care doctors and specialists (or their pay) as there is in the U.S.

4) Bankruptcy due to medical bills is unheard of in these countries.

5) Most utilize some form of IT, electronic medical records, and individual smart cards with medical history.

Great Britain excels at providing preventive health care. There is no health care billing to Britains. An example of true socialized medicine, providers work for the government, and are paid a fixed government salary, negotiated annually. General pracitioners are paid a bonus for keeping patients healthy. Britain has succeeded in reducing wait-lines for non-emergency procedures, e.g., hip replacement have been reduced from 18 months to 2-6 mos. Since 2008, Britains can choose among government hospitals. General practitioners act as gatekeepers to specialists.

The Japanese live the longest and have lowest infant mortality. Not-for-profit insurance in Japan is managed by employers, who pay half of the $250 family monthly health fee. Eighty percent of hospitals are private. Toyota has built hospitals for its employees in Japan. The Japanese Health Ministry negotiates a standard fixed price for doctor fees, drugs, etc. Because Japanese costs are so low (e.g., cost is $10/night for a hospital room for 4), 50% of hospitals are in financial deficit, demonstrating the need to raise rates. Japanese spend 8% GDP on health, half as much as the U.S. Reid notes that U.S. health costs are much higher due to the hodge-podge of many different systems for everyone. Most countries have the same care at the same price for all.

Germany has had the Bismarck model of comprehensive health care since late 19th century. Ninety percent remain in the system; about 10% of the rich opt out and pay private coverage. Germany eliminated its former profit-based insurance. Now income-based premiums are paid to 1 of 240 private not-for-profit insurers. There is a $15 copay every 3 months, with pregnant women exempted. Insurance management gets better pay for serving more customers. Doctors (with free medical education) earn half of U.S. doctors’ pay, and work long days (family doctors make $120,000/yr. – 2/3 of U.S. doctors’ income). Reimbursement is negotiated annually by the German states. To equalize insurers’ risk, insurers that end the year in the black, share their income with companies in the red.

Taiwan designed a new health care system in 1995 after looking at 15 other countries, discounting the U.S. health care model as a "market-not-a-system." They created a national insurance with no opt out, no gatekeepers and no wait lines. Information technology plus smart card with each person’s medical history facilitate health care. Taiwan has the least administrative costs of all countries (2%), as providers bill the government directly. Taiwan’s health costs are less even than Japan’s (6.3% GDP). They have the leeway to increase premiums, but because they are so reluctant to do so, the government must borrow to pay providers.

The Swiss passed a referendum by slightly more than 50% to create national health care in 1994. In Switzerland, insurance is mandated and not-for-profit. Strong incentives keep administrative costs at 5% (vs. 22% in U.S.). Insurances may offer supplemental care for profit. Premiums are $750/mo for family (2nd most expensive after U.S.). The Swiss see limits to a pure free-market, and view health care as a value. The conservative Swiss President calls health care "a right," and says it would be a "scandal" for the Swiss to experience medical bankruptcy, as many do in the U.S.

Reid notes that for most of its history, until the 1980s, U.S. health insurance was not-for-profit. Since then, insurance administrative costs have ballooned. Consequently, he notes, the new Colorado Health Sciences Center has a 6-story building dedicated solely to billing, handling 1600-1700 different forms. U.S. insurances are not transparent. The for-profit insurance industry overhead costs are 18-24% of health care dollars. Other countries present one bill for surgery, whereas a single U.S. procedure can come with 30 different bills. When asked what might happen to insurance middlemen in a reformed system, Reid replied that there would be plenty of health care jobs for which to retrain them.

Reid’s next documentary, due in April, will examine what happens to Americans who think they are insured, but because they carry high deductibles of $2,000-10,000, cannot access their insurance, and cannot pay for health care.

View "Sick Around the World" and related interviews

The dialogue around health care reform has been stifled and distorted by those who profit from the current system, so I wanted to share with you a piece I wrote for the Huffington Post -- Corporate Profit Continues to Define Health Care Reform & the U.S. Race to the Bottom. Please comment on the piece, if you like. I think that employers should certainly contribute to health care based on numbers of employees, but health care should not be tied to employment. 

T.R. Reid, PBS journalist who made the documentary, Sick Around the World, is scheduled to show his documentary & comment to a joint session of the Senate-House Health & Human Services Committees this Thursday, Jan. 8 at 1:30pm- 3:30pm at the Legislative Services Building (across from the Capitol at 14th St. on Sherman) in Hearing Room A. The documentary has been shown a number of times on PBS Frontline. Reid lived in other countries, including England, where he found health care to be much more accessible and affordable than in the US.

Failed U.S. health care is a major contributor to our systemic economic crisis. Indeed, the excesses of Wall St. and the subprime mortgage catastrophe mirror U.S. health care policy – both are typified by privatized profit (for investors and insurers), and socialized risk (for taxpayers and consumers). Inflated U.S. health care costs – 16% of GDP and rising – are major contributors to an inflationary economy. Redress of this single aspect of an out-of-control U.S. economy would lift all boats. Comprehensive health care reform would improve the economic status of all, relieving health access concerns of families, individuals and businesses, large and small.

So-called "legacy costs" alone, comprised largely of retiree health and pension benefits, have contributed significantly to General Motor’s negative cash flow, prompting yet another request for government bailout. In 2005, costs of health care coverage to GM amounted to $5.6 billion for 1.1 million employees, retirees and their dependents. In 2005 BusinessWeek reported that legacy costs added $1,600 to the cost of each GM vehicle.

It’s time to confront the crippling economic effects of employment-linked health coverage that reduces competitiveness of businesses in the world marketplace, reduces effective employee take-home pay, and adds to the costs paid by all for goods and services (note above cost added to each U.S. -made car). State and city budgets, too, are depleted by escalating health costs for employees and retirees.

Progressives leaders must do a better job of promoting civic discourse while clearly defining issues, like health care reform. Democrats shoud cease parroting right-wing framing and code words intended to distort the issue, e.g., "government health care" or "socialized medicine," as a couple of recent Colorado candidates have done. We need to refute Republican "free-market" advocacy that treats health care as a commodity to be exploited for maximum profit, with top-skimming of over 25% of health care dollars for private insurance shareholder profits, CEO salaries, excessive administrative costs, marketing, lobbying, etc. "Free-market" health care is as perverse an incentive as free-market police and fire protection would be, leaving everyone vulnerable, at the mercy of the marketplace.

Barack Obama showed promise broaching issues during the campaign. He made a start at explaining the high cost of privatizing Medicare (13% higher than traditional Medicare), and the failure of Medicare prescription drug reform that prohibits negotiation of bulk drug rates, as the VA does to save money. The 2003 reform was a giveaway to insurance and pharmaceutical lobbies, with billions of dollars of taxpayer subsidies and inflated costs to benefit their bottom lines. Now is the time to make the case for an improved Medicare for All - a public insurance with true free choice of providers and hospitals. By contrast, for-profit insurance choices are narrowly limited to "in-plan" providers, necessitating change of providers with change of insurance.

Comprehensive health care reform shoud be part of a broad economic remedy. U.S. health costs are almost double those of all other industrialized nations, and growing; yet we still experience worse overall health outcomes. Increasing numbers of underinsured pay escalating costs for decreasing coverage. Taxpayers currently pay for over 60% of health care costs, including 70% of legislators’ health coverage. By many accounts, that is enough to provide single-risk-pool coverage for all.

In fact, single-payer health care is the only model of reform that has demonstrated in over 20 federal and state studies the capacity to save money and provide comprehensive coverage for all.

It is time for reform that benefits the worker as well as the CEO.

First posted on Huffington Post 11-13-08

The "right-to-life" movement that elevates embryonic life above women's lives is more accurately termed "right-to-prenatal-life." One of the most extreme 2008 anti-abortion, anti-contraceptive ballot measures is the so-called Colorado "Personhood" amendment - number 48 - defining fertilized eggs as "persons" with Fourteenth Amendment rights to "life, liberty and due process of law." Simultaneously, rightists have opposed the same rights for women as "reading feminism into the Constitution."

Both Amendment 48 and a rule change proposed by the Bush administration Department of Health and Human Services would re-define pregnancy as the point of conception, disregarding the medical definition of pregnancy - "the implantation of a fertilized egg." They would effectively categorize as abortion any contraception (e.g., the pill, IUD, emergency contraception, contraceptive patch) that interferes with the implantation of a fertilized egg, thus outlawing most contraception - the primary means to reduce the need for abortion.

In a slippery slope to 19th century status for women, rightists have promoted "conscience clauses" permitting pharmacists' and others' refusal to fill prescriptions or provide health care for women. The HHS proposal states, "[T]he conscience of the individual or institution should be paramount in determining what constitutes abortion..." - holding women's health hostage to anyone's professed religious/ideological beliefs.

It is time to recognize that abortion serves as surrogate for a spectrum of unspoken issues related to female personhood and male entitlement. The anti-abortion political litmus test was introduced by Paul Weyrich, who dictated that women step aside and "make way for new life." It serves dual purposes - the marginalization of women and the lightning rod around which to mobilize political coalitions, notably, Evangelicals and Catholics. The elevation of fetal life over women's lives, coupled with conservative strategist Howard Phillips' euphemistically described goal of return to "one-family-one-vote," is calculated to marginalize and disenfranchise women, consistent with the ultraright tenet that ultimately, only select white Christian males should retain the right to vote or hold office.

Rickie Solinger concluded from her historical research of women's health care that women's rights have often been held hostage by politicians and others with "political agendas hostile to female autonomy and racial equality" (Wake Up Little Susie: Single Pregnancy and Race Before Roe v. Wade, 1992). The criminalization of contraception and abortion, and the widespread U.S. adoption black market that assigned value to babies and punishment to women based on race, were some effects of pre-Roe efforts to control women's reproduction.

At core, Weyrich's anti-abortion, anti-contraceptive and abstinence-only ideology serves as cornerstone of an anticipated male supremacist theocracy. It is the platform upon which the majority of Republican candidates continue to run in 2008. The greatest conceit - that pregnancy is not a health issue and women's lives are expendable - underlies the dual standards of Republican Party pronatalist policy demanding female submission to males who presume the right to hold women hostage to personal beliefs.

On August 29, the Friday before the Republican Convention, members of the Council for National Policy convened in Minneapolis to grant their imprimatur to the vice presidential candidacy of Sarah Palin. Focus on the Family's Tom Minnery described the group's reaction in a Focus on the Family Action video, which has since been removed from their website: "There could not be more excitement based on the little we know about Palin so far," enthused Minnery. Given general longstanding opposition to women in positions of power among CNP members, Minnery was asked whether James Dobson could possibly support a woman for the office. He quoted Dobson: "If it's the right woman, we are ready to vote for her." Dobson has been hoping for some time to find a "Margaret Thatcher" type, noted Minnery.

Outside the obvious, i.e., her anti-gun control and anti-abortion positions, Minnery recited Palin's positives as a conservative candidate: a hocky mom in an intact marriage who "has not rejected her feminine side"; because she and her husband are union members, it was speculated that blue collar voters in important swing states would be attracted; and (improbably) because she is a woman, that she would appeal to Hillary Clinton supporters.

The Council for National Policy (CNP) has remained largely below the radar since its 1981 founding as an umbrella group uniting a network of over 500 members from Congress, the business community and hard-right evangelicals. The press are excluded from their secretive invitation-only strategy meetings, held three times annually.

The group is strongly influenced by the teachings of the late Rousas Rushdoony, a CNP member and patriarch of the reactionary Christian Reconstructionist (Dominionist) movement that has infused the doctrine of conservative churches since the '60s, and seeks Christian dominion over all aspects of society and the world.

When Democrat Mark Udall debated Republican Bob Schaffer in July, he made no effort to refute Schaffer’s distortions surrounding health care reform. In fact, he essentially short-circuited meaningful debate by adopting the nebulous right-wing description of single-payer health care as “government health care,” thus capitulating to Republican framing of the issue.

Just what is government health care? Is it the more than 60 percent of all health care costs that are paid by taxpayers, including subsidies for inflated costs of private insurances? Private insurers skim the cream and game the system for profit, and count on government (taxpayers) to pick up the health care costs of all whose coverage they reject. Does government health care include the 70 percent of our legislators’ health coverage that is funded by taxpayers?

Democrats who facilely echo GOP talking points grossly misrepresent single-payer health care. In fact, contrary to assertions by the right-wing “free market” chorus, only single-risk-pool insurance provides true free choice of private providers, the same as traditional Medicare before Republicans moved to privatize Medicare (at 12 percent higher cost). Private insurance plans limit choice to “in plan” doctors, often requiring change of providers when plans are changed. Only single payer is capable of providing comprehensive, continuous health care benefits and protection against medical bankruptcy.

Our leaders should vigorously protest the abomination of Medicare prescription drug reform that was written by insurance and pharmaceutical lobbies with billions of dollars of taxpayer subsidies and inflated profits to benefit their bottom lines, while prohibiting negotiation of bulk drug prices.

Instead of privatizing Medicare-for-profit, why not improve and expand its coverage for everyone? Traditional Medicare has lower overhead costs – less than 4 percent – whereas private insurances divert 25 percent or more to profits, lobbying, marketing, exhorbitant CEO salaries and wasteful administrative costs. Profit is a perverse incentive for health insurance, which protects its bottom line by reducing benefits and shifting ever-greater costs to consumers.

The insulated political class in Washington, dependent upon corporate money and privy to 70 percent taxpayer-subsidized health coverage, seem out of touch with the U.S. people. Polls by Pew and others have revealed that increasing numbers – 54 to 65 percent – support a national single-payer health care plan. A recent study reported in the Annals of Internal Medicine (3-31-08) that 59 percent of U.S. physicians “support government legislation to establish national health insurance,” an increase of 10 percent since 2002.

Notably, more than 20 federal and state studies since 1990, including the 2007 Lewin Group evaluation in Colorado, have demonstrated that single-payer health insurance is the only reform model that can both save money and provide comprehensive health care benefits for all. The Colorado single-payer proposal and Rep. John Conyers’ national health care bill, HR 676, both deserve serious further study.

We have everything to gain from an honest dialogue about quality-, saftey-centered universal single payer health care, in place of profiteering health insurance gatekeepers.