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By Mike Hall
AFL-CIO Senior Writer

Last year, when Congress passed the Affordable Care Act, it was a “historic milestone on our path toward a more just society,” says AFL-CIO Executive Vice President Arlene Holt Baker, “But we also know that much work is left to be done.”

That work includes moving to a single-payer, universal health care model as called for by the AFL-CIO Convention in 2009 and this week  in the America Health Security Act, introduced by Sen. Bernie Sanders (I-Vt.) and Rep. Jim McDermott (D-Wash.).

Speaking at a Capitol Hill press conference, Holt Baker said:

We in the labor movement have long insisted that health care is a fundamental human right and an important measure of social justice. And for more than 100 years, we have fought for universal health care coverage based on a social insurance model, an approach that has proven to be cost-effective and efficient in countries across the globe and in this country to provide health security for seniors.

Jean Ross, R.N., and co-president of National Nurses United (NNU), says the bill will “create a more just health care system.”

Providing a single standard of high-quality care for all is a priority for registered nurses who have seen their abilities to act as patient advocates made more difficult as for-profit interests control more patient care decisions.

Sanders says the fight for universal health care “is the civil rights battle of our time.”

The legislation establishes a national health care program that requires each participating state to set up and administer comprehensive health care services as an entitlement for all through a progressively financed, single-payer system, as administered by the states. Benefits emphasize primary and preventive care, and free choice of providers. Private health insurance sold by for-profit companies continues in the form of supplemental coverage only. Says McDermott:

If an insurance company’s objective is to make a profit rather than deliver health care, a patient’s best interests may not always be in the forefront of their thinking. Decisions are made by accountants and actuaries, not necessarily on the basis of what’s best for the patient.

The program will be progressively financed, including a surcharge on high-income individuals and a tax on securities and other financial transactions.

“Let’s face it,” says Sanders in a guest column in the Guardian:

until we put patients over profits, our system will not work for ordinary Americans.

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Re-Posted from the AFL-CIO Now Blog

By Leo W. Gerard
International President

Just days ago, America celebrated her birthday with fireworks, spontaneous renditions of the Star Spangled Banner and chants of, “We’re Number One!”

In a crucial area, health care, the chant is untrue. Many of us love the individual doctors who may have saved our lives or the lives of loved ones. But the health care system in this country is not top-ranked.  It’s not even close to number two. Its poor quality and excessive expense are sucking the life out of America. For the health of the nation, both physically and economically, we need a system with a public option – that means a government-sponsored and managed alternative. And we need it now.

First, the issue of ranking. In the year 2000, the last time the World Health Organization stacked up countries’ health systems, the United States came in 37^th, behind the likes of Chile, Morocco, Cyprus, even drug war-torn Colombia, to which the U.S. donates hundreds of millions in foreign aid. The U.S. Centers for Disease Control and Prevention pointed out late last year that the U.S. ranked 29^th in the world for infant mortality in 2004, a statistic that steadily worsened since 1960, when the U.S. ranked 12^th. Twenty-two countries’ rates were below 5 deaths per 1,000 live births. The U.S. rate was 6.78 deaths.

Similarly, the U.S. ranks 42^nd for life expectancy, down from 11^th two decades ago. Contributing to that decline is the parallel drop in Americans covered by health insurance, researchers said. While 46 million Americans lack insurance, Canadians and residents of European Union countries benefit from universal health care.

We are 37^th – Yea! We are 29^th – and falling! We are 42^nd — and dying! These are not the chants of proud Americans. These are not the chants of vibrant Americans. In fact, these are not the chants of Americans who could continue financially supporting this sick system even if they wanted to. And they don’t.

The cost of the American system, with its private health insurance industry in the business of profiting off of illness by limiting care, cutting corners and denying access to those with “pre-existing conditions,” is suffocating the U.S. economy. In this one unenviable area – spending — the U.S. is number one. Health care expenditures are a shocking 16 percent of U.S. gross domestic product (the value of all goods and services produced in a nation in a year), far ahead of the closest competitor. That would be France, where it’s only 11 percent. That’s followed by Switzerland, Germany, Belgium, Canada and Austria, where it ranges from 10.8 down to 10.1 percent. These are all countries that provide national health care.

Looking at it another way, the average expenditure per individual, America remains in the undesirable position of most profligate spender. The average for an American was $7,290 in 2007, the latest year for which comparable statistics were available. But the average for the 30 countries in the Organization of Economic Cooperation and Development was a mere $2,964, with the closest to the U.S. being Norway at $4,763.

Those costs marginalize U.S. manufacturers as they attempt to do right by their American workers while scrambling to compete in international markets. Here’s how Dr. Atul Gawande put it in his June article, “The Cost Conundrum,” in “The New Yorker:” “Spending on doctors, hospitals, drugs, and the like now consumes more than one of every six dollars we earn. The financial burden has damaged the global competitiveness of American businesses and bankrupted millions of families, even those with insurance . . . By a wide margin, the biggest threat to our nation’s balance sheet is the skyrocketing cost of health care. It’s not even close.”

President Obama warned the American Medical Association, which opposes national health care, about exactly the same thing in June when he said this: “If we do not fix our health care system, America may go the way of G.M.” Would those wealthy physicians bail out the government then?

Clearly these costs don’t contribute to quality since U.S. rates of infant mortality and life expectancy are so relatively poor. And they factor large in personal bankruptcies and delay of care as individuals are unable to keep up with medical care’s morbidly obese costs.

A Kaiser Family Foundation poll in February found that 53 percent of Americans cut health care because of cost in the previous year. A quarter reported putting off health care they needed such as doctor’s visits and surgery, and twenty percent said they have not filled a prescription. Another part of the poll explains this: “13 percent say they have used up all or most of their savings trying to pay off high medical bills in the past 12 months, and just as many say their medical debt means they have difficulty paying other bills.  A similar proportion (12%) say they have been contacted by a collection agency, while a smaller share (7%) report being unable to pay for basic necessities like food, heat or housing.”

We are Number One? This is cruel. This is wrong. This must stop.

I know that many Americans view my native land, Canada, not as a country, but as an unofficial 51^st state. But the difference between Canada and the 50 states is that Canada has national health care, thanks to Tommy Douglas, the former premier of Saskatchewan, and a party leader. One huge difference between the American system and Canada’s national health care is the extreme cost of administering private insurance in the U.S. A study published in 2003 in the New England Journal of Medicine showed that administrative costs were $1,059 per person in the U.S. but only $307 per person in Canada. That excessive $752 in administration costs paid in the U.S. for each insured person has only grown larger in the ensuing years. The study concluded: “A large sum might be saved in the United States if administrative costs could be trimmed by implementing a Canadian-style health care system.”

In 2004, the Canadian Broadcasting Company conducted a poll to determine the country’s greatest citizen. People everywhere could vote, for anyone they wanted, so an actor, like Tommy Douglas’ grandson, Kiefer Sutherland, could have won, or a famous singer like Celine Dion or Shania Twain. But Canadians chose a politician — Tommy Douglas, the father of national health care. That’s how we feel about the national health care system in Canada.

Don’t let the Republican Party-of-No stop this. Don’t let big vested interests like the pharmaceutical, insurance, and for-profit hospital corporations keep America down. In poll after poll, Americans have made it clear they want a public option. They want care as good as Canadians get. They’re paying more than twice the price for it. To ensure that America is Number One, Congress better deliver it before the end of August.

By Robert Kuttner
Co-Founder and Co-Editor of The American Prospect

I’m sure I’m not the only reader who noticed the juxtaposition of two front page stories in Sunday’s New York Times dealing with health care. The first article cited a new Times-CBS poll showing that 72 percent of Americans favored a government run health plan comparable to Medicare, which would be available to everyone.

The second reported on a rogue radiologist at a Philadelphia VA hospital who botched 92 prostate procedures.

The right will doubtless go to town on that one, as what we can expect of government-sponsored medicine. I’ll have more to say about the VA in a moment, but first let’s consider the poll findings.

The poll is relevant because Congress will soon decide whether to include the so-called “public option” in the Obama health reform bill. As drafted by three House leaders and unveiled last Wednesday, the 852-page bill would include a government-sponsored, Medicare-like public plan.

Republicans and the health industry have been kicking and screaming that this is socialistic. But the poll suggests that defenders of the public plan have nothing to fear politically, and that Republicans are in danger of getting on the wrong side of a popular issue.

However, that’s only the beginning of the story. The reform package, as drafted by the Obama administration and the House leadership, is dubious legislation even with the inclusion of a public option. Basically, it leaves the two worst aspects of the system intact. First, private insurers will continue to dominate. Second, most people will continue to get their insurance through their employers. Given these two bedrock realities, there is no way that the bill can make serious inroads on cost without cutting back on care. The high cost of the approach is already causing key legislators to back off. The current system wastes huge sums, but because it is so fragmented the money flows to profit opportunities and not to the most cost-effective forms of health care.

Also, as my American Prospect colleague Paul Starr warns, a mixed system with a public option effectively invites the most expensive and hard-to-treat people to opt for the public plan, while private insurers will seek to insure the young and the healthy. This is a familiar problem known as adverse selection. The private insurers will then smugly point out that the public plan is less “efficient,” when in fact it simply will have a more costly population. The only way to avoid this problem is to have everyone in the same universal plan–what’s otherwise known as a single-payer plan.

The public option is a not-very-good second best–because our leading liberal politicians lack the nerve to embrace the one reform that simultaneously solves the problem of cost, quality, and universal inclusion. The policy that dare not speak its name is of course comprehensive national health insurance, or Medicare-for-All. I try to avoid using the term “single payer,” because a technical, policy-wonk phrase not understood by most civilians has become insider shorthand for national health insurance. Let’s call the thing by its rightful name. Medicare-for-All is something regular people understand.

The Times-CBS poll is evidence that this is what more than two Americans in three really want. Most voters have not followed the nuances of how the public option in the Obama plan would compete with private insurance. The poll simply indicates that voters want access to a straight-up, Medicare-style plan to be available to one and all. In past polls, when Times-CBS pollsters ask whether people favor national health insurance, responses generally favor Medicare-for-All by margins of about two-to-one.

In the current debate, liberals find themselves fighting to keep the public option alive, so that some form of efficient, publicly-run health insurance will stay in the mix–but knowing that it is embedded in a reform package that is far more costly and inefficient than it should have been. Instead of validating the common sense and reformist demands of ordinary Americans and identifying the insurance, drug, and corporate elites as the obstacles to real reform, too many of our liberal leaders from President Obama on down hope to co-opt business elites with a convoluted scheme that undermines the efficiencies of a comprehensive and universal system. And just wait until it gets watered down further in order to retain the support of these same elites. A plan that all of these groups would endorse would not be worth having.

So what’s the matter with our politicians? Why are the people so far ahead of their elected leaders on this one? One reason, as usual, is money. The combination of the insurance industry, the drug industry, the American Medical Association, the hospital lobby–all of whom oppose Medicare-for-All–represents a huge amount of political spending. It takes a brave politician to face down all of these industries, even though the people are on the side of real reform. The AMA’s position is especially shameful, since the professional societies that represent most actual physicians favor national health insurance.

The second reason that liberal politicians wimp out on single payer is that the self-styled realists in this debate have decided that Medicare-for-All, even if it’s the first-best system, is too hard politically. But think about it. Has the administration picked up one Republican vote by supporting the present system plus a public option? Hardly. The current House leadership bill, offering a mixed system, with a robust public option, a requirement that employers provide good insurance or pay a tax, and that insurers not discriminate against pre-existing conditions, is just as heavy a political lift as national health insurance–and far inferior policy. So why not just go for the first-best?

The advocates of Medicare-for-All have become something of an embarrassment to the liberals. The White House forum on health reform on March 5th, which boasted a diverse range of viewpoints, including representatives of the Business Roundtable, the health insurance industry, the drug lobby, as well as a broad spectrum of business, labor and Congressional leaders, left advocates of Medicare-for-All banging on the door. None were included, despite requests for invitations.

When Sen. Bernie Sanders recently arranged for five prominent advocates of national health insurance to have a courtesy meeting with Senate Finance Committee Chair Max Baucus, the story was newsworthy because the political elite usually pretends that this viewpoint doesn’t exist, much less that it represents the desires of two Americans in three. The mainstream media have also colluded in the general effort to keep the single-payer option out of the limelight. The organization FAIR recently published an important study in its heroic magazine, “Extra”, titled “Media Blackout on Single-Payer Healthcare.”

Indeed, the Sunday New York Times-CBS poll didn’t even offer Medicare-for-All as a free-standing option. It took the Obama position as the left edge of the debate.

As for that rogue doctor at the Philadelphia veterans’ hospital, quality control is not what it should be throughout our fragmented system. And the oases of public medicine are particularly starved for resources. Yet studies consistently find that on average, the VA does more with less than its private sector competitors. Phil Longman has written the definitive book on the subject, “Best Care Anywhere.” Here is a summary.

In this case, the offending radiologist, Dr. Gary D. Kao, was actually a contract employee and not a VA physician.

Only by having a comprehensive system can we marry quality, cost-effective care, and universal access. One of these days, a national leader will have the nerve to embrace national health insurance and fight for it. Until then, we will keep paying more money for less care, and liberals will defend reforms they themselves scarcely believe in.

***

Robert Kuttner is co-editor of The American Prospect, and senior fellow at Demos. His recent book is “Obama’s Challenge“.

QUESTION:  “The U.S. House and Senate are completing drafts of health care reform legislation. President Barack Obama has said he wants Congress to pass the legislation so he can sign it this fall. What do you believe must be included in that legislation to resolve the health insurance crisis in the U.S.?”

Real Public Option; Choice

The most attractive and beneficial, for the society as a whole, would be the single-pay system that is standard in most of the industrial nations of Europe. The reality, of course, is that Obama himself has already ruled this out as undoable given the historical and political conditions that prevail in the US today.

Having passed on that, the irreducible minimum the American people should insist upon is a public option alternative to the current system that will, in a short time, implode like the so-called free-enterprise system did beginning in 2008. The current system excludes some 45 million who have no health insurance at all. The cost of the current system runs about $2 trillion a year and provides less health care and protection than any of the health systems in Western Europe, Australia and New Zealand, for example. We can only expect the costs to rise and the service in general to deteriorate over the next 5 years.

Obama must see that the public option is on the table and that he holds the feet of the Democrats in Congress to the fire—they either support a public option or they can expect nothing from his office by way of support down the line. The opposition to a public option is entrenched and powerful—Big Pharma, the insurance industry, Rightwing bloggers like Rush, Hannity, O’Reilly, the GOP and the newpaper czar Rupert Murdoch, and people of his ilk.

Obama and the Americam people must see to the creation of an authentic public option. One that allows for a real choice in medical programs.

Dr. Gerald D. McKnight
Frederick, Md.

Disconnect Insurance from Employment

1) Health Insurance should not be tied to employment.

In our society, we expect employees to be fungible. They have to be able to go from job to job as needed. We do not expect employers to be loyal to their employees. If a company has to cut costs, employees are the first to go. Older employees that can be replaced with younger, cheaper employees are a common target for termination.

Having health insurance tied to employment results in people being uninsured when they least can afford insurance. It also creates a problem for older people and people with pre-existing conditions who are terminated. Employers don’t want to hire older individuals or individuals with pre-existing conditions and insurance companies don’t want to insure them.

Having health insurance tied to employment also gives US companies a disadvantage against foreign companies who don’t have to pay for health insurance.

2) Insurers can’t be allowed to avoid individuals with medical conditions and must pay all health costs.

Two-thirds of health care costs in the U.S. are paid for through Medicare and Medicaid. Private insurers are making their money by insuring individuals who need health care the least.

Sixty-one percent of bankruptcies are a result of medical bills. Three-quarters of that 61% of bankruptcies had health insurance. No one should have to pay for health insurance that doesn’t pay all the costs and won’t keep you out of bankruptcy.

3) We need universal health care to avoid the costs of sales commissions and exorbitant executive pay.

James K. McCabe
McCabe & McCabe, Ltd.
Brookfield, Ill.

Health is in the Nation’s Interest

The most important item to include in any health reform legislation is single payer.  For too long private insurers have controlled individual access to health care, which I see as a right, not a privilege; that should not be controlled by corporations.  Millions have no health coverage at all, and thousands lose theirs every day by losing their jobs in this recession.  Does anyone ever ask why health care should be tied to employment?  Consider that a healthy society is also in the nation’s interests, not only the individual’s.

Private insurers routinely deny care for so-called “pre-existing conditions,” even those only marginally related to a current illness, and they too often deny life-saving procedures.  They raise premiums unconscionably when their insured become sick and try to use the medical benefits for which they have been paying all along.  And they do it in the name of profit!  Why does profit control an individual’s health care?

Further, why don’t private insurers cover more preventive care?  Money would be saved in the long run, not to mention how much improved patient outcomes would be.  But CEOs get credit for short-term profits earned during their tenure, not long-term profits, regardless of the impact on patients.

As an employee, I was covered by private insurance and have witnessed such problems all too often.  Government programs don’t require profit, and I’m hoping we won’t be “Harry and Louise’d” out of single payer.  I have also been covered by military medical care and Medicare, both government-run programs, and have never had a bureaucrat get between me and my doctors.  But private insurers intervene in a doctor’s care every day of the week to control their costs and ensure a profit.  In a word, it’s sickening!  Private insurers need some competition to keep them in check.

Americans are unhealthy, live shorter lives and have a higher rate of infant mortality, and we pay far more for our health care than Europeans, who suffer no loss of the individual liberties we have.  In fact, their freedom is enhanced by the “portability” of their single-payer health care, independent of their employment.

The insurance companies are, shall I say, “deathly” afraid of single payer, and they will fight it.  We must fight back by holding our elected representatives accountable.  Senator Durbin said the banks own the Senate, but we should be suspicious of the insurance and pharmaceutical companies also owning it twice over.

Gloria Aukland,
Mesa, Ariz.

Appalling to Exclude Single-payer

My opinion is that we in this country desperately need a health plan like the single-payer plan which has been working for years in most of Europe and Canada. It is outrageous that this plan is not ”on the table” with the 15 other plans in Congress.

The “consumer co-op compromise” that the Senate is discussing at present only serves to kill the full public health insurance option.

For so long, the nation has been strongly influenced by both the insurance companies and the pharmaceutical companies. They have lied to us about what can happen under a single-payer plan, claiming it will mean we can’t choose our own doctors and will have to wait for long periods of time to get any medical help. This seems to be nonsense.  I have talked with many people in England and in Canada who say it is not true. They are very grateful for their socialized health plans and feel very sorry for us in the U.S. with the situation we are in.

If people are frightened by “socialized” programs, they might think again about our socialized libraries, socialized schools for our children, socialized parks across the country, our socialized Medicare program for those with disabilities and the elderly,  etc., etc. We need a plan, such as single-payer, which will cover the millions who have nothing and live in dread of being ill.  Those who can afford to pay and are happy with paying insurance companies, can continue on that road.

We also need to change the use of money that special interests and lobbyists use to “pay off” our Congress people. This is disgraceful.

Dallas Cline
St. Johnsbury, Vt.

Let Us Care for Each Other

Our way of seeking health care as a system should be the same as our conception of firefighting.  Although the days of bucket brigades (in which everyone in the community carried water to put out a fire) are gone, and firefighting is now done by professionals hired for the job, the responsibility for providing a system to fight fires still must be shouldered by every able member of the community.  And the benefits of the system are shared by everyone equally, regardless of taxpaying status.

So should it be with our medical needs.  We should provide for each other, through our representative government, everything we need in the way of health care.  Nothing should be left out except elective procedures such as cosmetic surgery not required by a disfiguring accident.  The fact that we have the ability to do this and yet must debate whether we should do this shows what fools we are.  Let us be wise, and say, “First we must pay for this, our health care, then we can allow our military to purchase hammers at a price of $750 per and nails for a dollar apiece if that is our pleasure.”

Aron Laub
Law Office of Aron Laub
Woodland Hills, Calif.

Public Option Essential

Legislation must include a public option, completely handled by the government. This option must include full ability to negotiate prices and services. Any bill that does not contain this provision will not fix the problem. The proposed comprises are either plans that will put more money in the insurance companies’ pockets or plans that will neither reduce costs nor provide affordable health care for everyone. It is time for our president and our Congress to decide whether they want a solution that will serve the American people or a bill that will continue to enrich the insurance companies. I have two children facing a world where they will either not have health insurance or will have to pay a huge premium for a bare-bones plan that only covers catastrophic events. As a union officer, I would love to be able to not spend all our time negotiating on new contracts fighting about this issue. Think of the things we could accomplish in the areas of pensions and safety if we could just say, “Keep your plan, boss! The rank and file is going to take the public option!”

Kristjan Dye
Prudhoe Bay, Ala.

Care for All Now

Universal public single-payer health care coverage for every man, woman and child in the United States and its territories, now. The tyranny of actuarial tables and the completely unregulated accumulation of vast wealth based on statistical probabilities and clever investments has come to its inevitable greed-fueled implosion.

It should never have been acceptable to the American people to start with; had anyone ever put forth the proposition that a third of the people in our nation should go without health care so that a tiny sliver of the population could have private jets, no one would have agreed – but they never asked us.

Mark O’Brien
St. Paul, Minnesota

National Health Care System Needed

We don’t need health care reform any more than we needed welfare reform in 1994. We need a real health care system run by the government and financed with taxes like Medicare. We are the only industrialized country without national health care, yet we spend twice as much as other countries for half the care. Our money goes to profits for the medical industry rather than health care and prevention. Congress listens to paid lobbyists and takes major campaign funds from the medical industry. Then, it parrots their arguments to justify doing nothing.

Economic collapse has not changed our spendthrift ways. We spend our money on war, weapons, and corporate excess in the name of national security. The working class pays for these extravagances with both blood and money, and gets shafted in return. We must insist on our rights to health, housing, education, food, and energy. National security and public safety do not exist without them!

Some developing nations and third world countries have refused to cut programs that protect workers, retirees and children. To pay for their investments in the citizenry they are levying taxes on large corporations and the wealthy and eliminating programs that give tax breaks to private sector endeavors. The Scandinavian countries and Germany are also maintaining their social networks while reining in other expenses.

In the 60s, President Johnson was accused of buying guns and butter, without being able to afford both. Our 21^st Century government has decided to only buy guns: To hell with the butter! The truly sad thing is that the amount we spend on the military and weapons is far more then we would need to spend on domestic programs and does nothing to improve our standard of living

Carol R. Campbell
Keaau, Hawaii

Why Not Single-payer?

Why, oh why isn’t single-payer national health on the table? Why does the government insist on protecting and preserving the health insurance industry which contributes absolutely nothing to health care while adding to cost and interfering with health care delivery? OK, if Obama and the politicians can’t or won’t deliver single-payer, then there must at least be a strong, comprehensive public, government program as an alternative to the private insurers.

David Arnow
Brooklyn, N.Y.

Stop Talking, Start Covering

The only solid answer to the health-care mess in the United States is to stop all the gumming that’s going on and go full-speed ahead for a unified single-payer program that emulates Canada and provides coverage for all citizens.

The health-insurance and big pharma lobbies should be run over with a steamroller, so we can and eliminate the billions of funds wasted on the for-profit “insurance” schemes whose primary business is to find ways to deny payment for needed medical expenses. A tight leash must be placed around the pharmaceutical industry’s neck to ban those “ask your doctor” advertisements, and drug prices should be negotiated, as they are in Canada, by a single-payer government program that spreads the medical risks by covering everyone, no exceptions, no problem with “pre-existing conditions.”

This is not socialism. This is to acknowledge that health care is as much as right as public education and police and fire protection in a civilized society.

J. Tyler Resch
North Bennington, Vt.

No Exclusion for Illness

Since it looks they are not going to the single-payer, a must is waiver of pre-existing conditions, caps or schedule of payment for doctors, hospitals, etc.  An MRI cannot cost $2,000 in one place and the same test $5,000 elsewhere.  Preventive medicine and nutritional advice are also very important. That will reduce costs in the long run.

Lourdes C. Garcia
Simi Valley, Calif.

Single-payer System Needed

The USA needs strong single-payer health care.

Kathryn Wood
Bend, Ore

Call to Support Single-payer

Single-payer is the only option that meets the criteria that President Obama has set forth.

There is a single-payer bill before the House.  It is H.R. 676, sponsored by Rep. John Conyers.  It currently has 79 co-sponsors.  It needs 280 to pass.  Can you get your Representative to sign-on?

In the Senate there is S. 703.  The major problem is a Republican filibuster, meaning 60 instead of 51 votes are needed.  In addition, some of the Democrats in a position of authority, like Sen. Baucus, oppose it.  The great mass of ordinary people need to make their weight felt to overcome the overwhelming financial influence of the insurance companies.

Roger Mills
Stockbridge, Ga.

Cut the Paperwork

For reform to save money, it’s got to get doctors off piece work.  See http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande.

Bill Brown
Chapel Hill, N.C.

Easy Answer

Easy answer: We must make sure that the health care that we, the citizens, are paying for doesn’t go to an illegal population. Are we required to provide social services to the world?

John BuPoint
Pleasant, N.J.

Reform to Solve Debt Crisis

Health care reform should be passed in the fall to prepare America to solve its ever-burgeoning long-term debt crisis. However, such legislation must include a timetable of a priority agenda that sets it in motion only after recovery of the economy.

The fact is if we pass a national health care plan, it can actually lower the corporations’ costs of benefits to their employees and make American companies more cost effective against foreign companies that avoid such costs.

Any new health care legislation has to be planned for implementation over years and must be paid for by having a healthy economy restored before actual implementation. Such benefits cannot be paid for by debt but must be paid for in new ways to dream. This may include new taxes on fast food, soft drinks, corn and corn products, and carbohydrates that add to obesity and often cause health problems.

In closing, only unions working with corporations and professionals can make this happen and look out for families and people in need, and that is why Unions Matter!

Joe Janos
Aliquippa, Pa.

Care Same as Congress’

We should have the same health care as our elected representatives. Our president, senators and congress people have a single-payer system that meets everyday medical needs. If these representatives won’t provide the same for us, they should give up their health care.

Alvy L. King
Austin, Texax

Single-payer or Public Option

I am writing about health care reform because I believe strongly that we need single-payer health care, and I would urge its adoption. If not that, then we should certainly have a government-backed plan to compete with private insurers.

Philip Lichtenberg
Kennett Square, Pa.

Eliminate the Profit Motive

My opinion is that we should have a national health insurance plan with premiums paid to a government program similar to Medicare.  The premiums should be able to pay the providers a reasonable amount for the services provided, and the insured should be able to choose the providers that best serve them. We need to eliminate the profit motive.

William R. McDonald
Long Beach, Calif.

Eliminate Health Industry

Single-payer health care: Not some sort of coercive “national health insurance.” An effort to address the health care crisis in this country is not worth the spent political capital if it stops anywhere short of single-payer.  The point is not to reform the health insurance industry.  The point is to eliminate it!

Ric Vrana
TriMet Capital Project Planning
Portland, Ore.

Affordable Health Care for All

There must be affordable health care for everyone.  This protects hospitals and physicians as well as their patients.  Anything else is unthinkable.

Nancy Kay Kennedy
Belding, Michigan

Single-payer Best

Single-payer is best.  At the very least a public option is necessary.  Also there are tons of people not covered by Medicaid who have no money and no job.  These people need to be covered free.

Pay for the public option by a pay roll tax on those with incomes. Let people keep their private insurance (if they still want it) and allow for income tax deductions of all premiums and co-pays etc.

Pat Flierl
Fresno, Calif.

Eliminate the Bureaucrat

Get rid of the middle man, the bureaucrat. With the HMO, a patient needs to make an unnecessary visit to the primary care doctor to get an authorization for a specialist. I have a pimple or a boil or a cyst on the back of my neck. I have had this before when I had an old fashioned plan. I called the dermatologist, got an appointment within three days and went in; he looked at it, and said what needed to be done. The office visit and the time the doctor spent in doing the procedure was about 20 minutes, and problem was solved. (There was some wait time when the nurse injected the anesthetic and we waited for it to work.)

Now I need to call my primary care doctor for an appointment, wait a week get one, spend 45 minutes in her waiting room. Then she spends 3 1/2 minutes looking at my swollen bump. She records into her recorder or writes on my chart and instructs the receptionist to get an authorization and forward it to the dermatologist.

I can call him two days later. They have an answering system. But I’ll have to wait the rest of the afternoon for someone to call me back. They look for the authorization, find it, look for an open time, no not this week, next OK.

Time spent in this office waiting is 45 minutes. He looks at it. By now it is much worse. He says he needs to get authorization to deal with it. And it needs to be done in the hospital. So far 10 hours of accumulated doctor and staff time in doctors’ offices and at the bottleneck of the authorizer offices have been spent on ths. And I still have my painful THING. The system is broken.

Betty Winkler
Corona del Mar, Calif.

Tax Write-off for Health Care

Concerning health care, I oppose government control of this. With the shekels come the shackles. I favor letting all Americans take a 100% tax write-off for all health care expenses they occur, which are not covered by a health insurance plan they might have.

Lawrence K. Marsh
Gaithersburg, Md.

Erase Private Companies

I feel that until the private insurance companies are out of the picture, we don’t have a chance of any kind of fair health care for all.  They’ve effectively destroyed the health care system.

Sally Rosoff
Laguna Woods, Calif.

Diminish Role of Corporations

What we’re talking about as a nation isn’t health care reform, it is health finance reform, and we can’t have any significant reform to the way we finance health care in this country unless we diminish the role of insurance corporations in the delivery of health care. Single-payer is the goal.

Bill Anderson
Silver Spring, Md.

Reform a Sham

What needs to be included in legislation to resolve the health crisis in the U.S. has been excluded; a single-payer universal health care plan.  The current exercise in Congress is a sham and nothing will come of it.  To get health care providers to participate in drafting “reform health care legislation,” President Obama and Congressional leaders had to agree not to even consider a single-payer concept.

As a result, the very same health care executives who have made fortunes while ruining our health care system will dictate the “reform” plan.  The current charade will not improve our health care system or reduce its cost.  Only if and when labor and its allies finally realize that the bosses own both major parties, and they don’t give a damn about working families will we start down the long road to economic justice and health care for all.

Wake up brothers and sisters and cut the cord to sell-out politicians in both major parties, or our children and grandchildren will be stuck in minimum wage jobs and no health care coverage.  We need our own party.

Jan Pierce
Quaker City, Ohio

Single-payer Will Control Costs

In my opinion, a single-payer public option must be included in any meaningful health care reform legislation. A single-payer/public plan is the only way to control costs and provide the competition that the private medical industry needs to bring down its predatory cost structure. This will provide a tremendous saving for American citizens, business, and society at large.

James G. Fordham
Coburn, Pa.

Health Care a Moral Right

A single-payer plan, such as in Canada, or a public plan, must be included. Health care should be a moral right, not a “for profit business.”

The evidence that this is true is in that I know people who have been bankrupted by the cost of caring for a loved one with an unexpected medical condition.

Marty Honig
Arvada, Colo.

Control the Costs!

Debate rages over the virtues of private vs. public health care and vice-versa, but the one issue left uncontrolled by current private and public plans (Medicaid, Medicare, and private insurers) is runaway health services inflation. Bring the rate of (health services) price increase in line with that of the overall consumer price index and the other problems will become much easier to fix. I am listening but am not yet convinced that any of the changes being proposed are going to reign in the inflation.

Extend Medicare to All

I think the most important component of any health care reform effort is to include single-payer as an option. Single-payer is the most efficient way to deliver health care in that it cuts out the obscene profits going to health insurance CEOs. The money saved by taking out the profit motive would probably be enough to pay for the 50 million who are uninsured. Instead of wasting a lot of time with trying to make the lobbyists happy, Congress ought to just pass the bill currently before it that extends Medicare to every American.

Dan Zurosky
Lexington, S.C.

Single-payer Way To Go

Single-payer appears the way to go, but a public option is an alternative more acceptable to the lobbyists that run this country.

Jonathan Macy
Boston MA

Government-run Quality Care

There is really just one major reform required – provide an option that doesn’t involve private insurance.  To see the reason why, you merely must consider what the insurance industry extracts from the health care dollar (advertising, CEO bonuses, commissions, salaries, contributions to legislators designed to discourage real change, enormous amounts of paperwork, filing, storage of records, efforts to coordinate benefits, and presently efforts to exclude patients, limit coverage, question doctors’ medical decisions about optimum treatment plans, and lawsuits to contest costly adverse – from their  perspective – decisions of doctors, patients, and hospitals) compared to what the industry contributes to health care – nothing, zilch!

Those who like the current system should be able to continue in it.  Let the insurance bureaucrats decide what procedures are available, restrict coverage, determine the dollars that are paid for all of the activities mentioned above for those who are pleased with the present system.  But we must have a government-run option.  This is the only way to get a handle on what quality care should cost and make it available to all who want it.

Frank Stewart
Windsor, Conn.

Universal Public Coverage

Health care reform must include: Universal public coverage of inpatient and outpatient care to preserve and restore function and comfort. Included must be:

• prescription drugs
• acupuncture and chiropractic treatment
• eye care
• dentistry

Utilization and prioritization should be determined by doctors on the basis of patients’ needs, not by cost accountants.

Income taxes should be graduated up to the level prevailing in the 1950′s to fund health care.

Limits such as the Medicare limit imposed on hospital days per lifetime for the treatment of mental illness should be removed.

June Forbes
Davis, Calif.

Replace Fragmented System

There already is a health care bill in Congress. It’s Sen. Conyer’s H.R. 676, the U.S. National Health Insurance Act, which has more than 70 co-sponsors. It is universal, affordable health insurance. It allows portability if someone is unemployed or changes jobs. Because everyone is covered, it spreads the risk, so the cost per person is reasonable and no one entity is stuck with the cost of coverage of only the oldest and sickest, as Medicare is now.

By removing the financial burden on employers, it allows them to compete with companies the rest of the industrialized world. Because it is single-payer, not for-profit, it diverts the more than 30 percent now going to enrich private insurance corporations, to doctors, nurses and hospitals who provide actual health care. It replaces our fragmented, dysfunctional system with one that works and will go a long way in boosting our financial health as well.

Elizabeth Sheppard
Longview, Wash.

Health Care for All

Health care for all!  Single-payer deserves our support.  I have a “government” health care plan.  I thought it wasn’t that good until I found out what others cost and what they (don’t) offer.  I stopped my complaints–fast.

All the Senators and Congressmen making a big fuss over how lousy a government plan will be also have a government-run health plan.  I don’t hear any of them telling us about how they have rejected the government plans and buy their health care on the “open market.”

On the other hand, they say that the private sector will not be able to compete with a government plan.  Make up your mind folks–either it is lousy or it will attract so many people making a choice to join the government plan that the privates will not be able to compete.

Renee Toback
Yonkers, NY

Health Care as Human Right

The only health care plan that would guarantee health care for all as a human right rather
than as a means of profiteering off others’ misery would be a single-payer health plan like most industrial countries and even some undeveloped ones have. Shame on us for allowing this disastrous state of affairs to flourish!

Paul Bennett
New York, N.Y.

Three Elements Crucial

Whatever comes from the Congress on reforming health care must contain three elements. First, every single person in the United States is covered. Opting anyone out means the rest of us pay for them. If it’s paid by taxes, individuals, employers or whatever, covering everyone is essential. Covering the poor can be the obligation of society. Second, the billing system for payment needs to be on one form. When a patient walks through the door, the health care provider knows who to bill and how much. Third, all drugs must be provided at a price negotiated for the nation as a whole. Prescriptions must be paid for by the insurance carrier.

If the for-profit insurance companies can compete on this basis-good for them. If not, good-bye. Health care providers need not check with anyone prior to treating a patient except for elective care. The definition of elective care is anything not listed as essential to the health of the patient and strictly regulated. Any insurance company will have 60 days to pay claims in full.

Harold Abbe
Camas, Wash.

Three Critical Components

Three things are critical:

Group health insurance must be eliminated.  This will eliminate the very real incentive to discriminate in hiring based on age, since average group age is a well established factor in establishing group rates.  It would allow consumers to “shop” for the best insurance perhaps using money directly paid by employers.

Hospitals receiving any federal funding must accept all government-approved insurances not just cozy deals with favorite insurers.  AARP (Aetna) health insurance, and other major alternatives, are not accepted at a local major hospital effectively driving older, cost conscious citizens, to the independent hospitals; good for their death statistics, good for their grants, bad for older Americans who are thereby discriminated against.

The plan must allow patients to have a knowledge of the costs and effectiveness of treatment options and share in the cost savings of choosing the more economic and additional cost of the more expensive but potentially more effective.  The “free” (knowledgeable consumer) market will then result in improved average care at lower average cost; no other approach can achieve that goal.  As it is, the doctor who operates mainly in fear of attorneys and insurance companies, makes all decisions essentially without regard to cost. Give the doctor and patient a financially safe (known and predictable outcomes based on data) place to practice, knowledge of the facts, a significant financial stake in the decision, and market forces can do the rest.  The financial share should be income-based but never go to zero and never consume more than annual income.

David A. Crosbie
Pittsburgh, Pa.

Single-payer Cheaper

That’s Easy! Throw the whole bunch of them out and craft a new one. Actually, John Conyers, HR 676 is a good start. Comprehensive, publicly funded, privately delivered, single-payer health care for all. We need health care, not healthy insurance profits. If our legislators ever get around to doing the math, they will probably be able to balance the budget with the savings. If we quit waging war with the world, we could probably provide health care for everyone on the planet with the savings.

If businesses would do the math, they would save their companies enough money to hire more staff. If state legislators would do the math, they wouldn’t have to lay off teachers.

Those legislators who don’t like single-payer can go out and buy their own health insurance instead of having it paid with our tax dollars. I wonder if greedy would be considered a pre-condition.

Susan K. Baritell
Petaluma, Calif.

Only One Option

Universal single-payer is the only feasible option.

For-profit health insurance must be stopped.  People go bankrupt every day because of medical expenses even when they have insurance.  No other industrialized nation in the world has a system as messy as ours.

Doris Vician
Albuquerque, N.M.

Don’t Recycle Phony

President Obama’s health care “reform” plan is complete bunk.  All he is doing is recycling a bunch of phony window dressing made to look like “reform.” How sad.

What we need is simple:  Universal, single-payer health care in the US of A.  Anything else is just profit protection for some of the greediest, self interested corporations there are.

Michael J. Germain
Apple Valley, Minn.

Enhance Medicare

A public single-payer system is needed. Enhanced Medicare would eliminate the duplication and waste associated with private, for profit health care insurance. Excessive drug company, hospital and doctors’ profits can be reduced. Folks must maintain the right to select their health care providers. Providers will be paid by insurance premiums from employees and employers, and from asset taxes on the obscene wealth of the very wealthy collected by the U.S. government.  Increased taxes on tobacco, alcohol and gambling products will reduce consumption and help offset the costs and harm done to users.

Unions must unite and push for a public, single-payer health care system – an enhanced Medicare system that is as good as or better than what other western industrialized workers and citizens enjoy.

The U.S. needs good health care services at the cheapest price. Usual medical services provided by doctors, hospitals, drugs and other therapies must be included. Keep folks as healthy as possible. Improve workplace health and safety. Too many workers suffer from an unhealthy work environment; union health and safety committees can provide lists of harmful agents and dangerous work sites. Enable citizens to control their lives with end of life directives. Pay providers to keep citizens healthy; to reduce the incidence of injuries, accidents and illness.

Establish worksite and community wellness programs to encourage folks to live well; eat healthy, exercise, avoid unhealthy behaviors, lower stress to enjoy life.

Bill Weiss
Morganton, W.Va.

Easy – Single-payer

Health Care Reform  –  it’s easy: Single-payer, so that we can recoup the more than $300 billion the insurance industry sucks up in administrative costs and profits and apply it to pay for health care for all.

I prefer the French model but would be content to see Canada’s model here.

Frank Cannonito
Irvine, Calif.

Price Controls Essential

Price controls for insurance policies: I understand that some versions of the plan call for subsidizing low-income people so that they can buy health insurance.  That is well-meaning, but does nothing to stop the rise in costs; it merely transfers them, in some cases, to taxpayers, i.e. the government.  The people most responsible for spiraling costs in my opinion, the health-insurance corporations, will not be made to be accountable. That’s billions of dollars to keep rich people rich. It does nothing to enhance our health. I am a cancer survivor, and if I needed to buy a policy on the market today, it would cost more than my husband and I make together. Protection for people in those cases must precede any mandatory purchase plan.  We’d be bankrupt and homeless. That isn’t a unique situation.  Single-payer is obviously the way to go, but right now there’s too much opposition, well-compensated by the  health-insurance industry.

Preventive/health maintenance:  Costs less to keep people healthy than to intervene once they are very ill.  It’s obvious but not glamorous–or profitable.

Cut loose big pharma:  there are several good sources for information on how the drug companies manipulate, cheat, and fabricate ailments, and how they compare new (more expensive) drugs to placebos rather than to older, cheaper, usually less dangerous drugs.  At the very least, mandate that people don’t pay top dollar for their drugs.

Don’t let the religious-fanatic wing decide what services are offered:
reproductive-health issues are not negotiable. We are not Saudi Arabia; we do not have ayatollahs.  Science, not any religion, should be the basis for health decisions.  Let’s hang onto that great old Constitution!

Mary Lou Carter
Endicott, N.Y.

Competing Government Plan Needed

With respect to health care reform legislation: What must be included in that legislation to resolve the health insurance crisis in the U.S. is a provision for government health care insurance.  It may be necessary to tax health insurance benefits to pay for a government health care plan, but we will never get health care coverage for all U.S. citizens unless the government has a competing plan.  The insurance industry, the American Medical Association (AMA), a large majority of the medical workers who call themselves doctors, and big pharma have turned health care into a profit system that competes not on the basis of the quality of health care but solely on the basis of the profit motive.

Edward L. Osowski
LaGrange Park, Ill.

Best Care, Lowest Price – Single-payer

Fifteen thousand physicians have agreed that a single-payer, national health care system would provide the best care at the lowest price for all Americans. In California this proposal has been examined and passed the legislature twice, only to be vetoed by our insurance-loving governor. If we have a public insurance option, the insurance companies will reject all the sick people, who will then go for the option. Burdened by a primarily seriously ill group, the cost will rise. Universal health insurance will cover everyone, sick and healthy alike, thus spreading the pain and enabling the agency to bargain with the pharmaceutical companies and other health vendors.

No one should make a profit from the suffering of sick people, or drive the sick into bankruptcy.

Peter G Cohen
Santa Barbara, Calif.

Expand Medicare for All

As a participant in Medicare A and B (but not the prescription drug thing), I want to see Medicare continued and expanded so that all can participate.  But procedures need to be changed so that doctors are motivated to make decisions based solely on what is best for the patient and not on economic considerations.  For example, malpractice suits must be handled differently, and doctors must be discouraged from ordering marginally useful tests and doing unnecessary surgery.

Ella Brown
St. Louis, Mo,

By David Sirota
Author of “The Uprising: An Unauthorized Tour of the Populists Revolt” 

The most-stunning and least-reported news about President Obama’s press conference with health-industry executives this week wasn’t those executives’ willingness to negotiate with a Democrat. It was that Democrat’s eagerness to involve those executives in a discussion about health-care reform even as they revealed their previous plans to pilfer $2 trillion from Americans.

That was the little-noticed message from the made-for-TV spectacle administration officials called a health-care “game changer”: In saying they can voluntarily slash $200 billion a year off the country’s medical bills over the next decade and still preserve their profits, health-care companies implicitly acknowledged they were plotting to fleece consumers, and have been fleecing them for years. With that acknowledgment came the tacit admission that the industry’s business is based not on respectable returns, but on grotesque profiteering and waste – the kind that can give up $2 trillion and still guarantee huge margins.

Chief among the profiteers at the White House event were insurance companies, which have raised premiums by 119 percent since 1999, and one obvious question is why – why would Obama engage those particular thieves?

It’s a difficult query to answer, because Obama is a health-care mystery, struggling to muster consistent positions on the issue.

Listening to a 2003 Obama speech, it’s hard to believe he has become such an enigma. Back then, he declared himself “a proponent of a single-payer universal health-care program” – i.e., one eliminating private insurers and their overhead costs by having government finance health care. Obama’s position was as controversial then as today – which is to say, controversial among political elites, but not among the general public. ABC’s 2003 poll showed almost two-thirds of Americans desiring a single-payer system “run by the government and financed by taxpayers,” just like CBS’s 2009 poll shows roughly the same percentage today.

In that speech six years ago, Obama said the only reason single-payer proponents should tolerate delay is “because first we have to take back the White House, we have to take back the Senate, and we have to take back the House.”

This might explain why when Illinois contemplated a 2004 health-care proposal raising insurance lobbyists’ “fears that it would result in a single-payer system,” those lobbyists “found a sympathetic ear in Obama, who amended (read: gutted) the bill more to their liking,” according to The Boston Globe. Maybe Obama didn’t think single-payer was achievable without a Democratic Washington. And when in a 2006 interview he told me he was “not convinced that (single payer) is the best way to achieve universal health care,” perhaps he was following the same rationale, considering his insistence that he must “take into account what is possible.”

Of course, even as a senator aiming for the “possible” in a Republican Congress, Obama promised to never “shy away from a debate about single payer.” And after the 2008 election fulfilled his single-payer precondition of Democratic dominance, it was only logical to expect him to initiate that debate.

That’s why the White House’s current posture is so puzzling. As The Associated Press reports, Obama aides are trying to squelch any single-payer discussion, deploying their health-care point-person, Sen. Max Baucus, D-Mont., to announce that “everything is on the table with the single exception of single-payer.”

So it’s back to why – why Obama’s insurance-industry-coddling inconsistency? Is it a pol’s payback for campaign cash? Is it an overly cautious lawmaker’s paralysis? Is it a conciliator’s desire to appease powerful interests? Or is it something else?

For a president who spends so much time on camera answering questions, these have become the biggest unanswered questions of all.

***

 David Sirota is a fellow at the Campaign for America’s Future. Find his blog at OpenLeft.com or e-mail him at ds@davidsirota.com