We have seen the enemy...

I love Barbara Ehrenreich's style. She calls it the way she sees it.

We Have Seen the Enemy -- And Surrendered

Bow your heads and raise the white flags. After facing down the Third Reich, the Japanese Empire, the U.S.S.R., Manuel Noriega and Saddam Hussein, the United States has met an enemy it dares not confront — the American private health insurance industry.

With the courageous exception of Dennis Kucinich, the Democratic candidates have all rolled out health “reform” plans that represent total, Chamberlain-like, appeasement. Edwards and Obama propose universal health insurance plans that would in no way ease the death grip of Aetna, Unicare, MetLife, and the rest of the evil-doers. Clinton — why are we not surprised? — has gone even further, borrowing the Republican idea of actually feeding the private insurers by making it mandatory to buy their product. Will I be arrested if I resist paying $10,000 a year for a private policy laden with killer co-pays and deductibles?

It’s not only the Democratic candidates who are capitulating. The surrender-buzz is everywhere. I heard it from a notable liberal political scientist on a panel in August: We can’t just leap to a single payer system, he said in so many words, because it would be too disruptive, given the size of the private health insurance industry. Then I heard it yesterday from a Chicago woman who leads a nonprofit agency serving the poor: How can we go to a Canadian-style system when the private industry has gotten so “big”? [...]

How can we not?

Think of the damage. An estimated 18,000 Americans die every year because they can’t afford or can’t qualify for health insurance. That’s the 9/11 carnage multiplied by three — every year. Not to mention all the people who are stuck in jobs they hate because they don’t dare lose their current insurance.

Saddam Hussein never killed 18,000 Americans or anything close; nor did the U.S.S.R. Yet we faced down those “enemies” with huge patriotic bluster, vast military expenditures, and, in the case of Saddam, armed intervention. So why does the U.S. soil its pants and cower in fear when confronted with the insurance industry?

That's a question 89.6 million Americans who found themselves uninsured at some point during 2006-2007 would like to have answered too.

Insurance industry to Hillary: Thanks

Yesterday, I had some serious reservations about Hillary's health care plan because it seemed to embrace the private insurance industry a little too much for my liking, but I was willing to give it a chance until I read what other people had to say. My first impression turned out to be right though, especially after reading this blurb at First Read:

But forget the poll, this positive review from the New York Times’ David Brooks is probably the campaign's favorite clip today. "Hillary Clinton’s health care plan is a huge step forward from 1993. It’s better than the G.O.P. candidates’ plans (which don’t exist)."

If GOP mouthpiece Brooks likes the plan, that means it serves the interests of the insurance industry and not the public. FireDogLake had the same opinion and calls it Hillary's Health Care Sham.

For you to proclaim that your plan provides, “Universal Health Care” is a decided misnomer. “Universal Health Insurance” might be more like it. [...]

Senator, your plan is basically a national version of Republican Mitt Romney’s “Universal Health Care” plan for Massachusetts, which has still left thousands in that state uninsured and even more struggling to make the payments on their new policies, which they are now required to have by law, but which may not pay them one thin dime should they actually become sick or hurt. [...]

Is there anybody here who believes that this plan wasn’t conceived and dictated to Senator Clinton by passels of high-end lobbyists for the insurance industry?

John Nichols believes the plan was defined exactly according to the needs of the insurance industry.

The Clinton plan maintains the current system of for-profit, insurance-industry defined health care delivery. The only real change is that, in return for minimal requirements regarding coverage of those with preexisting conditions, the government would pump hundreds of billions in federal dollars into the accounts of some of the country’s wealthiest corporations. The plan’s tax credit scheme would buy some more coverage for low-income families, which is good, but it would do so at a cost so immense that, ultimately, Clinton’s plan will be as tough a sell as the failed 1993 “Hillarycare” proposal.

And Physician's for a National Health Program have this to say about Hillary's tax credits:

Further, the administrative complexities of refundable tax credits and means-tested premium caps would still leave many without coverage. Coverage will never be universal unless it is truly automatic for everyone.

If we are going to use the tax system to pay for health care anyway then why should we waste funds on the profoundly inefficient system of segregated private health plans? A universal risk pool that is equitably funded through the tax system is the most efficient and least expensive method of ensuring comprehensive coverage for everyone.

Nichols echoes PNHP too:

Despite what Mitt Romney says, Clinton and the Democrats would have a far easier time selling “European-style socialized medicine” that what the senator from New York is peddling. And that does not even take into account the potential appeal of a uniquely American single-payer system that might intelligently combine the necessary efficiency of a publicly-funded and defined payment program for covering costs with the appealing prospect of allowing Americans to choose their own basic plans and doctors.

Sorry, Hillary, but I also prefer a single-payer plan, along with a majority of other Americans based on this latest poll from CBS:

Americans were also asked to choose between keeping the current health care system, with insurance provided by private employers and some people uninsured, and a government-run system that provided universal coverage. Fifty-five percent said they preferred the government-run system, while 29 percent said they preferred the current system. This is an increase in support for the government-run system, which was favored by 47 percent of Americans in February. [emphasis added]

Fifty-five percent favor a government-run system, yet Dennis Kucinich is the only presidential candidate promoting a single-payer health plan. That tells us the others care more about appeasing the insurance industry and lobbyists than they do the uninsured.

Government can be a force for good

As we consider the fruits of our labor this weekend, most of us will be discussing the growing number of working people without health care. By and large, Americans feel insurance companies are the problem, and a majority of us think the government should provide health insurance for all of us - even if it means raising our taxes.

Canada's health system is often used as an example of the kind of plan we should emulate. Is this a good idea? One Canadian businessman thinks so.

Canadian care costs less, insures all citizens and could help cut U.S. poverty, crime rates

By David Karwacki
The Salt Lake Tribune
08/10/2007

(Editor, Salt Lake Tribune: The writer is addressing the question, “Should the U.S. use Canada as its model for health-care reform?”)

SASKATOON, Saskatchewan - Americans set their sights admirably high by seeking a Jeffersonian guarantee of life, liberty and the pursuit of happiness.

Advances in medical science and technology, especially diagnostics and pharmaceuticals, can certainly help them achieve those goals - if they can afford them. Many millions, unfortunately, find their life, liberty and happiness threatened because of illness and a lack of access to even basic, let alone advanced, medical care.

Access to universal medical coverage was introduced in my province of Saskatchewan in 1962 and was adopted by the federal government to apply to all Canadians in 1964.

Instead of life liberty and the pursuit of happiness, Canada’s constitution stresses “peace, order and good government.” We believe that government can be a force for good and in some areas - public health care being one - and can actually do a better job than private corporate interests.

For more than 40 years Canada’s Medicare has improved the quality of life for tens of millions of people, liberated them from the threat of unaffordable medical bills and made it easier for them to pursue their own definition of happiness.

Our Medicare system isn’t perfect, but then neither is democracy. We don’t think that’s reason enough to get rid of them. Besides, there’s more than just a political “feel-good” reason for embracing universal health care. It’s good for business.

I’m the owner of a company in Canada and another in the United States that distribute fresh produce around the globe. My Canadian company has three corporate advantages over my U.S. company and our U.S. competitors: healthy workers, lower operating costs and better worker safety through social cohesion.

In my experience, healthy workers are more productive because they take less sick time than those who don’t, or can’t afford, to take care of their health. Lack of health-care access is a barrier to preventive care. Those who ignore early symptoms of an illness because their credit cards are maxed-out end up being less productive and may have to leave the work force. Then the employer faces the expense of training replacement workers.

The Organization for Economic Co-operation and Development estimates that total health expenditures in Canada amounted to 9.9 percent of GDP in 2004. In the United States it was 15.3 percent. And even though Americans spend more on health care, their life expectancy is, on average, two years less than Canadians.

Many U.S. companies enjoy a competitive edge in technology because of the R&D of the military industrial complex. In Canada it’s our single-insurer health-care system that provides us with a competitive advantage.

My U.S. company pays, on average, a premium of $9,300 per year for each employee to provide just basic medical insurance. My Canadian firm pays no premium. The costs are paid out of taxes and from resource royalties.

High health-care costs in the United States have been cited as one very big reason for what some people are calling “the outsourcing of America.” Witness the steady decline of the domestic auto-manufacturing sector.

Finally, I would argue that universal health care provides a social cohesion and increases our general security by helping to lift people out of poverty. A healthy population with access to health care is more likely to be productive and beneficial to the community. The rates of violent crime in Canada have yet to reach even a shadow of what is happening in America.

The economic reasons for universal medical coverage are clear. Just as important, however, is what Medicare says about our country and its people. We believe in the principle that everyone should have access to reasonable health care. That way life, liberty and the pursuit of happiness is for all of us - not just those who can afford it [all emphasis added].

Most Americans believe that everyone should have access to health care too, but it won't happen unless we vote for the candidates that see eye-to-eye with us instead of the insurance companies and lobbyists.

Labor unions are on our side. So are Physicians for a National Health Plan, Rep. John Conyers and presidential candidate Dennis Kucinich. They all sponsor HR 676, which would expand Medicare to everyone. Medicare is a government success. It's provides accessible health care to millions of senior and disabled Americans, and about 98% of the money that goes into the Medicare program comes back out as medical services. I call that a good government program, and we all deserve to have that same level of care.

A question for Rep. Vern Ehlers

Lew Scannon wrote his representative, Vern Ehlers (R) MI, and asked him to get behind Rep. Kucinich's call for impeachment. In his letter, Lew asks Ehlers a question that deserves serious consideration.

Our political system has a series of checks and balances to prevent the types of abuses that the current administration is involved in. So I ask of you: Which is more important, the constitution and the country it protects, or the party for which you belong?
If you say the former, than I urge you to contact Rep Conyers and agree to start impeachment proceedings. Then, if there is just cause for impeachment, I ask you to vote for it, just as I would expect you to vote against it if there is no cause.
If you say the latter, then I hope you remember this missive when in the future, another president continues the arrogant abuses first conceived by the current administration, and your children, or perhaps your grandchildren ask you why our country has strayed so far from it's original intentions, that you had an oppurtunity to stop this now, but chose instead to be loyal to your party moreso than to the constitution you swore to uphold. Thank you. [emphasis added]

I hope Lew shares Ehler's response, although I'm not optimistic that Ehlers will do what's right for the country and our constitution. Can you say rubber-stamp?

2008 Democratic candidates on health care

I know where the 2008 Republican presidential candidates stand on the issue of health care (they put it at the bottom of the list), but what about the Democrats? Do they concur with voters who see it as our number one domestic issue? After checking their various campaign websites, I can say they've definitely put a lot of thought into the issue and given it priority status.

First up is Bill Richardson and his plan as described at a recent health care forum:

New Mexico Governor Bill Richardson said the "cornerstone" of his plan is to allow all Americans and business to be able to purchase the same coverage that members of Congress have, while offering "help" for those will low incomes. He also argued for an expansion of Medicare to cover those 55 and older, and a "cooperative relationship" between individuals, businesses and states "catalyzed by the government." Without naming Edwards, he argued that additional sources of revenue are not necessary, saying increased efficiency, preventative care and an exit from Iraq will provide enough revenue to expand coverage. But it wasn't clear if Richardson was pledging to achieve universal coverage.

Additionally, from Joseph Paduda's blog, "Richardson appears to be pushing for the elimination of Medicare Advantage and other private-insurer based Medicare programs." That's a plus since these plans cost on average 19% more than traditional Medicare, but he's also promoting tax breaks for lower-income Americans to help them buy health insurance. Several Republican candidates mentioned tax breaks too, but I don't see how that will help poor people buy health coverage unless the government advances them the money up front.

Mike Gravel solves that problem with vouchers.

Former Alaska senator Mike Gravel proposed a single-payer system of sorts, but under his system each American would get a health care voucher that they would use to purchase their choice of five or six private insurance plans. “Everyone gets the same product. If you want more than the product you’ve got, you pay for it,” he said. Gravel said he would not expand Medicare or Medicaid unless “we don’t see the private insurance companies shape up.”

Gravel's voucher idea is interesting, but I don't see the private insurance companies shaping up, and I don't see Gravel winning the primary either.

On to the next candidate, Hillary Clinton, best remembered for championing universal health care long before anyone else would even touch the subject. Here's a brief description of her plan from a recent speech:

There are three parts to my approach. First, lowering costs for everyone. Second, improving quality for everyone. Third, insuring everyone. [...]

My plan will offer individuals and small businesses market access to larger insurance pools that will lower costs and end insurance company discrimination against people with pre-existing conditions. As part of a plan for universal coverage, which I will discuss in detail in the coming months, we would create large insurance pools that lower administrative costs for small businesses and individuals by spreading the risk. In a system of universal coverage insurance companies cannot as easily shift costs through cherry picking and other means.

Clinton would also push legislation to provide respite care for caregivers of elderly and disabled Americans, something I approve of and believe is desperately needed. However, from a recent health care debate, she said "it would take her two terms to get a universal health care system in place." That's unacceptable to me. The number of uninsured is at crisis levels and Americans can't wait that long.

I'm not totally sold on her plan to create large insurance pools either. I no longer trust corporate America to put people before profits, and the fact that Clinton received hundreds of thousands of dollars in campaign contributions from insurance companies for her 2006 re-election in the Senate disturbs me too.

John Edwards has also been pushing universal coverage for sometime now, and he has the most comprehensive and detailed position on health care to date. Here's a brief description from The Nation:

Edwards' plan, first unveiled earlier this year, calls for an expansion of both public and private health plans, forces employers to either provide health care or pay into a fund that does, mandates individuals to buy insurance and offers government subsidies for families with incomes of up to $80k who can't afford it.

He also has plans [pdf] to expand the infrastructure for long-term care, offer respite care and support to families caring for loved ones, and improve the wages, training and working conditions for aides, which definitely scores brownie points with me.

Edwards also gets more points for his honesty and candidness. When asked at a recent health care debate about the transitional costs to a new system, he said "it would cost $90 to $120 billion a year, which he would pay for by rolling back President Bush's tax cuts for those making more than $200,000." This honesty won't hurt Edwards since polling shows that voters are willing to pay higher taxes in order to solve our health care crisis.

Moving along to Barack Obama, you can read about his plan on his website, but here's a short synopsis from CommonSense:

If you don't have health insurance through your employer, you will be enrolled into a new, comprehensive public health insurance plan that emphasizes prevention, chronic care management and quality care. The benefits will be similar to those available today to every federal employee.

This plan will enjoy the great efficiencies we see in public plans like Medicare but, if you still cannot afford it, you will receive a subsidy to pay for it. Of course, you can choose private insurance if you prefer but the private plans will have to compete on a level playing field with the public plan—without the extra payments that tip the scales in favor of private Medicare Advantage plans today.

Employers who do not offer meaningful coverage or a meaningful contribution to the cost of quality health coverage for their employees will be required to pay a percentage of payroll to the plan and their employees will be enrolled. Any employer can decide it no longer wishes to administer insurance and can offer insurance through the exchange. Self-employed Americans will find it easy to enroll as well at no disadvantage. Children will be covered and no one can be denied health insurance because of a preexisting condition or illness. [...]

Much of that tracks what Edwards has offered, and in fact, Obama offered that Edwards' plan is "very credible."When asked if additional tax revenue is needed, Obama did not dismiss the possibility, saying we need to "do whatever it takes" but noted there is much savings to be reaped with a more efficient system. He also said he would need to "put some money on the front end in creating a new system" and then "get those savings on the back end," emphasizing that "those savings [should] go into the pockets of families, and not just insurance companies or drug companies."

Obama only recently posted his plan on his website and it does sound very similar to Edwards'. He does get points from me though for mentioning there would be no extra payments to private Medicare Advantage type plans. (Taxpayers have been fleeced enough by the private sector under the Bush administration.)

Chris Dodd also has a plan to fix health care on his campaign website, although it doesn't appear as though he'll be a contender. Here's a brief synopsis of his plan from CommonSense:

Connecticut Sen. Christopher Dodd said his plan was based on four principles: universality (“everyone participates, everyone benefits,” prevention, extend Medicaid to more families, and improving the use of technology. He referenced his leadership in getting the Family Medical Leave Act written into the law as proof of his commitment to working families and to the health care issue. [...]

As did some of the other candidates, Dodd said that all Americans should be able to get the same type of health care plan as members of Congress.

That type of plan has already been introduced. The Kennedy-Dingell Medicare-For-All plan offers the uninsured a choice to use Medicare or the federal employees health plan, the same plan members of Congress and the president currently enjoy, but I agree with Dodd that all Americans should be able to get it.

That brings me to Dennis Kucinich. He's the only presidential candidate with a plan for a universal single payer, not for profit health care system. The National Health Insurance Bill (HR 676) is being sponsored by Congressman John Conyers and Kucinich, along with the backing of Physician's for a National Health Program. Click the links to read more, but here's a brief description from CommonSense:

Ohio Rep. Dennis Kucinich used the forum to continue his vigorous pitch for a single-payer health care system, arguing that the plans of the other major candidates were too dependent on insurance companies and others with a profit motive that was antithetical to the notion of universal, nondiscriminatory care. To critics who raise the fear that a totally government-run system would end up rationing care to control costs, Kucinich said that insurance companies already ration care. He also scoffed at the argument that private-sector competition would reduce costs, saying that the opposite has been the case in health care.

I like HR 676 (and the Medicare-For-All plan) and I agree with all of Kucinich's points, but I don't think he has a chance of winning the nomination either, so that leaves me undecided about who I'm backing in the primary. I want to vote for the person I think has the best chance of winning the White House AND delivering on health care, but I also want that person to be someone who is interested in delivering every dime possible toward providing care, not delivering for the investors. Who would you vote for?

Conyers' plan to cover the uninsured

In keeping with Cover the Uninsured week, here's information about John Conyers' Congressional Forum - Universal Health Care with Single Payer Financing - held in Washington today to educate and enlighten his Congressional colleagues about HR 676.

And here's some background to explain details of the single-payer plan from The Nation:

More than 47 million Americans are now living without health coverage. Representative John Conyers's United States National Health Insurance Act (HR 676) would create a single-payer healthcare system by expanding Medicare to every resident. All necessary medical care would be covered--from prescription drugs to hospital services to long-term care. There would be no deductibles or co-payments. Funding would come from sources including savings from negotiated bulk procurement of medications; a tax on the top 5 percent of income earners; and a phased-in payroll tax that is lower than what employers currently pay for less comprehensive employee health coverage. [...] To get involved, check out www.Healthcare-Now.org.

There are currently 62 co-sponsors of HR 676, including Rep. Carolyn Kilpatrick of Michigan, and almost 260 union endorsements in 40 states. Some of Michigan's unions throwing their support behind the bill include:

Local 6000, United Auto Workers (UAW), Michigan State Employees, Lansing, MI
Branch 3126, National Association of Letter Carriers (NALC), Royal Oak, MI.
Local Lodge 141, International Association of Machinists (IAM), representing airline workers at Northwest, United, Southwest, and Alaska. Detroit, MI
Local 547, International Union of Operating Engineers, Detroit, MI
Jackson/Hillsdale Counties Central Labor Council, AFL-CIO, Jackson, MI

Five Michigan steelworker locals endorse HR 676 too. The growing union support isn't surprising. Unions have traditionally bargained for and delivered good health insurance for their workers and families, but downsizing and off-shoring in manufacturing industries has resulted in workers losing their insurance altogether or being forced to pay more for less.

It's not just union workers facing health insurance insecurity though. From TPM Cafe:

26% of Americans say there has been a time in the last 12 months when they have been unable to afford necessary health care for themselves or a family member. Support for extending health care to all Americans trumps any tax-phobia: 66% of Americans favor "the government guaranteeing health insurance for all citizens, even if it means raising taxes."

There's still a lot of doubt a single payer system could surmount the special interest group lobbyists, but Congressman Dennis Kucinich thinks it has a good chance:

It is true that large corporations, who are currently making millions every year off the backs of every American who pays for health care, will fight hard to protect the unsustainable status quo as long as they possibly can.

But with health care costs rising faster than inflation with no end in sight; and with the abject failure of managed care to contain those costs; and with the number of uninsured growing steadily; and with American companies losing their competitive edge because they are paying so much more for health care than other developed countries; the opposition will not be able to hold justice at bay for much longer. So when people tell me that national health insurance is the right answer but is not politically feasible, I tell them that the opposite is true. Passage is inevitable - it is only a matter of time.

Another argument against public programs like Medicare is that private insurers are just more efficient, but that's simply propaganda according to Jonathan Cohn at TPM Cafe:

It works as propaganda because it’s consistent with the public’s deeply held skepticism of government. But it’s just not true. And this week Wall Street gave us yet more proof of that.

It happened yesterday after Aetna, one of the nation’s largest insurers, released its first-quarter earnings report. Earnings were up more than 3 percent – the kind of news that, one might suppose, Wall Street would greet with glee. Not so. Shares actually plummeted...by more than 20 percent.

Reason: Aenta’s medical loss ratio was going up – i.e., that it was spending more money on its patients – provoked a sharp rebuke from Wall Street.

The amount Aetna paid for covered services divided by the amount of premiums collected was 79.4%, up from 74.6%, but as Cohn points out:

"About 98% of the money that goes into the Medicare program comes back out as medical services - in good part because the program doesn't siphon money for marketing and profits. But, then, Medicare doesn’t have to satisfy investors. It has to satisfy voters. Big difference."

Absolutely, but I have a feeling when it comes to people's health that voters want every dime possible directed toward providing care, not delivering for the investors, which probably explains why 66% of Americans favor the government guaranteeing health insurance for all citizens, even if it means raising taxes. People know that Medicare has been a government success.

If you like Conyers' plan and believe that establishing a universal health care system is essential to resolving our nation's health care crisis, click here to sign his petition and support the passage of H.R. 676.

UPDATE: Click here to get more information about the Executive Summary of The United States National Health Insurance Act (HR676).