Single Payer News

From Forbes Magazine: More Proof That The American For-Profit Health Insurance Model Is Doomed

2011-12-30T09:41:00.000-08:00

More Proof That The American For-Profit Health Insurance Model Is Doomed

Forbes Magazine 12/28/11
Rick Ungar

Recently, I published a piece arguing that the medical loss ratio (MLR) requirements of Obamacare would spell the end of the private, for-profit health insurance payer system in the United States and clear the way for universal, single-payer coverage provided by the federal government.

The MLR requires that insurance companies selling to small groups and individuals spend 80 percent of premium dollars received on actual health care (not administrative costs or profits) and 85 percent for large group policies.

Many readers responded to the column by noting that the health insurance companies have experienced healthy rises in share prices since passage of the Affordable Care Act, leading some to believe that it was unrealistic, on my part, to predict the demise of the for-profit health insurance industry in America.

Yet, a report issued this week by, of all places, the conservative Galen Institute, reveals that you can’t judge the long-term viability of an industry by its current share price. Indeed, the results of the Galen study highlight that the exodus of insurance companies from the health insurance business may be happening far more quickly than I imagined.

Among the many companies that are dropping out of the business —rather than comply with the MLR requirements that would force them to actually spend an appropriate share of the premium monies received from customers on real health care— are some of the nation’s largest carriers.

Principal Financial Group had already announced late last year that they were leaving the health insurance business, impacting on some 840,000 insured.

Another key player in the business, Cigna, has decided to quit the small business market in states like California, Connecticut, Florida, Georgia, Hawaii, Illinois, Kansas, Missouri, New Hampshire, New York, North Carolina, Ohio, Pennsylvania, South Carolina, Texas and Virginia.

In Colorado and Michigan, insurance giant Aetna is bailing on both the small business and individual markets.

The list goes on and on and can be reviewed in its entirety in the Galen Institute report.

While there are some additional issues causing trouble for this now out-of-date payer system, most insurers will tell you that the MLR requirements of Obamacare are the key factor that is projected to make the health insurance business not worth pursuing. Indeed, Aetna estimates that, as a result of failing to meet the MLR requirements in 2011, the company will be forced to pay out 100 million dollars this year to it’s customers.

To be sure, the Galen Institute does not see this exodus from the private health insurance model as a positive development. Indeed, their report is offered up as proof that Obamacare is going to hurt Americans by causing them to lose their coverage— an opinion shared by many a conservative commentator.

But they miss the point by a mile.

If an insurance company cannot make money while holding onto 15 to 20 percent of every dollar they take in, why should they continue as a business? Wouldn’t the free marketers argue that if a business model cannot profit on so wide a margin and still offer an acceptable product, the business does not deserve to survive?

The simple reality is that the health insurers can only function at a profit —and a small one at that—by denying needed care to their customers so that they can cover their own administrative costs. This is the model that Obamacare opponents, such as the Galen institute, seek to perpetuate— despite the fact that it clearly no longer works to the benefit of customers or society as a whole.

Still, the critics argue that the result will be a catastrophe and that, by forcing health insurers to play fair, the ACA is harming the public.

But if it is truly the public that these conservative critics are worried about, where were they when so many were pursuing the public option during the debate over health care reform? After all, the public crisis that these people profess to fear can be easily resolved by offering up such a public option or, even better, an optional, Medicare-for all plan.

The truth is that the public option argument was never an ideological debate. Those who opposed Obamacare and, more importantly, a public health insurance option, were so busy protecting the interests of the for-profit health insurance companies that they failed to realize they were defending a dinosaur doomed to extinction. Now that we’ve asked these companies to conduct their business in a way that is fair to their customers, the conservatives are crying foul and blaming the ACA for putting these companies out of business— when they should have been gone long ago.

It’s easy to support the for-profit health insurer model when you have not yet found yourself in the position of needing to call upon the insurers at a time of crisis. It’s easy to support the private health insurance model if you are unaware that each time your physician believes that a procedure or test is required for your heath, he or she is forced to spend a ridiculous amount of time attempting to convince your insurer to pay for the treatment. For most people—those who have yet to have to test the system—it’s simply a matter of paying your premium, complaining about the high cost, and then sleeping soundly at night in the belief that, should someone in the family get sick, it’s all going to be okay because you have health insurance.

But it’s not okay. As many find out when the moment comes that they must call upon their insurer in a time of expensive illness, it is often anything but okay. Why? Because the insurers are struggling to provide the services for which they have contracted and manage to make a profit at the same time. And as this pressure builds, the insurers will simply leave the business—taking their billions into businesses where profits are far easier to come by.

So, like it or not—as the growing exodus of insurers from the marketplace bears out—government, single-payer coverage is coming.

The only question is whether we will get out in front of the problem that will be created by private insurers bailing or wait, as we often do, for the system to collapse.

If you can manage to check your ideology at the door, the wisdom of getting started with the inevitable should be clear.

contact Rick at thepolicypage@gmail.com

From the New Ulm Journal: December 10, 2011

2011-12-18T22:16:00.000-08:00

Business breakfast speaker discusses single payer health care
December 10, 2011
By Josh Moniz, Staff Writer

NEW ULM - Physicians for a National Health Program - Minnesota hosted an informational presentation for business owners on single payer health care Friday at the New Ulm Country Club.

Single payer health care is funded by a single entity, usually a government, that collects all health care fees and pays out all costs. The method would allow universal health care, and hospital billings would be nearly eliminated.

The speaker for the event was David Steil, a Pennsylvania resident who served as a Republican legislator for 17 years and has been a business owner for 35 years. He is currently the president of Health Care for All - Pennsylvania.

Steil said his support for a single payer system came from his time as a business owner and a legislator. He said he concluded that businesses were not the proper entity to provide health insurance.

"I quickly came to the conclusion, 'Why am I involved in health care [as a business owner]?' I don't have the expertise. Many small businesses are in the same situation, but still need to offer health insurance to be competitive," said Steil.

He said the current system causes premiums and health care costs to skyrocket while making it more difficult for people to get access. He said the current system is poised to implode the country's health care system.

He said he came to support single payer plans despite being a Republican legislator while researching methods for addressing the health care issues.

"I believe, as a fiscal conservative, you'll ultimately have to accept some form of single payer system," said Steil. "My belief is that government exists solely to provide what we can't do for ourselves. I consider health care the same as the government providing for the education system or filling a pothole in the street. Many of us don't have the knowledge to do it ourselves."

He said there would have to be several requirements for a single payer system to be successful.

First, he said, it would have to be universally available to all.

Second, he said, it would have to be driven by the free market. He said the current problem with health care is that it is operating at the insurance company level instead of at the provider level.

"So much of the cost is driven up, even if insurance companies want to it lower, because of all the administrative costs. So many people are needed for the paperwork because its so inefficient," said Steil.

He said a single payer system would essentially eliminate massive administrative costs, making care more affordable, and it would make it possible for the government to keep costs under control.

Third, he said, a single payer system would have to be funded by a naturally appreciating tax to keep pace with inflation and provide fairness for tax payers.

"We're still determining the right number, but we're considering a 3 percent income tax on individuals and a 10 percent tax on payrolls for businesses in Pennsylvania," said Steil. "People may jump at the 10 percent, but when we talked with U.S. Steel [in Pennsylvania] about the idea, they were already spending 17 percent on health care costs."

He also said the 3 percent tax was almost guaranteed to be much smaller than what most people pay now for health care, especially when the administrative costs are reduced.

Finally, he said the system would help address the biggest burden on health care systems, long-term or chronic illness, by being able to allow physicians to perform more preventative measures. He said the current problem is many don't address serious issues, like diabetes, until they hit 65 and obtain government care. He said at that point, prevention is usually impossible and the situation is so severe little can be done.

Steil said his points were why he took issue with the health care overhaul passed under President Obama. He said it forced businesses to be the main supplier of health care while failing to address the root causes of increased health care cost.

Steil then addressed two criticisms of the single payer plan.

He said many believe big government is completely incapable of administrating properly.

"That's not right. Right now, between 40 and 50 percent of all health care is already delivered by the government. It's done through Medicare, Medicaid and health care for the military," said Steil.

He also said there was a concern of state sovereignty.

"That's why we're specifically pushing for state plans system. For example, Minnesota is already starting to work on one," said Steil.

Additionally, he addressed what he called misinformation about other countries that used single payer systems.

"The claims that Canada's health care is so bad they come down here has absolutely no data to support it. Similarly, the claims that England has huge wait times is off. There is some waiting, but no more than you typically see here for some procedures. Also, you get to go in immediately if it's an emergency," said Steil.

He said there has also been misinformation denying how outsized U.S. health care cost are compared to other countries. He said the U.S. spend one-third to one-half more per capita on health care than any other country.

Steil answered some questions from those attending. One expressed concern about legislators being unable work together and the effect of this inability if they administered health care.

He said the system would be run by a board filled with people selected by the respective legislature, but the legislature would not have direct oversight and control of the board.

Another asked if people would have to make sacrifices under such a system because of set funding.

Steil said it would be addressed by allowing doctors to be more entrepreneurial.

"If they want to offer you services beyond the reimbursements, that's fine. We want them to compete for your businesses to give you the best care," said Steil.

Steil concluded by saying that businesses would have to take the lead in lobbying for a single payer system. He said they would not only show legislators how much support there is, but they would also be addressing an issue that is poised to be a serious problem for them.

Josh Moniz can be e-mailed at jmoniz@nujournal.com.

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2011-12-12T14:17:00.000-08:00

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Whistleblower Wendell Potter writes about the 'best health care system in the world'

2011-12-01T12:44:00.000-08:00

Does the U.S. Have the World's Best Health Care System? Yes, If You're Talking About the Third World

by Wendell Potter

A little more than a year ago, on the day after the GOP regained control of the House of Representatives, Speaker-to-be John Boehner said one of the first orders of business after he took charge would be the repeal of health care reform.

"I believe that the health care bill that was enacted by the current Congress will kill jobs in America, ruin the best health care system in the world, and bankrupt our country," Boehner said at a press conference. "That means we have to do everything we can to try to repeal this bill and replace it with common sense reforms to bring down the cost of health care."

Boehner is not the first nor the only Republican to try to make us believe that the U.S. has the world's best health care system and that we're bound to lose that distinction because of Obamacare. I've heard GOP candidates for president say the same thing in recent months, charging that we need to get rid of a President who clearly is trying to fix something that doesn't need fixing, something that isn't broken in the first place.

Well, those guys need to get out more. Out of the country, in fact. They need to travel to at least one of the many countries that are doing a much better job of delivering high quality care at much lower costs than the good old USA.

If they're not interested in a fact-finding mission abroad, then perhaps they might take a look at two recent reports before they make any other statements about the quality of American health care.

Last week, the 34-nation Organization for Economic Cooperation (OECD) released the results of its most recent study of the health care systems in its member countries, including the U.S., plus six others, for a total of 40. And those results are illuminating.

If Boehner and his fellow Republicans had characterized the U.S. system as the most expensive in the world, they would have been right on target. But they would have been way off base by calling it the best.

The OECD report is just the most recent evidence that Americans are not getting nearly as much bang for the health care buck as citizens of most other developed countries -- and even some countries in the developing world.

The OECD found that the United States spends two-and-a-half times more on health care per person than the OECD average. The U.S. even spends more than twice as much as France, which many experts contend has one of the best health care systems on the planet.

The average expenditure per person in the U.S. is $7,960, a third more than in Norway, the second highest. The OECD average, by comparison, is just $3,233. (It is $3,873 in France.)

Here are some reasons why: Hospital spending is 60 percent higher than the average of five other relatively expensive countries (Switzerland, Canada, Germany, France and Japan); spending on pharmaceuticals and medical goods is much higher here than any of the other countries; and administrative costs are more than two-and-a-half times the average of the others.

It was not all bad news for us. We're number one in the five-year breast cancer survival rate and number two (behind Japan) in the five-year colorectal cancer survival rate. We're also number one in costly knee replacements and number two (again behind Japan) in the number of MRI units per million people.

But we rank 29th in the number of hospital beds per person and 29th in the average length of a stay in the hospital. And we have high rates of avoidable hospital admissions for people with asthma, lung disease, diabetes, hypertension and other common illnesses.

When it comes to access to physicians, we're also near the bottom of the pack. We rank 26th in the number of physicians, especially primary care or family doctors, per 1,000 people.

In terms of life expectancy, we rank 28th, just behind Chile. The average age of death in the U.S. is 78.2, well below the average of 79.5 years in the other OCED countries.

The OECD study backs up the results of a report released by the Commonwealth Fund in October, which showed that the U.S. is actually losing ground to other countries in assuring that its citizens have equal access to affordable, efficient care.

The Commonwealth Fund "scorecard" found that the U.S. is failing to keep up with gains in health outcomes made by other nations. We now rank last out of 16 countries in the Commonwealth Fund study when it comes to deaths that could have been prevented by timely and effective medical care.

A big reason for the dismal results is the fact that more and more Americans are falling into the ranks of the uninsured and underinsured. As of last year, according to the Commonwealth Fund, 81 million adults in the U.S. -- 44 percent of all adults under age 65 -- were either uninsured or underinsured at some point during the year, up from 61 million as recently as 2003.

So the next time you hear a politician claim that the U.S. has the best health care system in the world, be aware that he or she is trying to get you to believe something that is demonstrably not true, undoubtedly for no reason other than to advance their political agenda. We deserve better -- in both rhetoric and results.

Wendell Potter is former Vice President of corporate communications at CIGNA, one of the United States' largest health insurance companies. In June 2009, he testified against the HMO industry in the U.S. Senate as a whistleblower. He is now the Senior Fellow on Health Care for the Center for Media and Democracy in Madison, Wisconsin.

Dr. Rick Kvam responds to Dr. Mark Liebow in the Post Bulletin

2011-09-11T16:30:00.000-07:00

Reform health care with evidence, not ideology

By Rick Kvam, M.D.
Letters, Rochester (Minn.) Post-Bulletin, Sept. 1, 2011

Dr. Mark Liebow's op-ed supporting single-payer health care reform flies in the face of current cries for smaller government and less regulation. Good. We need logical strategies, not simplistic formulas, when U.S. health care spending is a $2.1 trillion gorilla menacing every state and federal budget.

Guided by evidence, not ideology, one finds that in health care, the unbridled free market returns a very poor value. We boast the most market-driven health care in the developed world, and, not coincidentally, far and away the most expensive. Our per capita costs are double those of other industrialized nations (in spite of 50 million uninsured!), but our outcomes (life expectancy, infant mortality, etc.) are nevertheless worse. Workers' inability to switch jobs for fear of losing health care coverage (“job lock”) is a major drag on our economy.

Nobel Prize-winner Kenneth Arrow showed almost 50 years ago that health care is a highly imperfect market, and that “the laissez-faire solution for medicine is intolerable.” We can no longer afford to insist on a “uniquely American” system that is uniquely wasteful.

As demonstrated in ALL other developed nations, a coordinated health care system (whether single payer or a private mechanism) will provide better care and cost less. Our health care crisis requires a rational solution, not free market skim milk masquerading as cream.

Dr. Rick Kvam resides in Rochester, Minn.

An Op-Ed in the Rochester Post Bulletin. Thank you to our member Dr. Liebow!

2011-08-31T14:24:00.000-07:00

Be the second state to pass universal health care

By Mark Liebow, M.D.
Rochester (Minn.) Post-Bulletin, Aug. 18, 2011

Well, Vermont beat us to it. The people of Vermont decided correctly that the advances of the Affordable Care Act weren’t enough. They looked at Massachusetts and found that with that state’s plan, which serves as the model for the Affordable Care Act, costs continue to rise and the rate of medical bankruptcies didn’t go down.

In fact, Massachusetts now has the highest insurance premiums of all 50 states. Vermonters pushed their elected officials to pass legislation that aims to set up a state single-payer plan, the first in the United States. We could be next.

The new private insurance that some Minnesotans will buy under the Affordable Care Act will not cover all their medical expenses. They will still face deductibles and co-payments that deter them from getting medical care. Some may be forced to choose between care and food or rent. Insurers will still take a big chunk of the premium for administrative expenses and profits which do not help patients. The flaws in our current system remain. There is a better way.

The Minnesota Health Plan, if enacted, would be a public program that covers all Minnesotans with better coverage and substantially lower administrative cost. The plan will cover all medically necessary services without deductibles or co-payments. There will be no complicated enrollment procedures or eligibility requirements. Health insurance bureaucrats will not stand between patients and their doctors.

The plan will save billions of dollars a year for Minnesotans. Even the non-profit insurance companies we have in Minnesota use 15 percent to 20 percent of the dollars they collect in premiums for overhead. Doctors, hospitals, and other providers also spend a substantial percentage of what they collect on administrative costs. Most of that needless spending will end when the plan is enacted. We can use the savings to lower the cost of services and to improve quality. Beyond that, doctors and patients will appreciate having less paperwork and the end of tedious struggles with insurance companies.

Of course, we’ll have to pay for this. There will be new taxes, which will be assessed based on ability to pay. However, we will stop paying premiums, deductibles, and copayments. For the average Minnesotan, their new taxes will be less than they are paying now. Businesses will no longer have the burden of purchasing health insurance for employees and dependents. This should lower retail prices and lower our cost of living.

The plan will be a big help to Rochester. Covering everyone will allow more patients to come to Mayo Clinic and Olmsted Medical Center. Furthermore, Mayo and Olmsted will no longer need to provide charity care or rack up bad debt from the care given to Minnesotans. Mayo Clinic alone will save hundreds of millions in health care costs for its employees and dependents. Rochester health care organizations will save hundreds of millions more in reduced costs for billing and collections. This will allow them to grow and hire more clinical employees.

We will lose jobs by eliminating health insurance companies, thus making most people in health care organizations doing billing, collections, and negotiations with insurers unnecessary. Many of these workers have clinical backgrounds and can move back into health care organizations as they grow. Others will need retraining. Fortunately, the Plan sets aside money for retraining those who need it and, most importantly, people losing jobs will not also lose health care.

Many at Mayo worry that a single-payer system will not recognize that Mayo sees more complex patients than most practices and hospitals, making its costs higher. They also worry about whether there will be support for research and education. The plan will negotiate annual budgets with Mayo hospitals and can provide the budget that will cover the costs of complexity. It will also negotiate provider fees and can set a higher fee for care provided at academic institutions.

Some have been concerned about “rationing” in a single-payer system. The plan is prohibited from restricting, delaying, or denying care, or reducing the quality of care to save money. Rather, savings come from streamlining our current administrative spending. We already spend enough on health care. By increasing efficiency, we can provide needed care to all Minnesotans.

While the plan can fix how we pay for care, it won’t fix problems in how we provide care, because it was never meant to fix those. We need to study those problems and figure out what we can do for them, since many will see the health care system as broken as long as the delivery of care is flawed. Still, fixing how we pay for health care at the state level would do many good things for Rochester, for Minnesota, and for Minnesotans. Vermont’s new law means we can’t be first, but we still can be the state with the best single-payer system. Let’s enact the Minnesota Health Plan (http://mnhealthplan.org).

Mark Liebow is a Rochester physician.

Everybody likes Medicare -- so why not try it for everybody?

2011-08-18T15:15:00.001-07:00

By Elizabeth Frost, M.D.
Twin Cities Daily Planet, July 31, 2011

The other day Representative Michelle Bachmann was taking a hit at President Obama: She accused the national health reform law of trying to destroy Medicare and force the evils of Obamacare onto the elderly. That Obama. But really, isn’t it interesting that even Michelle Bachman jumps up to defend one of our nation’s largest "socialist" programs? Why is that? Why is it so popular that Paul Ryan may meet his political demise by trying to gut it? This weekend Medicare has its 46th birthday, and I want to write a little about why we should be celebrating.

First of all, Medicare saves money. Its overhead is between 1-3%, in contrast to the private insurance industry that has administrative and profit overheads of 10-25%. That is a savings of 10 – 20%. Also costs don’t increase as fast in Medicare as they do in private insurance. We are a nation with a lot of new health technology, we live longer and this does cost money. For example since 1970 the cost of medical care adjusted to inflation has gone up 400%. That is a big increase, but the same time period from 1970 to today the cost of private insurance adjusted for inflation has gone up 700%.

We also know that Medicare is a good deal for the tax payers by looking at Medicare Advantage Insurance programs. This was the attempt by the Bush Administration to create "competition" by privatizing some Medicare programs. They have shown to waste billions of dollars by charging more for healthier patients and then dropping those same patients once they become sick. It is called "picking the cherries and spitting out the core" and it is a real phenomena. The Obama’s Affordable Care Act is slowly shutting down the wasteful private health insurance options for Medicare.

So all we need to do to make Medicare financially solvent is to increase the payroll tax by a small fraction of a percent. The rate has only been increased once, in the mid-80s, and it is time to do it again.

Medicare is an efficient, effective way of health care financing. It is what we all want for our parents and ourselves as we get older and heck -- it probably is a good idea for the entire nation. If we had Medicare-For-All maybe it would be so popular that Michelle Bachmann would be forced to defend it, too.

Elizabeth Frost is a family doctor practicing in Minneapolis. She co-chairs the Minnesota Chapter of Physicians for a National Health Program.

Be the second state to pass universal health care - Rocheter Post-Bulletin

2011-08-18T15:13:00.000-07:00

By Mark Liebow, M.D.
Rochester (Minn.) Post-Bulletin, Aug. 18, 2011

Well, Vermont beat us to it. The people of Vermont decided correctly that the advances of the Affordable Care Act weren’t enough. They looked at Massachusetts and found that with that state’s plan, which serves as the model for the Affordable Care Act, costs continue to rise and the rate of medical bankruptcies didn’t go down.

In fact, Massachusetts now has the highest insurance premiums of all 50 states. Vermonters pushed their elected officials to pass legislation that aims to set up a state single-payer plan, the first in the United States. We could be next.

The new private insurance that some Minnesotans will buy under the Affordable Care Act will not cover all their medical expenses. They will still face deductibles and co-payments that deter them from getting medical care. Some may be forced to choose between care and food or rent. Insurers will still take a big chunk of the premium for administrative expenses and profits which do not help patients. The flaws in our current system remain. There is a better way.

The Minnesota Health Plan, if enacted, would be a public program that covers all Minnesotans with better coverage and substantially lower administrative cost. The plan will cover all medically necessary services without deductibles or co-payments. There will be no complicated enrollment procedures or eligibility requirements. Health insurance bureaucrats will not stand between patients and their doctors.

The plan will save billions of dollars a year for Minnesotans. Even the non-profit insurance companies we have in Minnesota use 15 percent to 20 percent of the dollars they collect in premiums for overhead. Doctors, hospitals, and other providers also spend a substantial percentage of what they collect on administrative costs. Most of that needless spending will end when the plan is enacted. We can use the savings to lower the cost of services and to improve quality. Beyond that, doctors and patients will appreciate having less paperwork and the end of tedious struggles with insurance companies.

Of course, we’ll have to pay for this. There will be new taxes, which will be assessed based on ability to pay. However, we will stop paying premiums, deductibles, and copayments. For the average Minnesotan, their new taxes will be less than they are paying now. Businesses will no longer have the burden of purchasing health insurance for employees and dependents. This should lower retail prices and lower our cost of living.

The plan will be a big help to Rochester. Covering everyone will allow more patients to come to Mayo Clinic and Olmsted Medical Center. Furthermore, Mayo and Olmsted will no longer need to provide charity care or rack up bad debt from the care given to Minnesotans. Mayo Clinic alone will save hundreds of millions in health care costs for its employees and dependents. Rochester health care organizations will save hundreds of millions more in reduced costs for billing and collections. This will allow them to grow and hire more clinical employees.

We will lose jobs by eliminating health insurance companies, thus making most people in health care organizations doing billing, collections, and negotiations with insurers unnecessary. Many of these workers have clinical backgrounds and can move back into health care organizations as they grow. Others will need retraining. Fortunately, the Plan sets aside money for retraining those who need it and, most importantly, people losing jobs will not also lose health care.

Many at Mayo worry that a single-payer system will not recognize that Mayo sees more complex patients than most practices and hospitals, making its costs higher. They also worry about whether there will be support for research and education. The plan will negotiate annual budgets with Mayo hospitals and can provide the budget that will cover the costs of complexity. It will also negotiate provider fees and can set a higher fee for care provided at academic institutions.

Some have been concerned about “rationing” in a single-payer system. The plan is prohibited from restricting, delaying, or denying care, or reducing the quality of care to save money. Rather, savings come from streamlining our current administrative spending. We already spend enough on health care. By increasing efficiency, we can provide needed care to all Minnesotans.

While the plan can fix how we pay for care, it won’t fix problems in how we provide care, because it was never meant to fix those. We need to study those problems and figure out what we can do for them, since many will see the health care system as broken as long as the delivery of care is flawed. Still, fixing how we pay for health care at the state level would do many good things for Rochester, for Minnesota, and for Minnesotans. Vermont’s new law means we can’t be first, but we still can be the state with the best single-payer system. Let’s enact the Minnesota Health Plan (http://mnhealthplan.org).

Mark Liebow is a Rochester physician.

Op-ed in Star Tribune for Medicare's Birthday

2011-07-31T19:40:00.000-07:00

Medicare, an effective program, turns 46

Article by: ANN SETTGAST

Whether the debt ceiling is raised or not in the days ahead, Minnesotans and the nation have reason to celebrate this weekend. Saturday marked Medicare's 46th birthday.

While we have a long way to go before our health care system works well for all patients, this anniversary gives us an opportunity to reflect on what we've done right.

Surprisingly, Medicare was born out of bitter controversy in 1965. It was condemned by some as "socialized medicine," a threat to basic freedoms. As a physician, I'm embarrassed to say organized medicine was among its key opponents. It all seems silly today.

Since its inception, Medicare has afforded hundreds of millions of Americans access to high-quality health care. It has reduced poverty among seniors and improved the financial security of their families. It has become one of the most popular government programs in history.

Current political discourse is centered on spending cuts, including Medicare. But covering Americans via Medicare saves money. No, that is not a typo.

Medicare boasts far lower administrative costs than the leanest private insurance company. While it is true that Medicare spending has risen dramatically over time, its growth is far less than that of the private sector.

And remember that Medicare pays for the care of our sickest and oldest, while private insurers foot the bill for the young and healthier.

In fact, uninsured Americans in their late 50s and early 60s routinely delay needed care, only to become expensive Medicare recipients once they reach 65.

Medicare is not the cause of health care inflation; rather, it is a victim of our country's sky-rocketing health care costs. Cuts to Medicare will not control these costs.

Rather, they will reduce access to care by the nation's elderly, worsen their health status, and increase financial hardship among already-struggling Americans.

Not only is Medicare less expensive than private insurance, it provides superior service. An example is the free choice of doctor granted to patients under Medicare -- a basic freedom many privately insured Americans are currently denied.

As a practicing internist, I can attest to the lower "hassle factor" doctors incur when dealing with Medicare rather than interacting with multiple private payers, each requiring different rules and regulations. Expecting us to treat patients differently because they have different or no insurance contradicts our professional responsibility.

Medicare is far from perfect, and it has some serious limitations. But for this weekend, let's celebrate a government program that actually works incredibly well. Americans are proud of Medicare. It should be strengthened, expanded and improved to include all of us. A sustainable Medicare-for-all system is the reform our nation needs.

Ann Settgast is a primary care doctor practicing in the Twin Cities. She co-chairs the Minnesota chapter of Physicians for a National Health Program.

Slipping Through the Cracks in Healthcare -- nice piece from the TC Daily Planet

2011-07-09T12:08:00.000-07:00

By Sheila Regan, TC Daily Planet
June 21, 2011

What happens when you tear a muscle and don't have health insurance? Or when you lose your insurance and you're still sick? Half a dozen Minnesotans shared their health and insurance stories, from a torn muscle in the Smoky Mountains to epilepsy in England.

Derek Miller: Sacrificing career to get health insurance

Local theatre artist Derek Miller went for many years without health insurance. In 2003, hiking in the Smoky Mountains on the Appalachian Trail, he slipped over the rocks while it was raining. He tore a muscle pretty much in half, and had to hike 15 miles to the closest ranger station (which was closed due to cutbacks.) Finally, he was able to find someone to give him a ride to the emergency room, where x-rays were taken and he was given a prescription for a drug that was basically extra strength Ibuprofen.

Luckily, he hadn’t actually broken his foot, but bills started coming for the x-ray technician, the x-ray machine, the prescription, the emergency room, the doctor: in total, more than $3,000. It took him two years to pay off the debt. “I was lucky,” Miller said. “What if my foot had actually been broken?”

After that experience, Miller pretty much stopped going to the doctor altogether. Fear of the exorbitant fees he experienced after his Smoky Mountains injury made him avoid the doctor even when a mirror fell and broke on his back when he was volunteering for a theatre group. “I literally duct taped bandages on my back,” he said.

Miller was fearful of the emergency room both from his own experience and that of his father, who worked for a factory. “I’ve seen him get hurt,” Miller said. “You always end up paying for something… I’m really reticent to go to the emergency room unless I’m dying.”

Nora Longley's story

Two years ago, the Minnesota Women’s Press highlighted the heartbreaking story of Nora Longley, a 27-year-old woman who died of adrenal cancer on May 9, 2009. After graduating from college, Nora was no longer eligible for her parent’s health insurance, and put off going to the doctor because her retail job offered insurance that carried a $500 deductible. When she finally consulted her doctor about her symptoms — anxiety, weight gain, and acne — the doctor told her to make a few changes and return in a few weeks. Longley never made another appointment, because she couldn’t afford it, and didn’t want to ask her parents for help.

When given the opportunity to participate in the Walker Art Centers’ Docent program, she had to quit her job that offered insurance in favor of a waitress job with a flexible schedule, and no insurance.

As Nora delayed going to the doctor because of the cost, her cancer worsened much faster and went undiagnosed and untreated longer than if she were getting regular checkups.

Nora’s mother, Nance Longley, said the healthcare situation has improved some since her daughter’s experience. With the Obama administration's health care reform legislation, young people can now be covered under their parents’ plan until they are 26. Despite that change, Nance Longley still sees health care as “a huge social justice issue.”

Before she died, Nora was active in groups trying to get single payer insurance, and Nora’s uncle went with a group to Washington D.C. fighting for health care reform. As for Nance Longley, who is a graphic designer and interacts with many freelance photographers and other artists, she sees every day how this country’s health insurance situation lets people fall between the cracks.

“My daughter went to school in Canada,” Longley said, “and I know in Canada it’s not perfect either, but at least people feel they can go to the doctor when they feel sick.”

Eventually, as Miller entered his thirties, he realized that he could no longer continue to not have insurance. He worked for years doing theatre for young audiences, teaching as an artist, performing puppetry and other artistic endeavors that paid him enough to get by. Though the artistic work was professionally fulfilling, it did not provide insurance, so he now works in an office setting where insurance is provided by his employer. “The last thing in the world I ever wanted to do was work in an office,” Miller said.

Laura Holway: On again, off again coverage, but bills keep coming

For years, local choreographer and multimedia artist Laura Holway paid for her own insurance. As an artist, she never had an employer who provided benefits, but she always made sure that she was covered, in case of disaster.

And Holway has had her share of disasters. Her insurance policy had a high deductible, and Holway ended up paying a lot of money for health troubles involving her reproductive system. She paid even when doctors made mistakes — like the time a doctor insisted that she had a high heart rate and she had to go to ER, costing her thousands of dollars, or the doctor who prescribed her a drug that sent her into labor, even though she wasn’t pregnant. All of that had to be paid for.

“And it’s not like one person is billing you," Holway said. "There are six people billing you, and they each have a minimum of $100." It took her years to pay off her medical bills.

When Holway, who supplements her income from choreography and teaching by working as a server at Barbette, knew that she was going to have to have surgery, she decided to move to full time work at the restaurant in order to qualify for health insurance. She counted on the insurance to cover a surgery that she needed. Unfortunately, her hours were cut at Barbette during the past winter, and she wasn’t allowed to keep her health insurance.

Before her benefits ended, she thought it would be a good idea to get a physical, and she ended up getting an abnormal test result. “After that, no one would insure me,” she said.

She couldn’t even go back to the Blue Cross plan she had before getting Barbette’s plan. Once they rejected her, she had to then write on applications for other health care plans that she had been rejected, and no one would accept her.

Finally, another dance artist, Megan Mayer, suggested to Holway a health insurance broker who aided her in getting on the Minnesota Comprehensive Program (MCP), for people with pre-existing conditions.

“It’s a good thing that I speak English and have a college degree,” Holway said. “That paperwork is a real bitch. It took me weeks to complete everything, and they make you pay it back from the day you lost your insurance.”

Once Holway has a clean bill of health and waits six months, she’ll be able to apply for regular private insurance again. She has decided not to go on Barbette’s plan again. “At this point I don’t want to have to work a certain number of hours,” she said. It's important for her to continue teaching and choreographing, which make an additional full-time job very difficult.

Kay Franklin: No transplant at any price

Michael David Franklin, Ph.D. from the University of Minnesota, tells the story of his mother, Kay Franklin. She lost her health insurance when Franklin’s father, Joe, decided to start his own business laying fiber optic cable lines after working 20+ years as a UPS worker. Unfortunately, the business failed, and the couple went into foreclosure.

Kay began developing symptoms for what turned out to be pulmonary fIbrosis, a condition which was creating scars in her lungs, slowly suffocating her. There is no surefire treatment, and because of the couple’s financial troubles, they did not have private insurance.

A year went by until she was able to get on a rudimentary plan, but it wouldn’t cover anything they deemed “experimental,” including a lung transplant.

The family pooled resources, and approached a transplant center, asking if they could pay in cash — to the tune of $100,000 — for her transplant. The center said no, because even if the family had money, she could only get on the list if she had insurance. “They told her upfront that it doesn’t matter if you don’t have the money: if you don’t have insurance, you can’t be on this list,” Franklin said.

Sic months later, Franklin’s father was able to get a job, which allowed them both to get insurance. By that time, his mother had gotten pneumonia, so she would have to recover first before getting a transplant. And her new insurance wouldn’t cover the transplant anyway, because it was a pre-existing condition. She died several months later.

Isabel Nelson: Malaria in England

People who have had health care issues while staying in other countries see firsthand the differences in attitudes toward health care between the United States and the rest of the world.

Local theatre artist Isabel Nelson was living and teaching in Uganda when she contracted malaria, despite being on anti-malaria medication. She discovered that she had the disease later, while living in England.

She had no national health insurance number or I.D., so she didn’t go to the hospital right away when she felt sick. “Being the American that I am, I wasn’t accustomed to going to the hospital,” she said. She let her symptoms go for a week before finally checking into the Center for Tropical Diseases in London. She waited for an hour before a doctor saw her. They did a number of blood tests, and asked her to come back a couple of days later. They told her she had malaria and gave her two prescriptions. She paid just under seven pounds (less than $14) each for the medicines. The center called her to follow up to see how she was. “I’m really lucky,” Nelson said.

James Lekatz: Covered in England, denied for pre-existing condition here

Local composer James Lekatz also got sick while living abroad. While he was living in England, he was diagnosed with epilepsy. He got CAT scans, MRIs, and other procedures for free. When he returned to the United States, he was denied coverage because of his preexisting condition. Finally he found a plan that cost $300 a month, but had a $5,000 deductible. Because he had to deal with his epilepsy condition, he went into considerable debt trying to get treated. He is still paying off the debt.

Now, Lekatz works for a bank, a job that gives him benefits. “It’s one of the main reasons that I keep my job,” Lekatz said. “I need to have health care.” Before living in England, he had made enough money teaching and doing other things in the arts. Now, however, he feels that he is tied to having a job that provides an insurance plan.

For a more in-depth look at the health care issues that face Minnesotans, check out Bruce Johansen's article about the facts and figures that face Minnesotans today.

Sheila Regan (sheila@tcdailyplanet.net) is a Minneapolis theater artist and freelance writer.

TR Reid's speech from our Summer Fundraiser.

2011-07-07T15:03:00.000-07:00

Did you miss our fundraiser? It was a lot of fun. We hope you make it next year.
TR Reid gave an interesting talk titled: 'The Uncertain Future of the Affordable Care Act...And What Comes Next' He also issued a challenge to Minnesota: could we be the first state for truly equitable health care? Click here to listen to the audio of his talk on Andy Driscoll's Truth to Tell radio show.

KSTP Covers Protest at the HMO Trade Group - MInnesota Council on Health Plans

2011-07-07T14:44:00.000-07:00

A group of doctors, pharmacists, nurses and citizens gathered Monday morning May 9 to protest the HMOs 2.5 billion dollars in reserve, and to ask them for fiscal transparency.

See this link for coverage the night before the protest.
And this link is coverage the day of the protest.

Papa John Kolstad inteviewed in the TC Daily Planet

2011-07-07T14:35:00.000-07:00

Papa John Kolstad speaks out on universal, single-payer health care

By Lisa Peterson-de la Cueva, TC Daily Planet
July 05, 2011

Musician and activist John Kolstad got involved in the health care debate back in the 1990s when he and a group of people informally studied it in a series of study circles where they’d discuss and study art, books and politics. Then the issue of health care came up. As the owner of Mill City Music, Kolstad is responsible for purchasing his and his wife’s health insurance. “I studied advanced physics and music, and I do some pretty good at those—but I could not understand my health policy,” Kolstad said. “It was maddening.” As he delved into the subject, first through his study circle and then as a concerned citizen, Kolstad became a proponent of universal, single-payer health insurance.

You're a musician. How does access to health care uniquely affect artists?

Originally I was thinking of this from the point of view of a small business owner. Then you realize that artists are small businesses too. Musicians and artists are people who have been revered by every single culture for years, but look at what we do to our musicians here. They have to fend for themselves because they are often self-employed. I’ve lost some friends because of that, and now I’ve been trying to get some of my artist friends to actually talk to the public about health care.

I was involved in an event with artists for health care in May, and a lot of artists got a concert type event together. I wasn’t sure how that would work, but we had speeches and then Pop Wagner came out and did these rope tricks and would talk about the health care system (his friends had gotten together for him to help raise his deductible, which was $10,000). Then Kevin Kling got up and told about his brush with the health care system. It was great. So this is something that affects a lot of people and there are more and more stories out there and they’ve got to be told.

Why are you advocating for the Minnesota Health Plan?

When we were reading about this back in the 1990s in our study circles, we were looking at all kinds of studies, including about of the experience of Europe. We realized that European countries are spending half as much money for the same results, depending on what outcomes you use. We were reading and picking apart all the bills being proposed, including one being proposed by Wellstone at the time, and it just became very obvious that of all these different approaches, single-payer was the best option.

What have you found to be the biggest challenge about pushing single-payer in Minnesota?

I tell you, my big shock was back when I was learning about this. I thought, “I just gotta go to the people in the DFL and let them know we gotta do this.” And I thought the DFL would fall over themselves. But the DFL wasn’t interested! At one time we had a convention and every single delegate supported single-payer, but the leadership of the party was not interested in solving this problem, or if they were they weren’t interested in going up against the insurance companies.

The insurance companies have lots and lots of money—and I’m not against corporations, my business is a corporation itself—but it’s hard to go up the insurance companies when they have so much money. So campaign finance reform is tied to health care in a major way.

So what do you see as the next step?

I think the media is losing its credibility and they’ve failed to tell the people of our state important information about health care. I tell you, now that I’ve heard so many presentations and sifted through all the bills and information on this—and I’ve sifted through a lot—I think that if the people of Minnesota knew what was going on, they would realize that this can’t be solved any other way. So the question is how do we get to the people of the state to recognize it?

I was involved in creating the Metro Independence Business Alliance, a coalition of independent businesses. One of the motivations for businesses to join is so they can pool together their collective clout. It took us a couple of years to get to where we could talk about health care. But then we invited our membership and we had three presenters on why small businesses should support single payer. The whole board has unanimously endorsed single payer and the John Marty bill. That’s the ticket though. It’s about, how do we keep the people of Minnesota informed and how do we go up against false information?

Why is it so hard for people to talk about single payer?

You know, the solutions are all around us and the only thing that’s blocking us is lobbyists and campaign money.

Copyright:
©2011 Lisa Peterson-de la Cueva

From Fox News: Olivia Wilde Endorses Single Payer

2011-07-07T14:33:00.000-07:00

TV Doc Olivia Wilde Endorses Single-Payer Health Care

By Hollie McKay

Published June 16, 2011

Olivia Wilde plays a doctor on TV, and she has her own real-life opinions on U.S. healthcare system.

The "House" star told FOX411's Pop Tarts column that she's long been an advocate for universal health care in the United States, and gives the thumbs up to Vermont’s single-payer system.

“I really like what Vermont is doing. They’re doing a single-payer healthcare experiment right now, and it will be interesting to see how that goes,” Wilde told us at the 10th annual Chrysalis Butterfly Ball fundraising event in Los Angeles over the weekend.

Last month Vermont became the first state to move toward a single-payer health care system when its Democratic Governor Peter Shumlin signed the bill which aims to provide healthcare for all 620,000 state residents. The system, which was approved by the Democratic controlled House and Senate, would be set up so single a government-run organization will collect all healthcare fees, and pay out all healthcare costs.

How Libby, Montana, Got Medicare for All - Posted on Fire Dog Lake

2011-07-07T14:30:00.000-07:00

By: Kay Tillow Wednesday June 15, 2011 8:27 pm

In 2009 when the Washington beltway was tied up with the health care reform tussle, Montana Democratic Senator Max Baucus, chairman of the all powerful Senate Finance Committee, said everything was on the table–except for single payer. When doctors, nurses and others rose in his hearing to insist that single payer be included in the debate, Baucus had them arrested. As more stood up, Baucus could be heard on his open microphone saying, “We need more police.”

Yet when Senator Baucus needed a solution to a catastrophic health disaster in Libby, Montana, and surrounding Lincoln County, he turned to the nation’s single payer healthcare system, Medicare, to solve the problem.

Baucus’ problem was caused by a vermiculite mine that had spread deadly airborne asbestos killing hundreds and sickening thousands in Libby and northwest Montana. The W. R. Grace Company that owned the mine denied its connection to the massive levels of mesothelioma and asbestosis and dodged responsibility for this environmental and health disaster. When all law suits and legal avenues failed, Baucus turned to our country’s single payer plan, Medicare.

The single payer plan that Baucus kept off the table is now very much on the table in Libby. Unknown to most of the public, Baucus inserted a section into the health reform bill that covers the suffering people of Libby, Montana, not just the former miners but the whole community—all covered by Medicare.

* They don’t have to be 65 years old or more.
* They don’t have to wait until 2014 for the state exchanges.
* No ten year roll out—it’s immediate.
* They don’t have to purchase a plan—this is not a buy-in to Medicare—it’s free.
* They don’t have to be disabled for two years before they apply.
* They don’t have to go without care for three years until Medicaid expands.
* They don’t have to meet income tests.
* They don’t have to apply for a subsidy.
* They don’t have to pay a fine for failure to buy insurance.
* They don’t have to hope that the market will make a plan affordable.
* They don’t have to hide their pre-existing conditions.
* They don’t have to find a job that provides coverage.

Baucus inserted a clause in the Affordable Care Act to make special arrangements for them in Medicare, and he didn’t wait for any Congressional Budget Office scoring to do it.

Less than two months after the passage of the health reform bill on March 23, 2010, Nancy Berryhill of the Social Security Administration in Denver joined personally in setting up an office in Libby to sign up these newly eligible people. “This is a new thing,” Berryhill told the Missoulian. “No other group like this has ever been selected to receive Medicare.” Berryhill issued a nationwide alert to inform anyone who had lived or stayed in Lincoln County of their eligibility. She opened a storefront in Libby at the old downtown city hall where she signed up 60 people on the first day. She plastered the towns of Whitefish and Eureka with pamphlets explaining the program and added three new staffers to the office in Kalispell.

Berryhill said she did not know how much the care would cost. That kind of analysis was beyond her directive to sign the people up. There have been no reports of competition from the private for-profit Medicare Advantage plans. The sick are not profitable.

No one should begrudge the people of Lincoln County. The mine wastes were used as soil additives, home insulation, and even spread on the running tracks at local schools. Miners brought the carcinogens home on their clothes. The W. R. Grace Company dumped much of the clean up costs onto the federal government. A June 17, 2009, order by the Environmental Protection Agency, the first of its kind, declared Lincoln County a public health disaster. The Libby Medicare provision in the health reform law is based on the area covered by that EPA order.

Baucus gave his reasons to the New York Times for its only story on this unique benefit: “The People of Libby have been poisoned and have been dying for a decade. New residents continue to get sick all the time. Public health tragedies like this could happen in any town in America. We need this type of mechanism to help people when they need it most.”

Health tragedies are happening in every town. Over 51 million have no insurance. Over 45,000 uninsured people die needlessly each year. Employers are cutting coverage and dropping plans. States in economic crisis are slashing both Medicaid and their employees’ plans. Nothing in last year’s reform law will mitigate the skyrocketing costs. Most insurance is threadbare and doesn’t cover. More than 50% of us now go without necessary care. As Baucus said of Medicare, “We need this mechanism to help people when they need it most.” We all need it now.

Bill Clinton recently stated that the U. S. could give coverage to all for one trillion dollars a year less than we now pay if we adopted the system of any other advanced nation. (Unfortunately, he did not say this when it would have mattered most during the 1993 and 2009 health care reform debates.)

Other industrialized countries have found that to cover everyone for less they must remove the profit-making insurance companies. Congressman John Conyers has reintroduced HR 676, the Expanded and Improved Medicare for All Act, which does exactly that. There are 60 cosponsors. It would cover all medically necessary care for everyone including dental and drugs by cutting out the 30% waste and profits caused by the private insurers.

So as the Ryan Republicans try to destroy Medicare and far too many Democrats use the deficit excuse to suggest cuts in its benefits, let us counter with the Libby prescription to clean up the whole mess. Only a single payer, improved Medicare for All, can save and protect Medicare, rein in the costs, and give us universal coverage.

Medicare will celebrate its 46th birthday on July 30, 2011, and all are invited to join in the festivities. Medicare was passed in 1965 and implemented within less than a year. When we pass HR 676, this single payer bill, we can all be enrolled in the twinkling of an eye.

www.unionsforsinglepayer.org

All Unions Committee for Single Payer Health Care–HR 676

Dispatch from the Onion

2011-04-26T11:47:00.000-07:00

Mitt Romney Haunted By Past Of Trying To Help Uninsured Sick People

April 21, 2011

BELMONT, MA—Though Mitt Romney is considered to be a front runner for the 2012 Republican presidential nomination, the national spotlight has forced him to repeatedly confront a major skeleton in his political closet: that as governor of Massachusetts he once tried to help poor, uninsured sick people.

Romney, who signed the state's 2006 health care reform act, has said he "deeply regrets" giving people in poor physical and mental health the opportunity to seek medical attention, admitting that helping very sick people get better remains a dark cloud hovering over his political career, and his biggest obstacle to becoming president of the United States of America.

"Every day I am haunted by the fact that I gave impoverished Massachusetts citizens a chance to receive health care," Romney told reporters Wednesday, adding that he feels ashamed whenever he looks back at how he forged bipartisan support to help uninsured Americans afford medicine to cure their illnesses. "I'm only human, and I've made mistakes. None bigger, of course, than helping cancer patients receive chemotherapy treatments and making sure that those suffering from pediatric AIDS could obtain medications, but that's my cross to bear."

"My hope is that Republican voters will one day forgive me for making it easier for sick people—especially low-income sick people—to go to the hospital and see a doctor," Romney added. "It was wrong, and I'm sorry."

According to Romney, if he could do things over again, he would do everything he could to make certain that uninsured individuals got sicker and sicker until they died. Promising his days of trying to provide medical coverage to the gravely ill are behind him, Romney said that if elected president, he would never even think about increasing anyone's quality of life or trying to lower the infant mortality rate.

In addition, Romney repeatedly apologized for wanting to help people suffering from diabetes, Crohn's disease, and anemia.

"I don't know what got into me back then," Romney said. "Wanting to make sure people were able to have health insurance if they left their job. Providing a federally funded website so individuals could compare the costs of insurance providers. Making certain that somebody who earns less than 150 percent of the poverty level can receive the same health care coverage as me or any government official. All I can say is that I was young and immature, and I am not that person anymore."

"The only solace I can take is in the hope that some of the folks I helped were terminally ill patients who eventually withered away and died," Romney added.

Though Romney has apologized profusely, Beltway insiders said he would need to distance himself from his I-tried-to-help-sickpeople image. Sources noted that Romney's current promise to take away health care from anyone who can't afford it is a step in the right direction, but might not be enough.

"The major strike against Mitt Romney is that he not only tried to help people get medical care, he actually did help people get medical care," conservative columnist Jonah Goldberg said. "No other Republican in the field has that type of baggage. And in the end, in order to defeat President Obama, the GOP needs someone who has a track record of never wanting to help sick people."

Thus far, Romney is polling strongly in early primary states like New Hampshire and Iowa, but Republican strategists and voters agree that even in a general election, his sordid past would continue to dog him.

"I don't think I can vote for someone like that," Pennsylvania Republican Eric Tolbert said. "He says he's sorry, but how do I know that's the real Mitt Romney? What happens if he gets elected and tries to help sick people again?"

"I like Michele Bachmann now," Tolbert added. "Because what this country needs is a president who doesn't give a f*** about helping people."

St. Paul joins Minneapolis and Duluth in supporting the single payer Minnesota Health Plan

2011-04-22T16:21:00.000-07:00

St. Paul City Council supports single-payer health care in state

By Joe Kimball

MinnPost.com, April 21, 2011

The St. Paul City Council passed a resolution Wednesday supporting the Minnesota Health Plan, a proposal that's floating around the Legislature (but not yet close to passing) for single-payer, universal health care in the state.

The Minneapolis and Duluth city councils previously have voted to support the plan, too.

The St. Paul council will now urge its local legislators to support the plan, which purports to make “health care guaranteed and affordable for every Minnesotan.”

The "Whereas" clauses in the council resolution note:

* At some point in 2009 approximately 14 percent of St. Paul residents were without health insurance
* Approximately 71 percent of those without health insurance statewide are employed
* The Minnesota Health Plan would lower the cost of health care through a single-payer system for all Minnesota residents
* Lower premiums as a result of the Minnesota Health Plan would have a positive effect on the city’s budget
* The Minnesota Health Plan would reduce the need for unnecessary emergency room visits, thus reducing the related costs and relieving area hospitals of a burden that threatens solvency.

The Minnesota Universal Health Care Coalition, applauded the vote, noting: "It is time to break the link of health insurance to employment. It no longer works in a society and time where people change jobs frequently and work one or more part-time jobs. When health insurance is linked to employment, people often lose health insurance for themselves (and their families) when they need it most — when they are ill and unable to work."

PNHP Members Featured in the Bemidji Pioneer

2011-04-12T14:56:00.000-07:00

The Bemidji Pioneer, April 12, 2011

*Knowledge is power: BSU students host public forum on health care option*

By Anne Williams

After asking people in the area what they knew about single-payer health care, Bemidji State University student Karen Crabtree said she met several people who were unfamiliar with the topic.

So, for a social work class project, she and classmates Erica Jepson and Rebecca Baumgart set up a free public forum on single-payer health care Friday morning at Bemidji High School. More than 20 people attended.

The forum featured Molly Maas, family practice physician's assistant with Minneapolis-based Johnson Healthcare Associates Inc., and Dr. Ralph Bovard, a public health doctor at HealthPartners Specialty Center in St. Paul. Both are advocates of the organization Physicians for a National Health Program.

Single-payer health care refers to a system in which a government-run organization collects all health care fees and pays out all health care costs. It would be federally financed and administered by a single public insurer at the state or regional level, therefore eliminating the need for private insurance.

By setting up the public forum, the BSU students received credit toward a class requirement of 15 hours of volunteer community service. The requirement encourages students to take part in a service learning project. Last February, a different group of social work students hosted a legislative meeting on the issue of mental health.

"We thought it would be good to educate people because anyone we talked to never heard about (single-payer health care) before," Crabtree said.

Baumgart said she became interested in hosting the forum after hearing her peers talk about the single-payer health care option. She asked if she could be a part of their group so she could learn more about it.

Jepson said bringing in speakers from the Twin Cities was "easy," and said she felt it was important the community be educated about health care options.

"I think it went really well," Jepson said. "We were expecting anywhere from five to 50 people. We really had no idea how many people to expect. I was just really happy with the turnout."

General Practice 3, which is the class the BSU students are enrolled in, teaches social work students on community organizing and how to create change within a community. Emphasis also is placed on how to advocate for a cause.

"Social work works a lot with individuals, groups and communities and so this is one option we wanted to educate people about," Jepson said.

Cheryl Byers, associate professor of social work at BSU, said the course offers students the opportunity to learn outside the classroom in neighborhoods.

"Much of what social workers do is community education on personal issues facing communities," Byers said. "This group of students wanted to educate people up here about this option."

Star Tribune March 17: Cut out the insurance middle men.

2011-03-17T10:05:00.000-07:00

Here's a bold action: Cut out the middle men

I agree with one point made by Julie Brunner ("Three bold actions to control costs in health care," March 15).

She is plainly interested in keeping the insurance industry's profits rolling into her coffers from the money the Legislature allocates to have the industry "manage" costs on low-income patients.But she says that "good public policy can help manage costs." Indeed!That's why I support recent bills in the Legislature that put aggressive controls and strict scrutiny on health insurance operations to correct a decades-long lack of transparency.

Better yet, Connecticut recently mandated that the insurers be cut off from "managing" taxpayer dollars for poor patients.That state is anticipating significant cost savings by simply paying doctors directly. No more hiding of how many taxpayers dollars are kept by the "managers" instead of paying for treatments of low-income patients. Minnesota should convert to such a system. Cutting out the managed-care middle men is the bold action I prefer from our Legislature.

DIANE J. PETERSON, WHITE BEAR LAKE

Our member, Dr. Kathleen Hall, rallies in support of Wisconsin workers at the capitol in St Paul

2011-03-01T13:39:00.000-08:00

Dr. Kathleen Hall MD, Minnesota Physician Rally for The American Dream in support of Wisconsin Public Employees

St Paul State Capital Building grounds
February 26, 2011

Thank you for allowing me to share OUR common space and get up here for MY soapbox moment. It's good for us to be together and I want you to know, I feel better already. And I hope my words will speak your anger; and inspire your ambition and passion.

I know you are struggling like I am daily to find truth tellers in the media and government. Enough!! we have had enough of the empty words, and deceptive arguments From Fox to NPR and the New York Times, while the heartless, polluting influence peddlers avoid truth, refuse fair share taxes and hire legal and PR teams and private police, if necessary, to protect them against laws and fairness in business, government and elections; THIS United States democracy has truly become a game of winner takes all. Decisions have been made at many levels of government to put corporate rights before human rights; (privacy is a perfect example) and as we know, life is far worse for average citizens of some countries that we have ensnared in our form of economic and political “progress.”

But today, Let's look at each other here and across the nation and realize this TRUTH.

It has also been hard to find HOPE when our modest demands for a health and retirement system that caresfor people are drowned out by capitalism's enshrined rights to quarterly profits above all else.

As if anyone, anywhere has to explain what it means to be human!
Do we need to explain to our government over and over again why we support the struggle for humanity as we ourselves grow old, carry illness, or exhaust ourselves to raise a healthy, educated, caring family.??
When we see healthy bodies broken by injury from heavy or monotonous work can we possibly, quietly stand by??
When we daily witness individual and institutional hatred or disregard toward the rights of women, gays, Muslims, atheists, racial identity of any kind or even community organizers, like ACORN, must we be satisfied with such feeble progress?

But today, we can meet each other and realize our common HOPE .
I also know you are seeking courage for appropriate, just action to deal with our entrenched problems. We are the stewards of this miraculous planet, we are the teachers and the wise elders; we are also the sick, we are the poor, we are struck with overwhelming despair; if not today, possibly tomorrow.

So let us find in ourselves a new boldness, a new courage. We are indeed awakened by the spectacular struggle for freedom in Egypt, and across the region. We are enraged by the colossal theft of our nation's wealth by Wall Street and global banksters. We stand in solidarity with Wisconsin public employees' rights. Now, here, we climb upon the shoulders of our Minnesota workers, union or non union, Minnesota students, teachers, nurses, fire and police officers, public employees and union leaders, uplifted further by honest accounts of our dark and bright American history: genocide, imperialism, worker rights as well as peaceful revolution.

Let us shout, along with our Minnesota 5thRepresentative Keith Ellison “Every body counts, Everybody Matters. “

Let us recall Daniel Ellsberg, a courageous journalist who exposed Vietnam War lies and now brave defender of Julian Assange, Private Bradley Manning and truth in government and journalism. Daniel Ellsberg challenges us - “Courage is Contagious.”

Let's shout against corruption. Let's drum our feet for our fellow man. Let's walk our neighborhoods and workplaces; fill the public spaces with placards to speak our thoughtful outrage.

Let's reclaim our power through transparent government able to uphold fair elections and encourage full participation in the U.S. and around the world.

I am a Minnesota Medical doctor and primary care provider; I support a single payer health plan for our state, the Minnesota Health Plan sponsored by Senator John Marty. I hope you will check out this opportunity for us to cover all Minnesotans, including dental health and mental health care and reduce the cost of healthcare greatly. The MHP will put priority into healthy living, healthy resources and reduce the overall burden of medical costs. This plan will also be a great opportunity for doctors, nurses, health researchers and healthy policy workers to look at health of the community more broadly; I am convinced that the best work of doctoring is in the community setting where we think about health as it relates to all other aspects of our economy. It keeps me awake at night, in a good way.

So today, let's really look at each other, and with a high five, fist bump or warm embrace realize our power is truly in each other, thank you.

PNHP letter to Governor Dayton

2011-02-14T13:42:00.000-08:00

February 9, 2011

Dear Governor Dayton,

We write to you representing the more than 600 Minnesota physicians of the Minnesota chapter of Physicians for a National Health Program. First, thank you for serving our state as governor. We are thrilled you were elected! PNHP is a national non-profit research and education organization of physicians and healthcare providers who support a single-payer healthcare system, which we know you also favor. The single-payer option provides the means to efficiently and effectively cover all patients while restraining healthcare costs. However, today we write to you about a different, but related matter.

As physicians, we welcome the Medicaid expansion occurring in Minnesota, and we applaud your executive order bringing 95,000 more patients into the program. For these patients, this will lead to improved health, and it will even save lives since we know uninsurance can lead to death. However, we are deeply concerned about the decision to disperse these enrollees into plans operated by private managed care insurers. At this time of severe state budget shortfall, prohibiting HMO participation in our public programs would provide a prime opportunity to increase efficiency and cut costs. While the HMOs claim their involvement will save the state money, there is no evidence to support this. Due to the lack of transparency surrounding how HMOs currently spend our public dollars, we do not know how much privatization is costing the state. However, it is reasonable to assume that outsourcing Medicaid contracts to private insurers is a major cost driver, and its elimination will lead to savings and longer-term sustainability for the patients who need this coverage. At the federal level, there is clear evidence that allowing private insurers to administer Medicare (ie. the Medicare Advantage program) raises costs about 14% more than standard Medicare.

Just last month, the Star Tribune reported our state's 12 HMOs earned $103.1 million in net income in 2009 from their involvement in the three public Minnesota health care programs. The same article stated the public programs provide more profit for HMOs than their commercial business! This information combined with the lower Medicaid reimbursement for providers offer indirect evidence of the waste involved in continuing to utilize this extra layer of bureaucracy. We firmly believe public dollars should be spent to benefit Minnesota patients who need healthcare, not to increase corporate profits.

We ask that you please enroll the 95,000 patients newly eligible for Medical Assistance directly through the Department of Human Services rather than through expensive contracts with insurance companies so that Minnesotans’ tax dollars will be spent on healthcare and not administrative waste. We see no benefit for our patients in doing otherwise. As physicians providing the day-to-day health care of Minnesota’s patients, we assure you the private insurance industry does not help us to diagnose, treat, or prevent illness. Thank you in advance for your consideration of our request.

Respectfully,

Ann Settgast, MD (612-387-7914) and Elizabeth Frost, MD (612-724-3995)
Co-chairs of the Minnesota chapter of PNHP

cc: Ed Ehlinger, MD, MPH
Lucinda Jesson, JD
Lt Governor Yvonne Prettner Solon

Op- Ed in Star Tribune February 8, 2011

2011-02-08T11:03:00.000-08:00

Rationing is not the only alternative - our health care has been 'privatized' by profit-seekers. We can target them.

By DR. RALPH S. BOVARD

"Of all the forms of inequality, injustice in health care is the most shocking and inhumane."
THE REV. MARTIN LUTHER KING JR.

Commentary

In a recent commentary (Opinion Exchange, Jan. 23), Dr. Virginia Dale told readers that they must choose between universal health insurance and rationing.

As a physician, I agree that we must get health care costs down if we're going to achieve universal coverage, but I strongly disagree that the only way to do it is to ration.

There is another viable and proven option: a single-payer or regulated multipayer health care system, such as exists in every nation in the Organization for Economic Co-operation & Development except the United States and Mexico.

The average OECD nation spends 6 percent to 10 percent of GDP on health care; we spend 17 percent. Their per-person spending averages $3,000 to $5,000 a year, compared with $8,000 in the United States.

We could save huge sums -- more than enough to insure the uninsured -- by cutting the administrative waste and executive profit in our system, and by collective bargaining to lower the price at which drugs, devices and medical services are sold in this country.

The true "elephant in the room," to use Dale's metaphor, is the fact that our health care system has been "privatized" by an insurance industry more intent on lining its pockets than on ensuring that the American people get the public service and care that they pay for.

HMOs reap a hugely profitable business by denying and limiting care (a more severe form of rationing than exists in any other OECD nation) and by taking upward of 20 percent from every premium dollar and even tax-funded programs to pay excessive salaries to people who provide no patient care whatsoever.

The 80 percent they are obligated to spend on your health care is called their medical loss ratio. Nice, huh?

In a recent survey, 23 percent of Americans felt they were inappropriately denied care, compared with 4 percent of Canadians.

It was revealing to look at the political cartoons in the same Opinion Exchange section in which Dale's commentary appeared.

One showed an American with a letter labeled "DENIED" and a caption stating: "50% of all Americans under 65 have preexisting medical conditions that may prevent them from getting insurance ... ."

The next image showed a smirking lawmaker in his Washington office with his feet up. The caption: "100% of the 249 congressmen voting to repeal health care have their health care plan paid for by those same Americans ... ."

And that is the truth.

The more somber note is that even if the American depicted in that cartoon has health coverage, with the loss of a job or the onset of a major illness that causes the loss of health benefits, he or she may easily join the millions each year who are bankrupted by medical bills.

That doesn't happen under universal coverage or a single-payer system.

Providing universal health care is not socialistic. It is the pooling of resources by a highly ordered social structure to provide for the common good. Some call it civilization.

Think about it: This is how we fund all of our public services, including fire, police, water, education, libraries, sewage, parks and recreation, and highways. Health care would seem the most essential of public services.

Why do some people call it "socialized" (like it is a dirty word) only when we apply the term to medical care, but not to the other public services that we fund and use daily?

Tommy Douglas, who was voted the "Greatest Canadian" in 2005, nearly 20 years after his death, for bringing a universal health care system to his nation, was a humble clergyman dedicated to the importance of economic democracy and the "social gospel."

If only our politicians had an ounce of his moral integrity and commitment to serving the nation's best interests.

It is highly misleading to tell the public that our choice is between continued high numbers of uninsured people or rationing.

Our choice is continued high numbers of the uninsured vs. cutting the enormous administrative waste and corporate profit out of our system with a single-payer system that allows us to lower the prices we pay for medical services, drugs and devices to levels paid in other countries.

As taxpayers and voters, we need to demand accountability, and we are not getting it from our current HMO system. The industry has had more than 20 years to get it right and has failed miserably to do so.

We are getting fleeced. As Paul Wellstone said: "We all do better when we all do better" -- not when the CEOs and executives of medical care organizations do obscenely better at the expense of our national health.

Ralph S. Bovard is a steering-committee member of Physicians for a National Health Plan-Minnesota Chapter.

Star Tribune Editorial asks if Outsourcing Public Health Programs is a Good Idea

2011-02-03T08:56:00.000-08:00

Editorial: Push to harness state Medicaid costs
Cost-cutting report didn't disclose plans' business interests.

Last update: January 30, 2011 - 4:24 PM

Star Tribune

A group of leading Minnesota insurers and providers deserve credit for voluntarily tackling one of the state's most daunting budget challenges: reining in the runaway cost of state medical programs for the elderly, the disabled and the poor.

While the group offered up clear-eyed, if painful, prescriptions in a report last week -- namely, benefit cuts and tax increases on tobacco and alcohol -- it undermined its hard work by not addressing these important questions:

•How much would the health plans profit from their proposed shift of more Medicaid patients into insurer-run managed-care programs?

•Could the health plans themselves trim operational or administrative costs to provide savings to the state?

Before Gov. Mark Dayton and the Legislature act on any of this report's recommendations -- before policymakers turn to cutting benefits for our most vulnerable population -- every option must be explored. Nonprofit insurers are fair game for more scrutiny.

In particular, legislators need to determine whether outsourcing public health program patients to insurers -- a $3.1-billion-a-year business in Minnesota -- best serves patients and the state, and whether they have enough information to make that decision.

Lawmakers should also join the push by Rep. Jim Abeler, R-Anoka, to determine whether competitive bidding by insurers for this business could help drive down costs.

Insurers said this week that they are open to that idea.

The insurers' self-interested recommendation to put more disabled Medicaid patients into managed care should bring to a head a long-simmering debate at the Capitol over whether the plans provide enough information on how they spend program funds.

The Minnesota Medical Association and legislators such as Sen. John Marty, DFL-Roseville, have argued for more disclosure.

Insurers understandably point to the reams of information they must provide. A quick analysis by an editorial writer found 1,094 required annual reports or information disclosures.

The real question is whether the right information is disclosed or made public so that lawmakers and consumers can judge how the money has been spent. Last week's report and the state's $6.2 billion deficit lend urgency to the issue.

Considering that the state has outsourced management of some Medicaid patients for nearly 20 years, it's shocking that there has been no deep, comprehensive analysis of whether something that was supposed to be a pilot program works in terms of cost and quality.

It's even more unsettling considering how much money is now spent on managed-care programs.

According to the report, 61 percent of Minnesota's Medicaid enrollees were in managed care as of June 2009. In 2010, Minnesota plans were paid $3.1 billion in state and federal funds to manage public health programs.

Fee-for-service spending for public patients totaled $4.8 billion.

Administering state government plans is now a bigger part of insurers' portfolios than is commercial business. In 2009, it was also more profitable -- something the report should have disclosed.

A Star Tribune analysis last week found that plans with state public health program enrollees earned a returns of 4.1 percent vs. 1.6 percent for commercial business, though they also lost money on MinnesotaCare and General Assistance Medical Care.

An overdue report from the state Department of Human Services may soon answer key questions about health plans' disclosure and spending on public managed care programs.

If that analysis isn't satisfactory, legislators need to consider a much broader audit.

On Deprivatizing our Public Dollars: Senator John Marty

2011-01-26T19:07:00.000-08:00

Who's Minding the Store? Billions in Contracts without Competitive Bids or Auditing
by Senator John Marty
December 15, 2010

Over the years, many items in the state budget have been scrutinized with a fine-tooth comb. Even relatively small expenditures and contracts are reviewed to see if there is a way to save money or perform the task more efficiently.

Sometimes, however, there are big-ticket items that get nowhere near the scrutiny they deserve.

I receive looks of disbelief, when I tell people at the capitol that there is one area of the budget where huge contracts - totaling over $3,000,000,000 per year - are made, without competitive bidding or auditing, and with minimal reporting.

Unlike all other parts of the budget, these contract holders are not required to use the standard "GAAP" (Generally Accepted Accounting Principles), that businesses, accounting firms, and other government agencies use. And, the system is rigged in a manner that whatever the contractors spend, the state will pay the bills.

Where is this shameful lack of oversight? It is in our public health programs, including Medicaid and MinnesotaCare. These are important programs, providing health care for hundreds of thousands of people, yet nobody is watching the store. We know how much the state pays health plans to provide care, but have no way of knowing how much money is going to the people who need care and how much is eaten up by insurance company overhead. The state blindly accepts whatever numbers the HMOs provide.

Now, with a $6 billion deficit, we can no longer stick our heads in the sand.

This is not meant to vilify health plans. There are good people working for them, and they help people access medical care. But that doesn't mean that we should leave the cash register open, and blindly let them take as much money as they want.

This situation occurred as the state privatized delivery of health care for low income and disabled people over the last twenty years. It started as a pilot project on the theory that private insurance companies could deliver health care at a lower cost. Instead of paying medical bills directly, Minnesota would contract with Health Maintenance Organizations (HMOs) to provide care for low-income people.

The pilot project was to be evaluated by the Department of Human Services (DHS), but that was never really done. In 1993, the Department conducted a study to find if HMOs were saving money, but the study was hampered by a lack of data from the HMOs. Even so, the study raised questions about whether the state was getting its money's worth. Rather than demand more data from the insurance companies, the agency buried the study. A front-page newspaper story at the time was titled, "Study Shelved After HMOs Complained." The story reported that DHS "reassigned the researcher.and abolished his job."

Instead of trying to learn whether the HMOs were spending money appropriately, the state brushed aside concerns and continued turning more public business over to them.

Despite two Legislative Auditor reports calling for greater scrutiny, DHS has not conducted any audits.

In these contracts, Minnesota allows the HMOs to define what they count as administrative costs and what they count as health care, enabling them to hide spending on administrative overhead. Even more surprising, the state covers all those costs, no matter how great they are. The director of these contracts at DHS said the administration believes the state must cover all of the costs, including the administrative costs, so that the HMOs will be "actuarially sound."

During the 2010 session we offered legislation that would require the HMOs to meet a medical "loss ratio," refunding money to the state if they spent too much on administrative overhead. But under the current irresponsible method of contracting with the health plans, the administration claims that if the HMOs broke the law and were required to pay a penalty, the taxpayers would have to reimburse even the costs of those fines!

As the state was cutting services to people who are sick and disabled, the HMOs made - even after unlimited administrative expenses - over $130 million in profit just from these public contracts in 2009 (technically they are "earnings," not profits, because the HMOs are non-profit). It's time that we show more interest in the financial soundness of the state budget than in higher profits for the insurance companies.

The 2010 legislation contained a provision that would require HMOs to use standard accounting practices like every other government contract requires, and be subject to audits. A Pawlenty administration official said that requiring the insurance companies to account for their spending this way would cost more, which the state would have to pay for. In other words, the administration suggests that taking off the blindfold and finding out whether we are being shortchanged, might cost us more money. That's absurd.

Unfortunately, pressure from the HMOs succeeded in blocking this legislation, so there is still no oversight of this $3 billion in public contracts.

David Feinwachs, an attorney for the Minnesota Hospital Association, is spearheading the effort to bring greater transparency and accountability to these programs because of his concern over the waste of taxpayer money. Although savings from this reform would benefit the hospitals, Feinwachs was recently fired after 30 years at the association, apparently because the HMOs put pressure on the Hospital Association to silence him.

This scandal is finally being exposed, with a TV investigative report and other media coverage. Even in good financial times, waste of public money is unacceptable. In times of financial crisis it is inexcusable.

Fortunately, there will be a new administration in just a few weeks. The Dayton administration has a great opportunity to open the books and provide some financial accountability here.

Dave Feinwachs in MinnPost: Where are our public dollars going?

2011-01-26T19:02:00.001-08:00

Several important questions left unanswered about how state medical-assistance money is spent.

By David Feinwachs | Tuesday, Jan. 4, 2011

On Dec. 23, 2010, Nancy Feldman, president and CEO of UCare, wrote to respond to a Dec. 20 MinnPost commentary by Sen. John Marty titled "Who's minding the store? Billions in Minnesota contracts escape competitive bids, auditing." In her article, ("It's inaccurate to say Minnesota health plans not audited by state, federal agencies"), Feldman claims that there is no reason to be concerned about the state's payment of some $3 billion to health plans who are vendors to our prepaid medical assistance program (PMAP). She notes that there are many requirements pertaining to the auditing of health plan finances.

This, of course, is true — but completely misses the mark and is unresponsive to the issue of how our tax-funded PMAP dollars are spent. There is no auditing that addresses this critical issue. I am the person Marty referenced in his article as spearheading efforts to bring greater transparency and accountability to these programs. As Marty indicated, I and others have been asking a series of simple and straightforward questions of our PMAP vendors. These questions are: 1.What did you do with the public money that was given to you? 2. What did you buy? 3. What did you pay for what you bought? 4. Who did you buy it from? 5. Most importantly, how much did you keep for yourself?

Not one of the reports or audits that Feldman references in her article in any way speaks to any of these questions. This is precisely the point we are trying to make. Insurance companies, doing the business of insurance, are extensively audited and provide numerous reports. However, when insurance companies act as administrators and do not assume insurance risk, do not issue insurance policies but rather function as disbursement agents for government programs, there are in fact no audits for this activity.

Given the amount of money that the state of Minnesota devotes to these programs and the fact that this disbursement function appears to be one of the most, if not the most profitable activity for health plans; shouldn't the state and its taxpayers know how and for what this money is being spent?

I, and others, have looked at the reports and the websites as well as the functions of the various state agencies that Feldman references, and I am unable to find anything that addresses the questions we are asking. There is nothing irresponsible about demanding answers to these questions. In fact, it would be irresponsible not to ask, and grossly irresponsible not to demand answers.

The Wall Street Journal (Dec. 29, 2010) carried the headline "Insurers bid for state Medicaid plans." According to the Journal: "Health insurers are preparing to capitalize on $40 billion of new opportunities to run privately managed Medicaid plans for the states, which would position insurers to benefit from the health overhauls expansion of Medicaid in 2014." According to the Journal, Gail Boudreaux, UnitedHealth's executive vice president, told investors last month: "The Medicaid space is a significant long-term growth opportunity for us."

Marty was recently quoted as suggesting that "our relationship to these health plan PMAP vendors is akin to leaving the cash register drawer open and allowing them to take whatever they want." The senator's characterization is completely accurate. Now the PMAP vendors want the elderly and disabled moved into this opaque and unaccountable system. Thus, it appears that the health plans not only want the cash register drawer left open, they now want the keys to the store.

Shouldn't we know what they do with the money we currently give them before we decide to hand everything over including our most vulnerable populations?

Single Payer in Vermont? Possibly, if states are allowed to innovate.

2010-11-28T19:25:00.000-08:00

Have Scott Brown and Ron Wyden figured out the way
forward on health care?

By Ezra Klein
Washington Post, November 18, 2010

The GOP’s slogan on health-care reform has, till now, been “repeal and replace.” But they don’t have the votes for either. What they might have the votes for is reform that, maybe, one day, if all goes well, could lead to replacement. And, believe it or not, liberals might be able to get on board with this strategy, too.

This morning, Sens. Ron Wyden (D-Ore.) and Scott Brown (R-Mass.) introduced the “Empowering States to Innovate Act.” The legislation would allow states to develop their own health-care reform proposals that would preempt the federal government’s effort. If a state can think of a plan that covers as many people, with as comprehensive insurance, at as low a cost, without adding to the deficit, the state can get the money the federal government would’ve given it for health-care reform but be freed from the individual mandate, the exchanges, the insurance requirements, the subsidy scheme and pretty much everything else in the bill.

Wyden, with the help of Sen. Bernie Sanders (I-Vt.), was able to build a version of this exemption into the original health-care reform bill, but for various reasons, was forced to accept a starting date of 2017 -- three years after the Patient Protection and Affordable Care Act goes into effect. The Wyden/Brown legislation would allow states to propose their alternatives now and start implementing them in 2014, rather than wasting time and money setting up a federal structure that they don’t plan to use.

In general, giving the states a freer hand is an approach associated with conservatives. On Wednesday, Sen. Orrin Hatch (R-Utah) sent a letter to the Republican Governors Association advocating exactly that. “The most effective path to sustainable health care reform runs through the states, not Washington,” he wrote. If it’s really the case that the states can do health reform better, Wyden and Brown are giving them a chance to prove it.

One state that wants to prove it is Sanders’s Vermont. “As a single-payer advocate,” he says, “I believe that at the end of the day, if a state goes forward and passes an effective single-payer program, it will demonstrate that you can provide quality health care to every man, woman and child in a more cost effective way. So I wanted to make sure that states have that option.” Vermont’s governor-elect, Peter Shumlin, is on the same page. “Vermont needs a single-payer system,” he said during the campaign.

Single-payer, of course, is even more objectionable to conservatives than the existing health-care law. But that’s the beauty of this option: It allows the liberal states to go their way, the conservative states to go their way, and then lets the country judge the results. If Vermont’s single-payer system provides universal care at a low, low cost, then maybe that nudges California -- which is facing massive budget deficits -- off the fence. After all, if the state spends less than the government sends it, it gets to keep the remainder. It’s a nice incentive for cost control. And if it works, how long will more conservative states wait before they decide to take part in the savings, too?

But conservatives don’t believe that will happen. They think a consumer-directed system will offer higher-quality health care at a lower price, and with more choice. If Tennessee takes that route and outperforms Vermont, it’ll be their system that spreads across the land.
The funny thing about the health-care reform debate is that for all the arguing, everyone says they’re in favor of it. The GOP’s "Pledge to America," for instance, promises that the Republicans will repeal Obama’s health-care law “and put in place real reform.” Shumlin, too, promises Vermonters that he’ll produce “real reform.” The problem is that no one seems able to agree on what real reform is. The beauty of Wyden and Brown’s approach is that the country doesn’t have to choose.

“Real reform,” in their world, is whatever works best to cover everyone at the lowest cost. Utah and California can go their separate ways, and the other states can judge the victor based on results, not ideology.

That an Oregonian and a Bay Stater are behind this legislation is perhaps no surprise: Wyden’s home state of Oregon just reelected John Kitzhaber, a former emergency-room doctor who pioneered a radical set of Medicaid reforms when he served as governor in the late '90s and early Aughts. Brown’s constituents in Massachusetts still overwhelmingly support the system that then-Gov. Mitt Romney signed into law in 2005 -- and that then-state Sen. Scott Brown voted for. “There’ve been a handful of states that’ve tried for some time to break out from the cookie-cutter molds,” says Wyden, and their senators want to protect their innovations.

The Obama administration is cautiously supportive. "The cliche about states as the laboratories of democracy is not just a cliche," CMS director Don Berwick told Wyden at a Finance Committee hearing. "It’s true." The question is whether the rest of Congress will agree. Liberal Democrats might shiver at the thought of conservative reform plans, while conservative Democrats might worry about the possibilities of public options and single payer. Republicans may worry that attempts to reform the health-care law will read to their base as if they’re making peace with it rather than working to repeal it. And both sides will face pressure from various industries involved in the provision of medical services that fear -- and will likely fight -- the prospect of reforms they can’t anticipate, and may not benefit from.

But those who hide from this proposal are fundamentally signaling a lack of faith in their own ideas. What Wyden and Brown are offering is the chance for the various sides to prove that they’re right. If the industry players make the system work better, then the states that prize their involvement will prosper. If conservative solutions are more efficient, that will be clear when their beneficiaries save money. If liberal ideas really work better, it’s time we found out. Forget repeal and replace, or even reform and replace. How about compete and succeed?

From Austin Minnesota

2010-11-20T14:56:00.000-08:00

Senator John Marty and Dr. Brian Yablon recently gave a talk at an event in Austin.

It was covered in a nice piece by the Austin Daily Herald here. The event was organized by the Minnesota Universal Health Care Coalition.

September Meeting Agenda

2010-10-26T19:36:00.000-07:00

1. Introductions:

Members present: David Mair, Gillian Schivone, Elizabeth Frost, Ann Settgast, Chuck Sawyer, Stu Hanson, Dave Dvorak, Jack Garland, Leda Barnes, Paul Pentel, Vince Hunt, Ken Joslyn, Jim Letts, Chris Reif, Jim Jordan, Ralph Bovard, John Salchert, Faith Kidder

2. PNHP-related revisions to the MHP – Ann to lead discussion

a. Chapter discussion re: alternative care coverage (PA and CA cover “…those shown by the NIH Division of Complementary and Alternative medicine to be safe and effective…”).

3. Cost study – Elizabeth to lead discussion.

4. Psychiatry outreach – David Mair/Lisa Capell

5. Discussion of “moral high ground” by Ken Joslyn

6. Governor race - positions of Governor candidates.

7. Treasurer report – Jim Letts

8. Summer report
- Interns: Kathy Mahan (now, 2nd year medical student) + James Ortmann (now, 1rs year law student)
- State Fair
- Speaking engagements

9. Upcoming events:
a. MMA meeting Sept 16 & 17. Resolution on the MHP to be introduced.

b. Annual Meeting, Saturday, Nov 6, "From PPACA to Single Payer: Next Steps for Single Payer Activists in the Wake of the Obama Health Plan" featuring Amy Goodman, host of Democracy Now
- Sheraton Denver Downtown Hotel, 1550 Court Place, Denver. Reserve a room by calling 800-325-3535 and
mentioning PNHP ($149 single/double, $125 senior rate) by October 5.
- Leadership Training begins at 1pm on Nov 5

c. Upcoming talks: see below

2010 PNHP Speaking engagements

Jan – Frost, Mair, Hasti, Peterson, Settgast at PNHP Speakers Training
Jan – Settgast, Nilles to MHP Forum at Holy Nativity Lutheran Church, New Hope
Feb – Yablon to attendees at a lobbying/house party event for the MHP, Eagan
Feb – Maas, Frost at “Politics and a Pint”, St. John’s University, Collegeville, MN
March – Mair, Lange to Minnesota Academy of Family Practice legislative committee
April – Settgast to SW students at the SW Day at the Capitol, St Paul
April – Frost, Gamm, Hasti, Lange at table at MAFP Spring Refresher, Minneapolis
April – Frost, Settgast at PNHP Speakers Training
April – Frost, Settgast on Suburban Community Channel’s Dianna Longrie show
June – Frost, Sullivan on ‘Of the People’ James Mayer’s radio show
July – DeBrule at DFL picnic, St. James
Aug – Gamm to Methodist Family Medicine residency, St Louis Park
Aug – Mair at COACT Farm Picnic, Pierz
Sept 7 – Gamm with Senator Marty to Park Nicollet executive group, St Louis Park
Sept 10 – Mair, Schivone, Mahan at table at Medical Student Interest Fair, Minneapolis
Sept 14– Mair, Ortmann to dentist study group, St Paul
Sept 15 – Settgast at Rochester Senate District house party, Rochester
Sept 16 – Mair at SD 54 meeting, Roseville
Sept 17 – Yablon to St. Joe’s Family Medicine residency, St Paul
Oct 22 - Frost to St. John's Family Medicine residency, St Paul
Oct 25 – Letts to United Family Medicine residency, St Paul
Oct 25 - Mair to speak to U of M Medical Students
Nov 9 – Pentel to Smiley’s Clinic Family Medicine residency, Minnneapolis

Star Tribune Opinion October 5, 2010

2010-10-12T20:11:00.000-07:00

Minneapolis Star Tribune, Oct. 5, 2010

Insurance is a strange model for health care

It's meant for life's uncertainties, but illness is actually a pretty sure thing.

By EDWARD P. EHLINGER, M.D.

For once I agree with Jason Lewis -- sort of. Using an insurance model to cover preexisting health conditions doesn't make any sense, as he says ("Government health care is on the way," Oct. 1).

But I would take his notion a step further. Using an insurance model for basic and essential health care also doesn't make any sense.

Insurance is a great mechanism that people can use to offset their risk of losing some material thing of great value like their house, boat, car or jewelry. It can also be used to protect a valuable personal occupational asset like a voice for an opera singer, a hand for a surgeon or a knee for a football player. And it can be useful in providing protection from a singular catastrophic event like a malpractice suit or the premature loss of life.

But for something that is predictable, ongoing, needed by everyone, or necessary for the welfare of our community, an insurance model makes absolutely no sense. That's why we don't use an insurance model to provide police or fire services or to provide an education to our children. For these we use the tax model. Basic essential health care should also be in this category.

We know that almost everyone will eventually need some health care and much of it will be ongoing. For a defined population, the health care needs are predictable, and we know that the health of individuals affects the overall welfare of our community. In addition, most believe that people should get treated for illnesses, diseases and injuries that might befall them and expect that everyone should have access to preventive services like prenatal care and immunizations that make our communities a healthier and better place.

Our insurance-based model doesn't match our societal needs and expectations in many respects. It denies coverage to those who need care the most. Since health and income are related, it charges more for the people who can least afford it. It encourages a link with employment that has numerous negative side effects. By its reimbursement mechanism, our insurance-based health care system has also fostered maldistribution of resources between primary and specialty care.

The proof of the folly of using an insurance-based model for health care is that, while we have the most expensive health care system in the world, approximately one-third of Americans are uninsured or inadequately insured. The consequences of this are that health status indicators for the United States are far from the best.

Lewis suggests that "most (perhaps not all) existing conditions can find coverage already -- for a price." That is true, but a free-market approach puts care out of reach for many of those who need it the most. Historically, it was the failure of the free-market approach that prompted us to go to an employer-linked health insurance-based model in the first place.

When health care costs, access to care and health status concerns became a major issue in the 1940s, the United States had a chance to implement a more rational tax-based health care financing system. However, the country did not have the political will to implement such a system and opted for the insurance-based model we have today. In the 1960s, the failure of that system for the elderly prompted the passage of Medicare, which has dramatically improved both the physical and economic health of senior citizens.

Lewis also rails against an entitlement mentality. As members of a civilized society, there are lots of things we should feel entitled to -- police and fire protection, clean air and water, a functional electrical grid, basic education, safe borders, stable currency, etc. It's logical to me and to most Americans that access to basic and essential health services should also be one of those entitlements.

With the continued problems of our insurance-based model of health care financing, perhaps it's time to implement an improved Medicare-for-all approach. Then preexisting conditions would not be only redundant, they would be irrelevant.

Edward P. Ehlinger is a Minneapolis physician.

Star Tribune Opinion September 15, 2010

2010-10-12T20:01:00.000-07:00

John M. Bryson: My experience with British health care

It worked very well on a personal level, and is effective overall. So why the suspicion here at home?

By JOHN M. BRYSON

Last update: September 15, 2010 - 6:44 PM

The emotional debates over health care reform in the United States last fall and again this election season are puzzling to my wife and me. We are professors who were on sabbatical leave in London from August 2009 through August 2010, so we missed last year's debates. While in the United Kingdom we were automatically covered by the National Health Service.

For us, the NHS worked quite well. One example: The week we arrived in London we went to the NHS Choices website (www.nhs.uk), punched in our postal code and immediately got a listing of local clinics. We chose the closest one, stopped by and filled out two short forms, let the reception staff make copies of our passports and visas, and that was it: We were covered. None of this business about needing coverage by an employer's plan, no concerns about preexisting conditions (we both have them), no rationing by what we could afford, and no excessive paperwork. All that mattered was that we were in the UK. We had a right to be taken care of by the NHS.

Another example: I badly sprained my back one evening. The next morning I was in severe pain and couldn't get out of bed. I called the clinic, and within two minutes a doctor was on the phone. He asked if I could come in immediately, but I was in too much pain. He offered to make a house call if I could wait for a few hours. I wondered if he might do something over the phone, so he ran me through a series of questions and little exercises to make sure he understood what was wrong. He then wrote prescriptions for painkillers and a muscle relaxant. My wife picked them up, filled them at a local pharmacy (at no cost because I am over 60) and was home within the hour. I was up and walking a few hours later and was fully better in a few weeks. How many times has anyone in the United States spoken to a doctor within two minutes of calling and had the same doctor offer to make a house call?

The British have a mostly socialized health care system, meaning they handle both finance and production through the government. In the United States, we mostly socialize risk through health care insurance paid for by employer, employee, consumer and government contributions, but we also socialize much health care financing; some estimate that government pays for about 50 percent of all health care costs. We leave production mostly to businesses and nonprofits, but there is also a lot of government provision through public hospitals and clinics. The Veterans Affairs health care system is as close as we get to the NHS.

What do the British get for their money? Using 2009 figures, they spend 9 percent of GDP on health care; we spend more than 17 percent. They spend $3,150 per capita on health care each year ($2,600 of which is public money); we spend $7,500 per capita ($3,500 of which is public money). They cover everyone (even visitors from abroad); we have a long way to go. They have an average life expectancy at birth of 79.4 years; here, the average is 78.2. Their infant mortality rate is 4.8 per 1,000 live births; here, it is 6.4. Is their system perfect? No, clearly not. For example, there are issues about timely access to specialized elective care, but they also do not ration that care based on ability to pay, which we do.

Having experienced the NHS and U.S. health care systems, I think it is safe to say that no one would design our system if they could start from scratch. Ours is 50 percent more expensive than almost any other nation's, has left way too many people out and produces many population level outcomes far worse than they should be. In addition, our system places a huge burden on company balance sheets, making it far harder for companies to compete in world markets where other nations pay for health care through taxes. I am not a health care policy analyst, but it doesn't take one to see that we are clearly not getting what we should for what we pay.

Just consider what is politically unimaginable: If we had the British system, we would have at least 8 percent of our GDP of $14.5 trillion left over -- or about $1.15 trillion each year -- that we could use to fix every problem with the system and still have money left to give back to employers, employees and taxpayers -- and we also would have better population-level outcomes. The switch to the NHS is not going to happen, but the thought experiment does help one see the merits of moving to a system that a least guarantees health care insurance to all, that moves away from reliance on employer contributions, and that produces better overall outcomes at less cost.

John M. Bryson is a professor at the University of Minnesota.

Mike DeBrule's column in the Marshall Independent

2010-10-04T18:42:00.000-07:00

Americans Without Health Insurance Hits Record 50.7 Million
Dr. Michael B. DeBrule

I apologize to my readers, but my column this month has a lot of numbers. Let’s start with the Census Bureau estimates for 2009, which show a 4.3 million spike in uninsured to a record 50.7 million Americans without health care insurance. The Census also reported 16.7 percent of the population lacked health insurance in 2009, up from 15.4 percent in 2008 when 46.3 million were uninsured.

This jump of 4.3 million uninsured is the largest one year increase on record and would have been much higher (over 10 million) if there had not been a huge expansion of public coverage with about 5.8 million people on Medicaid.

What is causing this sharp rise in the number of uninsured? The short answer is job loss from the recession. Employer-based health care coverage disappears when people lose their jobs.

Lack of health insurance is also known to have deadly consequences. Last year researchers at Harvard Medical School showed that 45,000 deaths per year are from lack of medical coverage. That figure is about two and a half times higher than an estimate from the Institute of Medicine in 2002.

Let’s put these numbers in perspective. If you do the math, that is about one death from lack of health insurance every 11 minutes. It is also the equivalent of fifteen 9/11 attacks each year. In Minnesota, the annual number of deaths is around 760 people.

How does Minnesota fare compared to other states? Minnesota is better than average. The new census estimates show about 10 percent of Minnesotans (about 450,000) lacked health insurance last year and more are using government programs for coverage. The share of Minnesotans getting insurance through medical assistance increased from 8 to 15 percent since the beginning of the decade.

Dr. Quentin Young, national coordinator of Physicians for a National Health Care Plan, predicts that after the Obama administration’s insurance mandate is implemented there will still be a large number of uninsured. Estimates project 23 million people will still remain uninsured in 2019. In Massachusetts, 295,000 people remain uninsured despite that state's 2006 reform with a similar insurance mandate.

Furthermore, the Census Bureau does not report on underinsurance or poor quality insurance. Having medical insurance won’t protect you from financial hardship, high deductibles, and medical services excluded by your health care plan. New research has found that about 14.1 million children and 25 million non-elderly adults were underinsured in 2007, a figure that is likely much higher today.

I know all these numbers and percentages can be confusing. However, the big question we should ask as a society is what number of uninsured people is acceptable? And why can’t that number be zero?
Dr.DeBrule@InnovativeFootCare.com

A Fall of Action!

2010-09-02T21:14:00.000-07:00

Thanks to our interns, James Ortman and Kathy Mahan, we have many upcoming speaking opportunities this fall! Here is a summary. Please let us know if you would like to attend any of these. More information specific information to be e-mailed.

Sept 7 – Gamm with Senator Marty to Park Nicollet group, St Louis Park

Sept 10 – Mair, Schivone, Mahan at table at Medical Student Interest Fair, Minneapolis

Sept 14– Mair, Ortmann to dentist study group, St Paul

Sept 15 – Settgast at Rochester Senate District house party, Rochester

Sept 17 – Yablon to St. Joe’s Family Medicine residency, St Paul

Oct 22 -  Presentation at St. John's Family Medicine residency, St Paul

Oct 25 – Letts to United Family Medicine residency, St Paul

Nov 9 – Pentel to Smiley’s Clinic Family Medicine residency, Minnneapolis

Visit Physicians for a National Health Program at the Fair!

2010-09-01T21:14:00.000-07:00

PNHP-Minnesota, together with Minnesota Universal Health Care Coaltion, is at the State Fair! We have booth in the Farmers Union building near the DFL booth. Come visit us.

PNHP Summer Educational Event August 11

2010-08-05T06:13:00.000-07:00

7-9 pm at 5433 Grand Avenue South, Minneapolis, MN. (612) 387-7914

Nationally recognized healthy policy expert, Kip Sullivan, will present on the evidence behind many 'fixes' of our healthcare system such as managed care, pay for performance and medical homes. He will discuss how they dominate the field of healthcare reform and sometimes serve as a barrier to single payer.

Joining us as a special guest will be Dr. Walter Tsou a leader in state reform in Pennsylvania. He will give us an update on the single payer movement in Pennsylvania, which we are looking forward to.

Please RSVP to the phone number above or e-mail pnhpminnesota@gmail.com

Letter to the Editor in the Star Tribune

2010-06-23T16:00:00.000-07:00

Read this nice piece on the benefits of the Minnesota Health Plan and single payer by Amy Lange, Executive Director of the Minnesota Universal Health Care Coalition, with whom we work with closely. Go Amy!

http://www.startribune.com/opinion/96923584.html?page=2&c=y

Nick Coleman on the Need for More Reform

2010-04-02T18:39:00.000-07:00

Nick Coleman: That reform sure doesn't go very far

Perhaps Minnesota can take the lead by embracing truly universal care.

By NICK COLEMAN, Star Tribune

Last update: March 27, 2010 - 5:18 PM

After she was diagnosed with kidney cancer, my mother was given a prescription for a daily chemotherapy pill that has been shown to extend the lives of patients with that cancer. When I went to pick up the medicine, the pharmacist asked if I had received financial counseling. No, I said, wondering why we were talking finances, not health care. Just how much is this prescription?

I almost needed a doctor when she told me: The first 28 pills would cost my mother $4,607 -- a full 40 percent of her meager annual income from Social Security.

I ended up buying one week's worth -- seven pills -- giving me time to try to figure out how we could afford a month's supply of a medicine that is fully covered in England and France: Kidney cancer patients in those countries do not have to pay for the medicine my mom needed. Perhaps that's the kind of anti-American thing that Gov. Tim Pawlenty had in mind when he denounced the Obama administration's health care reform bill as a foreign measure built on a "European approach" -- you know, the funny idea that people shouldn't be bankrupted by their medical care.

My mother passed away before I had to go back to the pharmacy for more pills, dying days before the health care reform bill passed. But I doubt she would have been comforted to find out that the great reform effort would mean she would get a whopping $250 rebate on that $4,607 chemo bill, or that if she lived until 2020, the "donut hole" in her Medicare drug coverage would finally be eliminated.

If this is "reform," it is at a snail's pace, a mammoth effort to bring forth a mouse.

Give President Obama credit for getting the bill passed over the shouts of temper-tantrum Tea Partiers and their red-faced enablers in the GOP. But the final bill fell far short of what was first proposed, has gaping holes, leaves gluttonous insurance companies still in charge of health care (Minnesota-based UnitedHealth Group posted a $3.8 billion profit last year) and doesn't even require insurance companies to insure adults with preexisting medical conditions until 2014. If they're still alive.

Still, passage of the national measure, as limited as it may be, gives us a glimmer of an idea of what real reform might one day look like. And one promising part of that picture might emerge in Minnesota, where the Minnesota Universal Health Care Coalition (www.muhcc.org), an alliance of physicians, unions and reformers, is pushing for a single-payer system.

Minnesota could become the next Saskatchewan. And that would be good.

Saskatchewan was the first Canadian province to adopt a single-payer health care system, paving the way for Canada's universal Medicare system. The plan remains so popular that the man who led Saskatchewan's reform, Tommy Douglas, was voted greatest Canadian of all time in 2004 (Wayne Gretzky, the putative "Great One," finished 10th).

The hope of reformers here is that Minnesota can help blaze a path to universal health care in this country.

"We've lost sight of what we've been fighting for," says John Marty, a DFL state senator from Roseville who is chief author of legislation that would create something called the Minnesota Health Plan. Marty is running for governor on a strong health-care reform platform and criticizes DFLers who aren't fully committed to universal care. "If the country had approached slavery like we have approached health care," he says, "we'd still have slavery, but Democrats would be bragging that the slaves only work 40 hours a week now. We haven't fixed the problem. There will still be people dying from lack of health care, and going broke."

The Minnesota Health Plan would fully cover all Minnesotans with a single-payer system like Canada's. A similar plan has been approved by the California Legislature but was vetoed by Gov. Arnold Schwarzenegger. More than a third of Minnesota's legislators support the proposed plan. If he is elected governor, Marty says, he will make the Legislature stay in St. Paul until the bill is passed.

Minnesota used to be proud to lead the nation. Maybe it should take the lead again.

The plan passed by Congress "is not nearly good enough," says Elizabeth Frost, a Minneapolis doctor who is one of the leaders of Physicians for a National Health Program and who says the biggest beneficiary of the plan is the health insurance industry. "There will be 32 million more people with health insurance, but the real question is whether the insurance will be any good. If you have to pay too much out of pocket, people don't go to the doctor. The fight for reform isn't over.

"Last Sunday wasn't the end. It was the beginning."

Nick Coleman is a senior fellow at the Eugene J. McCarthy Center for Public Policy & Civic Engagement at the College of St. Benedict/St. John's University. He can be reached at nickcoleman@gmail.com.

The Minnesota Health Plan Moves Forward

2010-03-12T13:48:00.000-08:00

MN Health Plan Passes House Health Policy Committee!
The House Health Care and Human Services Policy and Oversight Committee took the Minnesota Health Plan off the table on February 23, 2010 and voted to pass it. No testifiers were called, but the bill received vigorous debate as House chief author David Bly fielded questions from Committee members.

The hearing room was packed to overflowing with advocates who erupted in spontaneous applause on a number of occasions. A number of legislators including Liebling, Laine, Hayden, Fritz, Ruud, Gardner and Loeffler spoke positively about the bill and declared their intention to vote affirmatively, in advance of the vote. Jeers and snickers broke out when Rep. Steve Gottwalt (HD15A- St.Cloud) criticized the plan as "socialist".

Dr. Ann Settgast in the Austin Daily Herald

2010-02-13T20:00:00.001-08:00

Heath Care Perspectives, Part 3

'Single-Payer' left out of health care debate, but many doctors want it in

By Mike Rose Austin Daily Herald

Published Saturday, January 23, 2010

Editor’s note: This is the last in a three-part series examining the health care debate from the perspectives of different social groups.

When the current health care debate began in earnest last year, one potential topic of discussion was largely left out — “single-payer” insurance.

Perhaps most indicative of the exclusion were remarks early in the debate from Sen. Max Baucus, D-Mont., who chairs the Senate Finance Committee and has been an influential player in the health care reform process. On several occasions, the senator said everything was on the table, except for the possibility of establishing a national health insurance plan that would supplant private insurers.

Leaving single-payer off the table, said Dr. Quentin Young, has been a great injustice.

“The health care system is going to hell rapidly,” the retired Chicago physician said. “(And single-payer) is mentioned only in passing.”

Young is working to change that. He is currently the national coordinator for Physicians for a National Health Program, a 23-year-old non-profit that counts 17,000 doctors as its members.

The organization is not alone in pushing for single-payer health insurance, but PNHP is among a number of groups focusing on the issue through the lens of the medical profession.

“Physician support (of single-payer) is getting stronger every day,” Young claims. “We’re doing a good job of publicizing.”

Numbers seem to support Young’s claim. According to a survey done by the Indiana University School of Medicine in 2007, 59 percent of physicians in the country supported legislation to establish national health insurance — up 10 percent from five years earlier. In Minnesota, 64 percent of doctors polled in 2007 said they favored a single-payer plan, according to an article in the journal Minnesota Medicine.

The doctor said the reason for moving toward national health insurance is simple — it would expand coverage to more people and reduce administrative costs that come from a complex private insurance industry.

But Young said his organization is willing to accept options short of a full-fledged single-payer plan, as long as coverage increases and prices decrease.

“We’re not single-payer or nothing,” he said. “We certainly welcome other reforms.”

However, that doesn’t include reforms in front of Congress now, Young said — the doctor believes the proposed legislation would do more harm than good.

“They’re both bad,” he said of the House and Senate health care bills. “They’re not tiny steps forward, (but rather) important steps backward.”

Dr. Ann Settgast, a St. Paul-based physician who is also in PNHP, said perhaps proposed legislation making its way through committees in the Minnesota Legislature could pave the way for national health insurance.

The state House and Senate health care reform bills, known collectively as the Minnesota Health Plan, would make Minnesota a single-payer state.

With 71 co-authors in the Legislature, Settgast said it is clear the plan has initial support. Now, she wants to see it move forward and see Minnesota become a pioneer by instituting a single-payer system.

If it does pass, Settgast said it could start a ripple effect, leading other states and perhaps the country as a whole to adopt similar measures.

Like the Chicago-based Dr. Young, Settgast said she sees more and more support along these lines, though she acknowledges true change will come slowly.

“Single-payer is very well supported,” Settgast said, though adding that “it was needed years ago. The sooner the better.”

Both Settgast and Young say the main obstacle to a single-payer plan is the health insurance industry. Settgast for one said groups like PNHP simply can’t compete with insurance lobbyists in Washington.

“Certainly, if your campaign contributions are resting on (insurance industry) money” that makes it hard to listen to other sides, she said. “The single-payer voice is largely underrepresented in the debate.”

But Robert Zirkelbach, strategic communications director for America's Health Insurance Plans, the country’s largest health insurance trade association, said the industry has not been a “bully” during the reform debate.

Instead, he said AHIP represents the majority of Americans who don’t believe in a single-payer plan.

“The American people do not support a government takeover of the health insurance system,” Zirkelbach said.

The spokesman said the private insurance industry has pioneered a number of innovative health care ideas, adding that a vast majority of Americans were satisfied with their current plans.

A single-payer insurance system, Zirkelbach said, would not lower costs and would only reduce services.

“Moving toward an entirely government-run system would turn back the clock on health care,” he said.

Weighing the Evicence for Single-Payer from Minnesota Medicine

2009-11-22T10:02:00.000-08:00

Weighing the Evidence for Single-Payer
By Ann Settgast, M.D., and Elizabeth Frost, M.D.
http://www.minnesotamedicine.com/ReflectionsonReform/WeighingtheEvidenceforSinglePayer/tabid/3228/Default.aspx

As physicians, we are troubled by the direction of federal health care reform. Whether via a public health insurance option or an insurance mandate, the proposals on the table build on the structure of our broken system—the most costly, fragmented, and bureaucratic in the world.
President Barack Obama acknowledged in his national address this summer that a single-payer system is the only way to cover all Americans. We agree, and we encourage him to re-embrace this solution to the health care crisis.

Conventional wisdom leads us to believe there are only two culprits responsible for skyrocketing health care costs—doctors and patients. Doctors order too many unnecessary tests, and patients demand too much care. We acknowledge that overtreatment of patients guided by improper incentives must be addressed. The issue of patients overusing care also must be confronted. However, the problem of overuse is minuscule compared with the consequences of underuse. In its most extreme form, underuse of health care contributes to more than 45,000 deaths in the United States annually, as revealed in a study by Wilper et al. in the American Journal of Public Health. But blaming doctors and blaming patients ignores the elephant in the room: private insurance.

Our unique multipayer financing structure based on private health insurance produces enormous waste. Of every health care dollar spent in the United States, 31 cents is spent on administration (more than double that of other industrialized nations). So we are wary of proposals that seek to simply expand private insurance and in so doing provide a bailout for this industry. Such expansion may decrease our embarrassing numbers of uninsured, but it will not solve our problems. Private insurance has been likened to an umbrella that melts in the rain. Consider the disturbing fact that 62 percent of all personal bankruptcies are related to medical bills. More astonishing is the fact that 77 percent of Americans who go bankrupt because of medical bills had insurance when they became ill. Because it is a business, private insurance has, at its core, the bottom line. The only way to succeed is to selectively recruit healthy patients or to deny coverage to patients when they become sick. As professionals who strive to make sick people well, we find this model for our system illogical and fatally flawed.

Elimination of U.S.-style private insurance has been a prerequisite to achieving universal health care coverage in every other industrialized nation. We ask, “What if the rest of the world is right?” Only under single-payer can we eliminate the administrative costs associated with billing hundreds of payers and the sizeable overhead of the private insurance industry. These overhead dollars are spent marketing, underwriting, lobbying, and fighting claims—none of which makes our patients healthier. Elimination of this administrative waste would save more than $400 billion annually.

As physicians, we are obligated to use evidence-based medicine. The reform debate must be held to the same standard. Ample evidence, including studies by the Congressional Budget Office and the Government Accountability Office, shows single-payer can assure universal coverage while saving money. For those who say competition among insurers is needed to keep costs down, we say the experiment must end. It has been tried. It has failed. For those who ask whether something is better than nothing (ie, implementation of a public option), we again look at the evidence. A number of states have tried to patch their systems with piecemeal reforms over the past two decades. None has produced universal coverage while controlling costs.
For those who suggest we would lose choice under a single-payer system, we ask, choice of what? Choice of insurance plan—yes. Choice of doctor and hospital—no. A high-quality system is not one in which our patients choose their insurance plan but one in which they choose their doctor. Single-payer is the only reform option that actually expands choice. Bringing private insurance or a public option to more Americans retains limited provider networks and restricted choice.

For those who say single-payer is socialized medicine and worry that government bureaucrats will suddenly begin making health care decisions, they need to remember that single-payer is publicly financed but privately delivered. Medical decisions should be made by patients and doctors.

Given the magnitude of these difficult economic times, including a projected $1.8 trillion federal deficit for 2009 and rising unemployment, it is high time to reconsider the most fiscally conservative and financially sustainable option for reform—a single-payer system.

Ann Settgast and Elizabeth Frost are primary care physicians practicing in the Twin Cities. They co-chair the Minnesota chapter of Physicians for a National Health Program.

How the Weiner Amendment Fell -- from Health Justice website

2009-11-08T20:18:00.001-08:00

What The Hell!!?!?
Saturday, 07 November 2009 08:34 Clark Newhall
After the Friday massacre of single payer, no doubt many of you are wondering the same things I am: who betrayed me? what happened? What next? Here is my take on the subject.

It started with the failure of Jon Corzine and Creigh Deeds to win the governor elections in New Jersey and Virginia, respectively.

Particularly in New Jersey, Obama put himself into the race in a state that went heavily for him in 2008. He traveled several times to New Jersey to make stump speeches for Jon Corzine, the incumbent. Despite his (supposed) personal popularity and his recognized oratorical skills, Obama was unable to push Corzine into the lead. Instead, a far-right Republican and protege of Bush won the race. Bad bad news for the Democratic party and for the mid-term Congressional elections.

Next thing we heard, Harry Reid is saying that the health reform bill might not even come up for a vote in the Senate this year because he can't round up sixty votes to bust a filibuster. to my mind, the election and the Senate delay are intimately connected.

At that point, Obama has to do something quick to salvage his most difficult political move. After all, he vowed to be the last president to attempt health reform. He HAS to get the House bill passed. If he doesn't get it passed, there will never be a vote on the Senate bill and his credibility will be zilch. You begin to hear more positive support from the White House for the public option and then you begin to hear specific support for the House version of health reform.

But there is a fly in Obama's ointment: single payer supporters have made enough noise that Pelosi has to keep her promise to let Weiner have a vote on the floor of the House on single payer. She can't wiggle out of it, even though she tries. You hear her say she supports single payer, then you hear that there will be a vote but no debate. That's not enough. She still can't budge enough Blue Dogs to get enough votes to pass the House health reform bill.

The Blue Dogs see that they are in command, because they are the only Democrats who has enough balls to draw a line in the sand and say 'Forget it -- we are taking our ball and going home unless you strip out the public option entirely. Watering it down is not enough. We want the insurance companies to control the whole shooting match. We have to kowtow to the tea-baggers and taxnuts who will defeat us in the next election if we even breathe a word about health care being anything other than bought and sold.'

Of course, every other Democrat, progressive or middle-of-the-road, is thinking the same thing: how do I hold onto this great gig I have? Some of them, purportedly single payer supporters, beg Pelosi not to bring single payer for a vote because it will be used against them. Some of them, Eric Massa among them, demand that undocumented aliens be specifically denied health care because their districts are full of rabid bigots. Some of them, Conyers among them, just keep quiet. Some of them, Kucinich among them, have a different axe to grind. And so Pelosi, despite every kind of concession to Blue Dogs, bigots, racists and know-nothings, still is short 25 votes to pass the watered down health reform bill. So what happens next? Whose prestige is this all about? Right. Obama steps in.

Obama personally arm-twists Weiner to drop his amendment vote demand. Take a look to see what Weiner will get down the road -- a new Brooklyn Bridge? Brooklyn and Queens being the next site of a giant Army base?? a giant new ship building program at Brooklyn Navy Yard?? Who knows.

Kucinich and Conyers are log-rolled too. Kucinich (Polish descent) goes down easy -- the President signs papers making Casimir Pulaski, Polish Revolutionary War hero, an American citizen, even though there wasn't any America in Pulaski's lifetime. (NB--I am receiving many many rude comments telling me that Kucinich is not Polish. That appears to matter more than any substance to the argument. Well, my information comes from the Associated Press, who described Kucinich as Polish in this article. So go make your rude comments to them.)

Conyers goes down a little harder. Who knows what he got, but note carefully what happens to the prosecution of his wife in Detroit for bribery.

And so it goes.

The latest CBO estimate on the House bill says that there are 50 million Americans without health insurance, which of course translates 'inadequate health care' and 44,000 deaths per year. How many will be uninsured after the 'buxom public option' is fully implemented in 2019? 54 million. Gee, what a great step in American health care and promotion of civil rights. Are you glad you worked so hard to get Obama elected? Are you glad there is a Democratic majority in both houses of Congress? Has your hard work paid off?

What next? I don't know. Whether or not I personally ask Congresspersons to vote against this bill, sarcastically named the Affordable Health Care for America Act, is really irrelevant. The game is not being played to the tune that you and I are hearing. It is being played to the tune of cash registers aka political war-chest contributions. That has always been true, but there was always hope that our noise made some difference at the margins. That hope is now gone.

Will our hope ever again have a realistic basis? Will health care ever be a human right in America, as it assuredly is in the rest of the industrialized world? Good question. But it will not ever be a human right under this legislation. Health care will still be a commodity, to be purchased at the highest price. Just like politicians. As you may recall: if you have to ask how much it costs, you can't afford it.

Mad as Hell Docs on KARE 11

2009-10-08T05:20:00.000-07:00

Mad as Hell doctors on Kare 11 here.

Mad as Hell on MinnPost

2009-10-08T05:19:00.000-07:00

Check out the coverage here.

Mad as Hell on MPR

2009-10-08T05:18:00.000-07:00

Mad as Hell Doctors covered by MPR.

'Mad Doctors' Lobby for Single Payer

2009-10-08T05:16:00.000-07:00

See Mad as Hell coverage from KTSP5 here.

Mad as Hell in Mankato!

2009-10-08T05:14:00.000-07:00

Click here for coverage of Mad as Hell Doctors in Mankato.

Nick Coleman: At least some are mad for the right reasons!

2009-10-08T05:12:00.001-07:00

Click here for Nick Coleman's column in the Star Tribune

2009-09-29T14:29:00.000-07:00

14-foot-tall vampire illustrates view of one physicians' group

Joel Koyama, Star Tribune

(From left to right) Cyrus Butler, Christopher D. Lutter, Jared Middle Calf, and Kajsa Ingemansson (megaphone) put on a skit by Mad as Hell Doctors.com at 5th and Nicollet in Minneapolis.

''Count Bleed-ya-dry,'' representing insurers, and an Uncle Sam puppet didn't quite get their point across.

By CHEN MAY YEE, Star Tribune

It's not every day you see a vampire on Nicollet Mall. But then it's not every day you see American doctors, traditionally a buttoned-down lot, agitating for an overhaul of the health care system.

The vampire, carrying the message that insurance companies are sucking the health care system dry, was the emissary of a group of Oregon physicians known as Mad As Hell Doctors, one of dozens of factions jockeying for influence as Congress hammers out legislation this fall. The group is conducting a cross-country caravan to Washington, D.C., with stops Wednesday at St. John's Episcopal Church in Mankato and the state Capitol in St. Paul.

They hit Minneapolis on the same day that two other developments showed intensifying pressures in the national debate over health care:

• The Kaiser Family Foundation released a report showing that the average family health insurance premium rose 5 percent this year to $13,375, even as general inflation fell 0.7 percent. Since 1999, the report said, health insurance premiums have risen 131 percent, faster than workers' wages (38 percent) or inflation (28 percent).

"That's why we are having a health reform debate," said Kaiser CEO Drew Altman.

• The New England Journal of Medicine published a national survey showing that a majority of physicians support a controversial proposal for a government-run insurance plan that would compete with private insurers.

Whether Minneapolis commuters made the connection Tuesday between vampires and health care policy wasn't entirely clear.

Passengers getting off the No. 8 bus near Neiman Marcus at lunchtime Tuesday were greeted by a 14-foot tall "Count Bleed-ya-dry" -- a puppet representing insurers -- hovering menacingly over a prone, white-haired puppet who was hooked up to a bag of blood -- Uncle Sam.

"I am a solution," the count intoned, "you can buy my products. Muah ha ha ha."

Wary pedestrians swerved by; a few stopped. A couple of toddlers looked worried. Not everyone got the message. "What is that man doing on the bed, with the blood?" asked one woman, pushing a stroller.

"That represents the U.S. health care system," said Dr. Elizabeth Frost, a family doctor at La Clinica in St. Paul, who was handing out fliers.

Not monolithic

The New England Journal survey, which was sponsored by the Robert Wood Johnson Foundation, came as something of a surprise because it suggests that doctors, long considered monolithic in their opposition to a government role in health care, are now so frustrated with the health insurance industry that they would consider embracing one of President Obama's more divisive proposals.

The survey found that 27.3 percent of respondents supported private-only insurance coverage, apparently a reflection of physicians' mistrust of the 45-year-old federal Medicare program.

Another 9.6 percent supported public-only coverage (the single-payer concept advocated by the Mad As Hell Doctors).

A majority -- 62.9 percent -- supported a public option alongside private plans.

AMA backs public-private

While physicians' professional associations have been vocal in the health care debate, the views of physicians in general are less well known, said the authors of the study, two doctors at Mount Sinai School of Medicine in New York who were funded by the Robert Wood Johnson Foundation.

Drs. Salomeh Keyhani and Alex Federman surveyed 4,936 physicians between June and September; 2,130 responded.

"We found that physician support for including a public option in the reform package largely mirrors the support revealed in national polls of the U.S. public throughout the spring and summer," the researchers wrote.

The American Medical Association, the biggest physician group, has historically opposed changes based on a government role. It initially opposed the public option but recently came out in support of a House proposal that included a public-private option.

The majority of physicians said they supported a public option even though they said traditional Medicare is worse than private plans in three ways: It pays less, is slower to pay and involves more paperwork and administrative hassles.

Reuters contributed to this report. Chen May Yee • 612-673-7434

The Mad As Hell Doctors Rally at the Capitol

2009-09-29T14:22:00.000-07:00

Mad As Hell Doctors press case for single-payer health care at Minnesota Capitol

By Casey Selix | Thursday, Sept. 17, 2009
Could Minnesota be the next Saskatchewan in the single-payer health care movement?

The possibility was raised Wednesday during the two-hour Mad As Hell Doctors rally in the state Capitol rotunda.

In 1947, sparsely populated Saskatchewan became the first Canadian province to offer a universal hospitalization insurance program in North America. In 1962, it created the first universal Medicare program in North America, blazing the trail for the rest of Canada to eventually approve a national health service.

"This is about movement-building," said U.S. Rep. Dennis Kucinich, D-Ohio, who spoke to the rally via telephone. "The day will arrive when health care is a civil right, and if there's one place in the nation that can make this happen, it's Minnesota."

Not if state Rep. Tom Emmers, R-Delano, has any say in the matter. On Monday, the gubernatorial candidate and two other lawmakers said they would introduce a state constitutional amendment to "protect the freedom of personal choice in health care.''

Effort to protect single-payer option for states
Kucinich is sponsor of an amendment to federal health care-reform legislation that would protect states' rights if they want to pursue their own single-payer plans. State Sen. John Marty, DFL-Roseville, a candidate for governor, and Rep. David Bly, DFL-Northfield, are co-authors of the Minnesota Health Plan, a single-payer health care program that would cover necessary services for Minnesotans from cradle to grave. The legislation has 71 co-sponsors.

The Mad As Hell Doctors left Oregon Sept. 8 on a 26-city road trip en route to Washington, D.C., where they hope to meet with President Barack Obama to lobby for a single-payer, or Medicare for All, plan. Obama hasn't said yes yet, but the White House has started blocking emails of the group's form letters. About 5,000 emails urging Obama to meet with the doctors had been sent at last check, said Dr. Paul Hochfeld, of Corvallis, Ore., who urged rally attendees to send emails from their own addresses.

Hochfeld, producer of the "Health, Money and Fear" documentary featured on MinnPost in July, said the White House called to find out when the form letter would be removed from the site because they were being inundated.

"We replied we would be delighted to do that as soon as President Obama agrees to meet with the Mad As Hell Doctors and have a discussion about single-payer," Hochfeld told the crowd.

That brought a round of applause and cheers from 100 or so folks in the rotunda.

The rally came four days after Obama visited Minnesota to push his health-care reform package, which includes a public option or insurance exchange but not a government-run single-payer plan.

Visits to Mankato and the Capitol
The Mad As Hell Doctors stopped at a Mankato church on Wednesday before arriving in St. Paul and parking their Winnebago in front of the Capitol, within the sight line of Republican Gov. Tim Pawlenty's office. Pawlenty, considered a 2012 presidential contender, has been critical of Obama's and Democrats' health-care reform proposals.

In an interview before the rally, Hochfeld acknowledged that single-payer is a long shot in this Congress. The group would like to see a presidential commission look at health care "objectively — with the insurance companies and stakeholders out of the room."

"When you look at the facts, the only reason single payer is not being considered is because of our political process," he said. "I'm not mad about health care — I'm mad about our political process."

If nothing else, he told MinnPost, the national debate will be an opportunity to make lemonade out of lemons. "If we don't get single-payer out of this Congress, and I don't think we're going to get single-payer out of this Congress, we'll be making lemonade. … We'll use health care as the poster child for why we need campaign finance reform and why we need to not give corporations any more rights over people."

'37th in health outcomes'
The doctors believe that a single-payer system is the best route to universal health care and that it would allow their profession to focus more on patients instead of the varying claim requirements of 1,300 health insurance companies in the nation.

One by one, doctors explained to the crowd why they're mad as hell about the state of our health-care system. Here are a few:

"I'm mad as hell when we're ranked by the World Health Organization as 37th in health outcomes and our nation spends twice as much on health care," said Dr. Marc Sapir of Alameda, Calif.

Minnesota Health Plan advocate Bernice Vetsch asks Tom Kelly, right, of the Minnesota Nurses Association to sign a petition Wednesday in the Capitol rotunda before the Mad As Hell Doctors rally begins.

Retired internist Robert Seward of Oregon, who once worked for the VA Hospital in St. Cloud, Minn.: "I'm mad because Americans are going bankrupt from health-care bills."

Dr. Joe Eusterman of Portland, who went to the University of Minnesota's medical school: "I'm mad as hell because of the lies and fear-mongering being used by the status-quo folks."

Not just doctors are mad. Mad As Hell Nurses from Minnesota spoke, too.

'Discharge instructions'Emergency room nurse Eileen Weber gave some "discharge instructions": Support the Kucinich amendment. Attend the town hall of Republican Rep. John Kline on Friday night in Lakeville. Support "the champions" of single-payer legislation in Minnesota, including Marty, Bly and other lawmakers attending the rally.

Rally attendees also got to express their anger in a cheer led by Mad As Hell Doctors' creative director Adam Klugman. The group's name, he explained, comes from the 1976 movie "Network," when a fired TV anchor becomes so anguished that he yells out the window: "I'm mad as hell and I'm not going to take it anymore."

Klugman got the crowd to raise their voices in the echo chamber-like rotunda: "I'm mad as hell and I'm not going to take it anymore!"

Single-payer advocate and Rep. Keith Ellison, D-Minneapolis, also spoke to the group by telephone. "Sixty-three percent of doctors support the public option. … I want to let you know we are rock-solid — we won't vote for anything that doesn't include a public option."

As for state Republican lawmakers' plan to protect personal choices in health care?

"They're thinking health insurance equals health care, and they're two different things," Marty told MinnPost. "Under health insurance, a lot of people don't get health care" because of the expenses and restrictions.

As for Minnesota becoming the next Saskatchewan? "We hope Minnesota can play a lead role in that," Marty said.

Wednesday's rally was sponsored by the Minnesota chapter of Physicians for a National Health Plan, which has more than 400 members in Minnesota.

Next stop for the Mad As Hell Doctors: Madison, Wis.

Casey Selix, a news editor and staff writer for MinnPost.com, can be reached at cselix[at]minnpost.com.

Nick Coleman: At least some are angry for right reasons

2009-09-26T11:13:00.000-07:00
Can the Mad As Hell Doctors counter America's nasty case of the Slime Flu?

By NICK COLEMAN, Star Tribune
Last update: September 19, 2009 - 10:57 PM

A group of crusading physicians calling themselves the Mad As Hell Doctors stopped in Minnesota last week on a tour from Oregon to Washington, D.C., to whip up support for a single-payer health care system, a plan they call "Medicare for All."

They may have been too late: Everyone is mad as hell these days, and we're not going to take it anymore (with "it" being whatever it is that drives you batty). A good portion of America is so angry that it has gone around the bend in opposition to All Things Obama, especially any reform of our leaky health care system that includes an expanded government role or health insurance for all.

It's as if we think we live on the wild frontier: They'll take away our freedom to enjoy medical neglect, lack of insurance coverage and an inability to pay for the care our families need when they pry it from our cold, dead fingers. Or our child's cold, dead fingers.
Don't worry about pulling the plug on Grandma. That lie has been repeated so many times by Obama haters and political opportunists that it doesn't matter that it is untrue. The bigger problem is that the effort to stop the spread of better, more affordable and fully accessible health care is pulling the plug on the country.

America's atavistic impulse is a mass psychosis that, from time to time, emerges like a retrovirus and spreads through mouth-to-ear contact. If you listen to the foam-flecked spouters on cable TV and talk radio, but have not yet yourself fallen victim to Slime Flu, you probably wonder why no family member or friend of these sputtering liars cares enough for them to lead them from the studio and to the nearest mental health center for a complete evaluation.
But they seem to be winning, if you can "win" anything by taking a crowbar to

A group of crusading physicians calling themselves the Mad As Hell Doctors stopped in Minnesota last week on a tour from Oregon to Washington, D.C., to whip up support for a single-payer health care system, a plan they call "Medicare for All."
They may have been too late: Everyone is mad as hell these days, and we're not going to take it anymore (with "it" being whatever it is that drives you batty). A good portion of America is so angry that it has gone around the bend in opposition to All Things Obama, especially any reform of our leaky health care system that includes an expanded government role or health insurance for all.

It's as if we think we live on the wild frontier: They'll take away our freedom to enjoy medical neglect, lack of insurance coverage and an inability to pay for the care our families need when they pry it from our cold, dead fingers. Or our child's cold, dead fingers.
Don't worry about pulling the plug on Grandma. That lie has been repeated so many times by Obama haters and political opportunists that it doesn't matter that it is untrue. The bigger problem is that the effort to stop the spread of better, more affordable and fully accessible health care is pulling the plug on the country.

America's atavistic impulse is a mass psychosis that, from time to time, emerges like a retrovirus and spreads through mouth-to-ear contact. If you listen to the foam-flecked spouters on cable TV and talk radio, but have not yet yourself fallen victim to Slime Flu, you probably wonder why no family member or friend of these sputtering liars cares enough for them to lead them from the studio and to the nearest mental health center for a complete evaluation.
But they seem to be winning, if you can "win" anything by taking a crowbar to it.

Before the Mad As Hell Doctors even pulled up in front of the State Capitol on Wednesday (in a Winnebago plastered with slogans such as "Single Payer or Bust!" and "Get Mad! Stay Mad! Make History!"), two things had happened to take some of the wind out of their sails:

1) A yearlong effort by the U.S. Senate to produce a health care reform plan that both parties could support brought forth a turkey that no one liked and few supported -- a plan without any "public option" whatsoever.

2) Conservative Republicans, including candidate for governor Tom Emmer, expanding on Gov. Tim Pawlenty's cockeyed threat to use the 10th Amendment to have Minnesota "opt out" of health care reform, proposed an amendment to the state Constitution "guaranteeing" a citizen's right to buy private health insurance. Next on the ballot: An amendment to guarantee your right to buy police and fire protection from private vendors so you don't have to rely on public safety services. (Word to the wise: Don't tell a cop or firefighter he is a freedom-sucking socialist.)
There have been positive developments, too: More than 70 legislators have signed on to a bill that would provide single-payer health insurance to all Minnesotans, a plan supported by 400 Minnesota doctors who belong to Physicians for a National Health Plan (that's the group that sponsored the Mad Doctors' visit).

Still, it will take "a miracle," as the Mad As Hell Doctors acknowledge, to get approval for a government-run single-payer system. That's what's got the doctors ticked off.
The fighting physicians brought their righteous anger to the Capitol rotunda and tried to prod Minnesota's conscience about reforming a system that offers great care to those who can afford it, but lets millions rely on emergency rooms (including the "illegal immigrants" who even Barack Obama has deemed unworthy of routine health care).

"Americans are going bankrupt from health care bills," a retired doctor named Robert Seward told a crowd of supporters in the rotunda. Another retired doctor, Joe Eusterman, said true reform was being obstructed by "lies and fear-mongering."

Whatever the outcome of the current standoff, one thing seems certain: America's health care problems are not going away. More than 400,000 Minnesotans have no health insurance, and perhaps 45,000 Americans die each year from causes attributable to a lack of proper health care, as was reported Thursday by the American Journal of Public Health. The fight over reform, despite appearances, is not over. And it's still worth fighting.

More madness may be called for. Pro-reform forces should get on board the Winnebago and show a little more spleen, and more backbone.

The Mad As Hell Doctors (www.madashelldoctors.com) hope to meet with President Obama when they reach Washington, and to stage a Sept. 30 rally across from the White House.
Just think of it as a symbolic return of the old-time physician: These doctors are traveling the country to make a house call, a White House call. Let's see if we're smart enough to take their medicine.

Nick Coleman is a senior fellow at the Eugene J. McCarthy Center for Public Policy & Civic Engagement at the College of St. Benedict/St. John's University. He can be reached at nickcoleman@gmail.com.

"Mad as Hell" Hits the Road. The AP Story.

2009-09-09T07:41:00.000-07:00
Oregon docs lead health reform caravan to Congress

By WILLIAM MCCALLASSOCIATED PRESS WRITER

PORTLAND, Ore. -- Some Oregon doctors are headed for Congress to ask lawmakers to take health care reform back to the drawing board and hold a real debate about a single-payer plan that would cover all Americans.
The small group of veteran physicians held a rally Tuesday in downtown Portland before leaving on a national tour to urge Congress and the Obama administration to consider every option for a complete overhaul before settling for anything less.

"Health care affects every one of us," said Dr. Paul Hochfeld. Congress needs to come up with a "real solution to our health care disaster," he said.
Hochfeld and his fellow physicians say a single-payer system of publicly funded universal health care could dramatically reduce administrative costs passed on by insurance companies and reduce chronic illness by expanding access to preventive care.

But Beth Ashmore, past president of the National Association of Health Underwriters, said the doctors are ignoring a number of potential problems with a single-payer system.

She compared it to the problems facing Medicare for older Americans, saying Medicare already shows signs of potential financial collapse under the weight of aging baby boomers without adding a national single-payer health care system that would include all ages."We cannot afford this," Ashmore said. "We have to keep from burying our grandchildren with debt."

Hochfeld, however, said the purpose of the tour is to put those issues on the table and try to find a way to deal with them, rather than just say it cannot be done.

The group of physicians calls itself the "Mad as Hell Doctors," borrowing from the famous line in the movie "Network" expressing anger over politicians and big corporations that do not care about the needs of the average person. In the movie, TV anchor Howard Beale rants, "I'm as mad as hell, and I'm not going to take this anymore!"

The doctors are driving a recreational vehicle to Washington, D.C., for a rally on the Capitol steps. They'll stop along the way for rallies to build support for a single-payer system - beginning in Seattle and including Spokane; Helena, Mont.; Salt Lake City; Denver; Minneapolis; Chicago; Detroit; and Nashville.

The 10 doctors in the group have a wide range of medical experience. Hochfeld is an emergency room physician in Corvallis.

They say a single-payer plan similar to Canada's was never debated but offers the only lasting solution to extending health care to every American without bankrupting the country.

Instead of a real debate, they say, Congress is offering up patchwork proposals that are temporary solutions at best, and leave many Americans without health care at worst.

Ashmore, however, said many of those proposals can provide long-term solutions - such as encouraging private employers to offer more preventive care, or tort reform to reduce the costs of medical lawsuits - if they are combined. "There are a number of things that can be done inside the system, inside of what we're currently spending, to really improve the cost effectiveness of the system," Ashmore said.

But Dr. Paul Gorman, a Portland internist and family physician, blames the existing private insurance system for one of the lowest life expectancies and one of the highest infant mortality rates among industrialized nations - despite some of the best-equipped hospitals and many of the best-trained doctors and nurses in the world.

"We're getting Third World results and third-rate health care because of an insurance system that prevents those nurses, prevents those doctors, and prevents those hospitals from giving the care they can," Gorman said.
Other nations, including those with single-payer systems, fare better in many categories, he said.
---

Mad as Hell Doctors are Coming to Town

2009-09-01T08:48:00.000-07:00
Mad as Hell Doctors Tour
Wednesday, September 16.

Visit www.madashelldoctors.com for more information.

11 am – 1pm Mankato. St. John's Episcopal Church 302 Warren St, Mankato, MN.

3 pm – 5pm Rally and Town Hall St. Paul Capitol Rotunda

7pm - Dr. Paul Hochfield, one of the 'Mad as Hell Docs' will present at Hazardous to Your Health Series. Jeanne d'Arc Auditorium, Whitby Hall. St. Catherine University. 2004 Randolf Ave, St. Paul, MN

Bait and Switch: How the Public has Been Sold On the Public Option

2009-08-04T10:38:00.000-07:00
Bait and switch: How the “public option” was sold
By Kip Sullivan
Physicians for a National Health Program
July 20, 2009

When the “public option” campaign began, its leaders promoted a huge “Medicare-like” program that would enroll about 130 million people. Such a program would dwarf even Medicare, which, with its 45 million enrollees, is the nation’s largest health insurer, public or private. But today “public option” advocates sing the praises of tiny “public options” contained in congressional legislation sponsored by leading Democrats that bear no resemblance to the original model.

According to the Congressional Budget Office, the “public options” described in the Democrats’ legislation might enroll 10 million people and will have virtually no effect on health care costs, which means the “public options” cannot, by themselves, have any effect on the number of uninsured. But the leaders of the “public option” movement haven’t told the public they have abandoned their original vision. It’s high time they did.

For reform advocates, the full article is a “must read”:
http://www.pnhp.org/blog/2009/07/20/bait-and-switch-how-the-“public-option”-was-sold/

Progressive Democrats Take a Stand

2009-08-04T10:30:00.000-07:00
Progressive Democrats in the house may have quite a bit of power if they oppose the watered-down public option. Check out this video. And get excited about the Single Payer vote on the house floor in September!

http://www.commondreams.org/video/2009/08/03

Pioneer Press Op-ed July 31, 2009

2009-07-31T11:55:00.001-07:00

Settgast, Frost: Want more choice? Pick single-payer

By Ann Settgast and Elizabeth Frost

Updated: 07/30/2009 05:51:27 PM CDT

The health care reform debate is reaching a feverish pitch. As physicians, we are troubled by the direction the debate has taken. Whether via a public option or a mandate to purchase insurance, the proposals on the table aim to cover more, but not all Americans. They build on the structure of our broken system — one that ranks as the most costly, fragmented and bureaucratic in the world.
President Barack Obama acknowledged in his national address last week that a single-payer system, because of automatic enrollment, is the only way to cover all Americans. We agree, and we encourage him to re-embrace this solution to the health care crisis. Single-payer is the only option that will actually work.
Mainstream media coverage of the health care debate is confusing. Conventional wisdom leads us to believe there are only two culprits responsible for skyrocketing costs — doctors and patients. Doctors order too many unnecessary tests, while patients demand too much care. As doctors, we acknowledge that overtreatment of patients guided by improper incentives occurs, and must be addressed.
There are also patients who overuse care. However, this problem is minuscule compared to well-documented underuse. In its most extreme form, this underuse leads to death for more than 18,000 Americans annually as revealed in a sobering 2002 Institute of Medicine report. Blaming doctors and blaming patients ignores the giant health care elephant in the room: private insurance. Of every health care dollar spent in the United States, 31 cents is spent on administration (more than double that of other industrialized nations). This enormous waste comes from our unique multi-payer financing structure based on private health insurance.
So we are wary of proposals that seek to simply expand private insurance. Such expansion may decrease our embarrassing numbers of uninsured, but it will not help the insecurely insured — a group to which we all belong, even those of us who "like what we have."
Private insurance has been likened to an umbrella that melts in the rain. Consider the study released last month in the American Journal of Medicine revealing that 62 percent of all personal bankruptcies are related to medical bills. More astonishing is that 77 percent of Americans who go bankrupt due to medical bills had insurance when they became ill.
Because it is a business, private insurance has, at its core, the bottom line. In his recent testimony before a U.S. Senate committee, Wendell Potter, former head of communications at Cigna, reported, "Members of Congress and the public have good reason to question the honesty and trustworthiness of the insurance industry. Insurers make promises they have no intention of keeping."
The only way to succeed in the insurance business is to selectively recruit healthy patients or to deny coverage to patients when they become sick. As professionals who strive to make sick people well, we find this model for our system illogical and fatally flawed.
Elimination of U.S.-style private insurance has been a prerequisite to achieving universal health care in every other industrialized nation. One must ask, "What if the rest of the world is right?" Only under single-payer can we eliminate the administrative waste spent on billing hundreds of payers and the sizeable overhead of the private insurance industry.
These overhead dollars are spent marketing, underwriting, lobbying and fighting claims — none of which makes our patients healthier. Elimination of this administrative waste would save more than $400 billion annually, enough to cover the uninsured and improve coverage for the remainder. There is enough money in the system. We do not need more money — we need a new system.
As physicians, we are obligated to use evidence-based medicine in our decision-making. The reform debate must be held to the same standard. Ample evidence, including studies by the Congressional Budget Office and the Government Accountability Office, have concluded single-payer can assure universal coverage while saving money.
For those who suggest we would lose choice under single-payer, we ask, choice of what? Choice of insurance plan — yes. Choice of doctor and hospital — no. A high-quality system is not one in which our patients choose their insurance plan, but one in which they choose their doctor.
Single-payer is the only reform option that actually expands choice.
Bringing private insurance or a public option to more Americans retains limited provider networks and restricted choice.
For those who say single-payer is socialized medicine and worry that government bureaucrats will suddenly begin making health care decisions, one only needs to remember that single-payer is publicly financed but privately delivered. Medical decisions should be made by patients and doctors alone.
Medicare is an example of a single-payer system.
For those who say competition among insurers is needed to keep costs down, we say the experiment must end. It has been tried, and it has failed.
While it is trendy to refer to patients as consumers who need to exercise more personal responsibility, we believe health care is a public good, not a commodity that can be bought and sold like a flat-screen TV.
For those who ask whether something is better than nothing (i.e., implementation of a public option), we again look at the evidence. Multiple states have tried to patch their systems with piecemeal reforms over the past two decades. None has produced universal coverage while controlling costs.
Given the magnitude of these difficult economic times, including a $1.8 trillion deficit for 2009 and rising unemployment, it is high time to reconsider the most fiscally conservative and financially sustainable option for reform.
Ann Settgast and Elizabeth Frost are primary-care physicians practicing in the Twin Cities. Gillian Schivone, a third-year medical student at the University of Minnesota, also contributed to this column. They serve on the steering committee of the Minnesota chapter of Physicians for a National Health Program (www.pnhp.org). Write to them by e-mail at pnhpminnesota@gmail.com.

MinnPost: Uninsurance is a Fatal Disease

2009-07-30T11:59:00.000-07:00

Uninsurance is a fatal disease

By Dr. Michael Belzer | Friday, June 12, 2009

When General Assistance Medical Care (GAMC) ends in July of 2010, approximately 36,000 Minnesotans will join the ranks of the uninsured. While much has been said about what this might mean for Minnesota's safety net hospitals and clinics as the number of uninsured Minnesotans swells to more than 400,000 people still needing health care, not enough has been said about the health diagnosis for those who find themselves uninsured.

The loss of insurance does not merely cause patients to experience the inconvenience of longer lines in public hospitals or community-clinic waiting rooms to see a doctor. No! Lack of insurance is a real disease and, as it turns out, a potentially fatal one.

The uninsured are a well-studied but misunderstood group. In the United States there are an estimated 47 million uninsured and, contrary to common belief, undocumented or newly arrived immigrants compose only a small fraction of this number. The uninsured are not elderly; typically they are under the age of 40. More than 80 percent of the uninsured are from working families, and 20 percent — or nearly 8.7 million of the uninsured — are children.
Much has been written about the increasing number of uninsured, their demographics, the reasons for uninsurance and the cost of providing universal coverage. Little has been published about the health consequences of being uninsured. It's a fact that uninsured people are sicker, span a wide range of ages under 65, have worse health status and die younger.

Lack of insurance leads to excess death rate
The prestigious Institute of Medicine, in its landmark 2002 report, estimated that 18,000 United States residents die each year because they lack insurance. Two longitudinal studies cited in the report estimate the uninsured have a 25 percent higher risk of death and are 3.2 times more likely to die in the hospital than the insured. This excess death rate does not respect gender, age or disease state.

Uninsured women with breast cancer have a 35-57 percent higher adjusted risk of death compared to insured women. Uninsured pregnant women have a 31 percent higher chance of an adverse hospital outcome, including infant death after giving birth. Uninsured diabetics are 11 times more likely to experience avoidable hospitalization.

A 2004 study from the Harvard Medical School faculty estimated the risk of death in the uninsured "near elderly" is a risk-adjusted 43 percent higher than age-matched insured; they have a 53 percent increase in premature deaths. This results in more than 100,000 premature excess deaths over an eight-year period in the 50-64 age group alone, attributable solely to lack of health insurance. Not surprisingly, patients with high blood pressure, diabetes, or heart disease were most affected.

The excess mortality seen in the uninsured is not only due to lack of screening, patient inability to afford prescription drugs or ability or lack of willingness to seek preventive care. A 2003 study from the Massachusetts Institute of Technology looked at an unplanned medical event: auto accidents. This study amazingly found that the uninsured receive 20 percent less overall treatment for their condition and are 37 percent more likely to die of their injuries than those with insurance.

Recent studies updating the 2002 Institute of Medicine report suggest that the annual number of excess premature deaths due to uninsurance is now 22,000 deaths per year, resulting in a total of 137,000 premature unnecessary deaths from 2002-2006.

Boomers will increase premature excess deaths
Aging baby boomers will increase the premature excess deaths greatly in the future and will result in 30,000 excess and unnecessary deaths in the near elderly each year by 2015. Therefore if the mere lack of insurance (uninsurance) were categorized as a disease it would be the third leading cause of death in the near elderly behind heart disease and cancer.

No doubt, health insurance saves lives. The governor and Legislators need to directly address whose interests are served by increasing Minnesota's uninsured by 36,000 individual lives. It is time to realize that uninsurance is fatal. Sustaining this newly defined disease in the name of fiscal responsibility, tax-increase avoidance, or a balanced budget is unconscionable and unethical — and certainly poor public policy.

Michael Belzer, M.D., is medical director/chief medical officer of Hennepin County Medical Center and associate dean of the University of Minnesota Medical School.

From MinnPost: Interview with PNHP president Dr. Oliver Fein

2009-07-30T10:22:00.000-07:00
Medicare 2.0: Doctors group urges health care for all
By Casey Selix Monday, June 22, 2009

Dr. Oliver Fein, president of the 16,000-member Physicians for a National Health Program, thinks the civil rights movement of the 21st century will be health care. As health policy reform moves up the domestic agenda of the president and Congress, a single-payer, government-run program appears to be off the table. But Fein, who was in the Twin Cities last week to launch the Hazardous to Your Health! series at St. Catherine University, thinks the single-payer concept is gaining momentum in the United States.He urges skeptics to think of a single-payer system as Medicare 2.0 or a new and improved Medicare for All. Fein, an internist and professor at Weill Medical College of Cornell University, explained his reasoning in a Q&A with MinnPost.com.

MinnPost: One report says that those at either end of the health policy spectrum — a single-payer, government-run plan on one end, a free-market approach on the other — are being marginalized in Congress and the administration. Is there any way to revive a single-payer proposal at this point and how would your group go about doing that?

Dr. Oliver Fein: We have been very active in attempting to do that over this period, and what we would say, frankly, is that actually we've gotten more visibility during this time, more discussion of single payer over the last six months than we've had before. So whether people say that we're marginalized or not, the fact of the matter is there seems to be more actual discussion of single payer. What I think is really interesting is that although Sen. [Max] Baucus says that single payer is off the table, at the minimum, we're the elephant under the table. Everybody is referring to us. So, you have someone like [Health and Human Services Secretary Kathleen] Sebelius now saying we'll create a public option that will not go to single payer. You have Republicans saying that the thing they fear is single payer; you have a whole variety of discussion that's going on that keeps referring to this thing called single payer. Probably one of the real problems is there's not enough of a definition for the public to make an assessment about what that really is.

MP: Would you like to explain that?

OF: I think there are certain principles that really define what single payer is. The first is automatic enrollment in a national plan, which would lead to universal coverage. What we have now are discussions of universal coverage favored by the health insurance industry — provided that there's a mandate to buy their product. There's every evidence that that is not going to lead to universal coverage.

Principle two is that benefits ought to be really comprehensive. There's a lot of discussion that single payer should be a basic package. We think it ought to be a comprehensive benefit package going from prevention, doctor, hospital, pharmaceuticals, to dental, mental health — all medically necessary services.

Principle three is that these things should be publicly financed; that means one would not use insurance premiums for financing. Premiums are really regressive because the president of a company pays the same as the secretary of a company. That seems to us grossly unfair because the incomes of those two parties are so different. So, we would propose either a payroll tax the way the Medicare program, Part A, is funded, or a mix of payroll and income taxes so that you have a progressive way of paying for health insurance. The only way you can do that is through public financing.

The fourth principle is single payer, and what that means is we're really able to eliminate the administrative waste that occurs when you have multiple payers. The Medicare program has an overhead of about 3 percent in contrast to private health insurance which, on average, has an overhead of 20 to 30 percent. It's not just the insurance overhead, but every hospital has to have a large billing department to deal with the multiple payers. In my personal office, I have to hire extra people to deal with prior approval, denials of claims, each insurance company having different regulations and different things that I have to fill out. Single payer would eliminate all of that. A study published in the New England Journal shows that $300 billion could be redirected if we went from a multi-payer system to a single-payer system. That would cover everyone who's uninsured and many of the people who are underinsured because they have high deductibles — without costing the overall system more. And that's the real dilemma that the Obama administration is facing right now with their notion of mandates.

The fifth principle is maximizing choice. Under our present private insurance system, health plans limit you to their network of doctors and network of hospitals and you have to pay more if you go out of network or not get covered at all. Many employers offer only one plan — 42 percent of employees in America are offered only one plan. That doesn't increase choice. The program in the country now with the most choice is Medicare. You have a choice of physician, a choice of hospital; so, again, single payer would lead to increased choice.

The final principle is essentially that this system would be delivered through a nonprofit, privately controlled system. Doctors would not be employed by the government; hospitals would not be owned by the government. What you have is public financing and collection of money by the single payer, but the private delivery system would continue.So, then people usually ask me is there a model for this, any place in the world that does this? And I respond, "Yes, right here in the United States. It's the Medicare program." The traditional Medicare program is very much what we're talking about. It needs improvement and better coverage. Dental care isn't covered, for instance; nursing home care isn't covered; the prescription drug benefit is a real problem because you have to use a private insurance company. The Medicare program can't negotiate directly with pharmaceutical companies. Medicare is structured on an 80-20 rule where the beneficiary has to come up with 20 percent of the cost. I would eliminate that. So, what we talk about is Medicare 2.0 — an expanded program of Medicare for all and an improved program that deals with many of these other programs. That would be the way a single-payer program would operate in the United States.

MP: What is your best hope — and worst fear — about the health reform proposals floated by Congress and the Obama administration?

OF: I guess our worst fear would be that Congress would pass essentially an individual mandate that everybody had to purchase health insurance AND that there would be nothing like a public option. That would be our worst fear because what that would do is essentially act as a bailout for the private health insurance industry — just like the bailout for Wall Street, frankly. It probably would not benefit patients but benefit the industry. Private health insurers have been losing people who pay premiums because essentially employer coverage has dropped over 10 million people over the last decade. We think they're out now for this individual mandate so that they can reverse that and have more people buy private health insurance. When it comes to the public option, we think there are many problems with it potentially. It could become a multi-payer system where private health insurance persists — a system in which the sickest patient would be dumped into the public option. The public option would, in fact on a per-beneficiary basis, become very expensive. People would say, "Oh, the government can't run a program." There would be strong attempts to underfund the program; it could become a total fiasco. The other thing that worries us a little bit is how are we going to pay for this public option and some of the proposals like taxing health benefits — why are we doing such a ridiculous thing? So we really think that's the major dilemma for the Obama administration at this point.

MP: Your best hope?

OF: It's really difficult to say what that would be other than that there would be an increasing awareness of the single-payer option and essentially out of all of this, an increasingly large mass movement that really begins to say, "Well, we need this kind of Medicare 2.0 type program in the United States." I'm not impressed with the idea that that's impossible. One has to think of the kinds of things we thought were really impossible. If you were in the 1960s and looking at the segregation that was in our society — separate waiting rooms in bus stations, train stations … in the South, you would come to think it was impossible that segregation would be erased in our lifetimes. But in four short years because there was a civil rights movement, we got the Civil Rights Act.My best hope is that there would be a growing awareness and mass movement for health care as a right. What I think that means is health care as a single payer. I think that is growing in the country. It's just not yet being recognized by politicians. Politicians are, to some degree, beholden to various interest groups, and that can change if there is this growing mass movement. The civil rights movement of the 21st century, I think, is going to be for health care as a right.

MP: Why do you think this nation has resisted universal coverage and/or a single-payer program for so long?

OF: I think it's an accident of history. During World War II, wages were frozen and unions couldn't bargain for raises. But they could bargain for fringe benefits. So, what happened is that health insurance got linked to employment and that then began to expand. Government involvement in guaranteeing health care is very young in the world. In Europe, it started in post-World War II. There, the accident of history was that they were in very devastated economies and devastated societies; they were rebuilding. The decision there was we've got to offer medical care, in essence, as a right. Well, we had a different model linking it to employment. Gradually, we got to 1965, the Medicare program was passed; why was that? What happened to most people when they turned 65? They retired. They lost their health insurance because they were no longer working for an employer. So, we instituted single-payer national health insurance for the elderly. Now, we have many more formidable interest groups that have built up since 1965 — the private health insurance industry, the pharmaceutical industry who really worry that they're at jeopardy if we go to single payer — and they're probably right. So I think it's no mystery why things have moved a little slower here. The problem is it's not sustainable in a global world, and in a global world, which is really the way things are moving, we're going to see single payer in the United States. It's inevitable.

Minnesota Health Plan on KSTP Channel 5

2009-07-23T15:55:00.000-07:00
http://kstp.com/news/stories/S1042481.shtml?cat=1

Dr. Oliver Fein speaks in the Twin Cities - Daily Planet

2009-07-06T14:33:00.000-07:00
Oliver Fein, of Physicians for a National Health Program, at St. Kate's: Give single-payer a chance

By Kathlyn Stone , TC Daily Planet
June 25, 2009

The American Medical Association has come out against President Obama’s “public option” for health care reform, but the AMA doesn’t represent all physicians. Some physicians’ groups support the public option but others think it doesn’t go far enough to fix changes in a badly broken system. Dr. Oliver Fein, president of the progressive Physicians for a National Health Program (PNHP), found a warm welcome in the Twin Cities last week. Fein was here to present PNHP’s vision for a national single payer health program. PNHP has 16,000 members, including 300 in Minnesota.

Fein, a general internist and professor at the Weill Cornell Medical College in New York, had a full schedule last week speaking at public forums and to physicians at Regions Hospital, the University of Minnesota, and Hennepin County Medical Center.

He was joined by Elizabeth Frost, MD, a family practice physician in St. Paul and co-chair of PNHP Minnesota, at a June 17 forum at the University of St. Catherine’s in St. Paul.

Fein said opponents to single payer mischaracterize the proposal as the government “taking over” the delivery of health care. Instead, single payer is a concept whereby health care services would be paid by a single source.

It’s “an improved Medicare for all,” said Fein. Medicare is much less costly to manage compared to insurance and HMOS. Overhead costs for managing Medicare are 3.1 percent of total costs compared to the 26.5 percent associated with investor-owned insurers, according a study published in the Journal of the American Board of Family Practice.

Opponents claim that single-payer would be too costly. Fein disagrees. A single-payer system would save the nation $400 billion in overhead costs, he said, while giving the 45 million uninsured access to care, and filling in the gaps in care encountered by underinsured people.

Maintaining the status quo will be much more costly than doing nothing, says Fein.

A recent study published by the American Journal of Medicine bears this out. Researchers from Harvard and Ohio University found that over 60 percent of all U.S. bankruptcies in 2007 were driven by medical incidents. The rate reflects a 50 percent increase since 2001.

Whereas the public option proposed by Obama would offer a government-managed alternative alongside for-profit health insurance, a single-payer system would eliminate private insurance companies entirely. Private insurance companies have denounced the public option, fearing that they could not compete with a lower-cost public option plan.

Both Fein and Frost assert that single-payer has not been given a fair hearing during the national health care reform debate. Advocates of the plan were repeatedly denied an opportunity to speak at Congressional hearings presided over by Sen. Max Baucus, chair of the Senate Finance Committee. When advocates, including some doctors and nurses, protested at the hearing room, they were arrested.

The public option still has an uphill battle, but Obama insisted at his June 23 press conference, that “yes, we can” pass health care reform with a public option this year.

Frost views the public option backed by Obama as “a compromise” that would be more costly than single-payer since it keeps the market-based health insurance industry intact.

Many legislators have looked to Massachusetts’s mandatory health insurance law as a national model for reform; but a study published May 28 in Health Affairs found that the Massachusetts law requiring all to show proof of health insurance has resulted in higher costs for those least able to afford it. People still pay premiums to private insurers, with 25 percent or more of their premiums going toward overhead and profit.

“The worst that could happen,” said Frost, “would be the passage of a bad public option like the Massachusetts plan, and people consider[ing] health reform [to be] done.”

Kathlyn Stone is an independent journalist in St. Paul. She maintains a health and science news site at fleshandstone.net

From the Daily Planet 7-5-09

2009-07-06T14:21:00.000-07:00
Ellison Health Care Forum draws overflow crowd
By Barb Kucera , Workday Minnesota
July 05, 2009

When the founding fathers (and mothers) declared their goals of “life, liberty and the pursuit of happiness,” did they mean to include health care? This Fourth of July holiday, many unions and citizens are saying yes.

For the first time in 15 years, Congress is considering legislation to provide health care to all. President Obama and many elected officials back a plan that includes a public option to private insurance. But opponents, including some labor-backed Democrats, are trying to block that effort.

At events in Minnesota and across the country, people are telling their elected officials that it’s time to act.

An overflow crowd of more than 200 people spilled out into the hallway at a forum Wednesday held by Congressman Keith Ellison, DFL-5th District. A town hall meeting held that same night by Congresswoman Betty McCollum also drew a large crowd.

On Thursday, SEIU activists gathered at McCollum’s district office in St. Paul to present her with a “Healthcare Independence Flag,” featuring photos and quotes from members sick and tired of enduring abuse when they try to get health care.

“Today we declare independence from a health care system that isn’t working for too many workers. This year—2009—is the year we fix health care and make sure all Americans gain the freedom of knowing we have affordable, guaranteed health care,” said Maristella Chimbo, SEIU Local 26 member.

Nationally, the United Food & Commercial Workers is inviting people to emulate their counterparts in the American Revolution by “declaring independence from the tyrannical insurance industry and demanding the choice of a public health insurance option.” (See the campaign website.)

Americans, like the crowd who packed his forum, are ready for action, said Ellison.
“This is a clear sign that the time for change is absolutely right now . . . We’ve gotta be heard. You’ve gotta get your voice out there!”

The facts are alarming:

• In 2004, half of all people filing for bankruptcy cited medical costs as a reason.
• In 2008, half of all home foreclosures were due in part to the high cost of coverage and care.
• Every day, 14,000 more Americans lose their insurance coverage during this economic crisis.
Nearly 1 million Minnesotans are spending more than 10 percent of their income to pay for health insurance and 250,000 are spending more than 25 percent, said Eliot Seide, executive director of AFSCME Council 5 and one of the speakers at Ellison’s forum.

“No one in our opinion should have to spend more than 5 percent of their income on health care costs,” he said.

At both the Ellison and McCollum forums, several people spoke in favor of a “single payer” health care system that would cover everyone and eliminate costly private insurance. Obama has said this option is not on the table in the current debate.

“We don’t need to give more money to the insurance industry,” said Dr. Elizabeth Frost, a member of Minnesota Physicians for a National Health Program.

John Kolstad of the Metro Independent Business Alliance said private insurance has become too costly for many small businesses.

Unlike businesses in most other countries, “we are forced to put health care in our costs of goods,” he said. “How can we compete in a global economy?”

Julie Schnell, president of SEIU Health Care Minnesota, urged single payer supporters to back the public option in Obama’s plan.

“A strong public option is as close as we can get to single payer” and get a bill passed, she said.

Dr. Oli Fein coming to Town! From MinnPost

2009-07-06T14:20:00.001-07:00
Physicians to address inequality in health care in lectures
By Casey Selix | Published Fri, Jun 12 2009 12:31 pm

As President Obama and Congress look at health care reform, a seven-part lecture series on inequality in health-care access is about to launch at St. Catherine University.

Dr. Oliver Fein, national president of Physicians for a National Health Program, and Dr. Elizabeth Frost, co-chair of the Minnesota chapter of PNHP, will speak at 7 p.m. Wednesday (June 17) in the Jeanne d'Arc Auditorium, Whitby Hall, 2004 Randolph Ave., St. Paul.

Fein and Frost will talk about the physician’s perspective in the series titled "Hazardous to Your Health!" The series, which ends Dec. 9, is sponsored by the Minnesota chapter of PNHP and by St. Kate’s. Minnesota’s new chapter has 360 members so far and the national group has 16,000, said Dr. Ann Settgast, co-chair of the state chapter.

PNHP is in favor of a single-payer system for all Americans, while the American Medical Association is opposed to the public option proposed by the Obama administration.

A survey of physicians [pdf] published in April 2008 in Annals of Internal Medicine found that 59 percent of respondents favored legislation to establish a national health insurance program. The respondents came from a sampling of 5,000 physicians in the AMA’s MasterFile. Current support for a national health insurance program grew 10 percentage points from a 2002 survey, when 49 percent of respondents said they favored such legislation.

Planning for the lecture series started a few months ago, but it’s particularly timely with national attention focused on health care reform.

"In terms of President Obama’s plan of implanting a public option within the current system, that’s not something we are advocating because it leaves all of the systemic defects inherent in our system," said Settgast. "The momentum is strong to do something but not just anything."

The lecture series is free and open to the public.

Here are topics and dates of events:

"The Physician’s Perspective": June 17

"Business Perspective": July 15

"Rural Communities and Access": Aug. 26

"Racial Disparities in Care": Sept. 16

"Immigrant Perspective": Oct. 14

"International Perspectives and Solutions": Nov. 18

"Economics of Health Care and Solutions": Dec. 9

Health | Fri, Jun 12 2009 12:31 pm | 1 Comments 1 Comment Comment

Bill Moyers Journal on Single Payer

2009-07-06T14:10:00.000-07:00
Bill Moyers featured an excellent journal documentary on how single payer is off the table. From May 22, 2009.

http://www.pbs.org/moyers/journal/05222009/watch.html

UPCOMING EVENTS with PNHP President Dr. Oliver Fein

2009-05-08T09:44:00.000-07:00
We are very happy to announce that the president of National PNHP, Dr. Oliver Fein, will be coming to the Twin Cities in June. He will be speaking at several grand rounds as well as our Gala Fundraiser. Below is our calendar of events. Hope to see you there!

Hazardous to Your Health: A Series Investigating Equality and Access to Health Care.Saint Catherine University, Jeanne d'Arc Auditorium. June 17 7pm.
First in the Series will be Dr. Oliver Fein and Dr. Elizabeth Frost presenting on the physician perspective.

Regions Hospital Internal Medicine/Emergency Medicine conference.
"National Health Insurance for the U.S.: Has Its Time Come?"
June 18 at 10 am in the 3rd floor auditorium.

University of Minnesota Internal Medicine Grand Rounds.
"National Health Insurance for the U.S.: Has Its Time Come?"
June 18 at noon in the Phillip-Wangensteen Building Rm 2-470

Minnesota Universal Health Care Coalition and
Physicians for a National Health Plan -- Fundraiser GALA!
"The White House Health Care Summit and Its Aftermath"
June 18. University Club. 6:30 PM.
Please purchase tickets at http://www.muhcc.org/
Tickets $50.

HCMC Internal Medicine Grand Rounds.
"National Health Insurance for the U.S.: Has Its Time Come?"
June 19 at noon - Red Lower Level Conference Room (RL 110), HCMC

Amy Goodman: Put Single-Payer on the Table

2009-03-12T06:22:00.001-07:00

Put Single-Payer on the Table
3/10/09 by Amy Goodman

President Barack Obama promises health-care reform, but he has taken single-payer health care off the table. Single-payer is the system that removes private insurance companies from the picture; the government pays all the bills, but health-care delivery remains private. People still get their choice of what doctor to go to and what hospital to use. Single-payer reduces the administrative costs and removes the profit that insurance companies add to health-care delivery. Single-payer solutions, however, get almost no space in the debate.

A study just released by Fairness and Accuracy in Reporting, a media watchdog group, found that in the week before Obama’s health-care summit, of the hundreds of stories that appeared in major newspapers and on the networks, “only five included the views of advocates of single-payer—none of which appeared on television.” Most opinion columns that mentioned single-payer were written by opponents.

Congress is considering H.R. 676, “Expanded and Improved Medicare for All,” sponsored by John Conyers, D-Mich., with 64 co-sponsors. Yet even when Rep. Conyers directly asked Obama at a Congressional Black Caucus meeting if he could attend the White House health-care summit, he was not immediately invited. Nor was any other advocate for single-payer health care.

Conyers had asked to bring Dr. Marcia Angell, the first woman editor in chief of The New England Journal of Medicine, the most prestigious medical journal in the country, and Dr. Quentin Young. Young is perhaps the most well-known single-payer advocate in America. He was Martin Luther King Jr.’s doctor when King lived in Chicago. “My 15-minute house calls would stretch into three hours,” he told me.

But he came to know Barack Obama even better. Though his medical partner was Obama’s doctor, Young was his neighbor, friend and ally for decades. “Obama supported single-payer, gave speeches for it,” he said.

This past weekend, hundreds turned out to honor the 85-year-old Young, including the Illinois governor and three members of Congress, but the White House’s response to Conyers’ request that Young be included in the summit? A resounding no. Perhaps because Obama personally knows how persuasive and committed Young is.

After much outcry, Conyers was invited. Activist groups like Physicians for a National Health Program (pnhp.org) expressed outrage that no other single-payer advocate was to be among the 120 people at the summit. Finally, the White House relented and invited Dr. Oliver Fein, president of PNHP. Two people out of 120.

Locked out of the debate, silenced by the media, single-payer advocates are taking action. Russell Mokhiber, who writes and edits the Corporate Crime Reporter, has decided that the time has come to directly confront the problem of our broken health-care system. He’s going to the national meeting of the American Health Insurance Plans and is joining others in burning their health-insurance bills outside in protest. Mokhiber told me, “The insurance companies have no place in the health care of American people. How are we going to beat these people? We have to start the direct confrontation.” Launching a new organization, Single Payer Action (singlepayeraction.org), Mokhiber and others promise to take the issue to the insurance industry executives, the lobbyists and the members of Congress directly, in Washington, D.C., and their home district offices.

Critical mass is building behind a single-payer system. From Nobel Laureate in Economics Joseph Stiglitz, who told me, “I’ve reluctantly come to the view that it’s the only alternative,” to health-care providers themselves, who witness and endure the system’s failure firsthand. Geri Jenkins of the newly formed, 150,000-nurses-strong United American Nurses-National Nurses Organizing Committee (nnoc.net) said: “It is the only health-care-reform proposal that can work. ... We are currently pushing to have a genuine, honest policy debate, because we’ll win ... the health insurers will collapse under the weight of their own irrelevance.”

Dr. Young has now been invited to a Senate meeting along with the “usual suspects”: health-insurance providers, Big Pharma and health-care-reform advocates. I asked Young what he thought of the refrain coming from the White House, as well as from the leading senator on the issue, Max Baucus, that “single-payer is off the table.” “It’s repulsive,” sighed Young. “We are very angry.” But not discouraged. I asked him what he thought about Burn Your Health Insurance Bill Day. “Things are heating up.” he chuckled. “When things are happening that you have nothing to do with, you know it’s a movement.”

Denis Moynihan contributed research to this column.

Amy Goodman is the host of “Democracy Now!,” a daily international TV/radio news hour airing on more than 700 stations in North America. She was awarded the 2008 Right Livelihood Award, dubbed the “Alternative Nobel” prize, and received the award in the Swedish Parliament in December.

Media Black Out on Single Payer?

2009-03-10T18:34:00.000-07:00

Study: Media Blackout on Single-Payer Healthcare

New Study on Media & Healthcare Reform

Proponents of popular policy shut out of debate

NEW YORK CITY - March 6 - A timely new study documents a significant gap in recent media coverage of healthcare reform.

Major newspaper, broadcast and cable stories mentioning healthcare reform in the week leading up to President Barack Obama's March 5 healthcare summit rarely mentioned the idea of a single-payer national health insurance program, according to a study by the media watch group FAIR. And advocates of such a system--two of whom participated in yesterday's summit--were almost entirely shut out, FAIR found. This despite the fact that single-payer polls well with the public, who preferred it 59-to-32 over a privatized system in a recent survey (New York Times/CBS, 1/11-15/09).

Of the hundreds of major newspaper, broadcast and cable stories mentioning healthcare reform on NBC News, ABC News, CBS News, Fox News, CNN, MSNBC, NPR and PBS's NewsHour With Jim Lehrer, the study found that:

-All but 18 stories made no mention of "single-payer" (or synonyms commonly used by its proponents, such as "Medicare for all," or the proposed single-payer bill, H.R. 676)

-Only five stories included the views of advocates of single-payer--none of which appeared on television.

-A media consumer in the week leading up to the summit was more likely to read about single-payer from the hostile perspective of conservative columnist Charles Krauthammer than see an op-ed by a single-payer advocate in a major U.S. newspaper. Of a total of 10 newspaper columns FAIR found that mentioned single-payer, Krauthammer's syndicated column critical of the concept, accounted for five instances, while only three columns in the study period advocated for a single-payer system.

-The FAIR study turned up only three mentions of single-payer on the TV outlets surveyed, and two of those references were by TV guests who expressed strong disapproval of it.
A full summary of the study's findings is available at: http://www.fair.org/index.php?page=3733

PNHP in the Wall Street Journal

2009-03-10T18:30:00.000-07:00

Invited to Summit, Single-Payer Group Cancels Protest

Barack Obama isn’t likely enact a Medicare-for-all, single-payer health plan. The White House Web site promises that, under the president’s proposed health plan, “if you like your current health insurance, nothing changes…”
US President Barack Obama speaks in the East Room of The White House in Washington, DC, on March 4, 2009. Obama warned Thursday that the United States would not rebuild its economy unless political leaders joined him immediately on a perilous political drive for healthcare reform. Originally excluded from the summit, single payer advocates declared a 'small victory' as two important members of the single payer leadership received invitations to the event. (AFP/File/Chris Kleponis)
Still, a gesture can go a long way.
Physicians for a National Health Program, a group of docs that claims 15,000 members and supports a single-payer system, had planned to demonstrate outside the White House today over what they said was the exclusion of single-payer advocates from the White House’s health-reform summit.

But yesterday, PNHP canceled the protest — after the group’s president was invited to today’s meeting. Rep. John Conyers (D-Mich.), who backs a Medicare-for-All bill in Congress, was also invited.

A PNHP spokesman told the Health Blog the invitations are a “small but important victory.”

Of course, those are only two people out of the more than 100 on hand for the meeting. As this list of participants shows, the White House halls should be thick with members of Congress.

Also in attendance are leaders from the AMA and other medical specialty societies; trade groups for drug makers, insurance companies and hospitals; CEOs of companies including Pfizer and General Mills; advocacy groups such as the American Heart Association and American Diabetes Association; and unions such as SEIU and the Teamsters.

We just watched Obama’s opening remarks, which sounded a lot like what he’s been saying recently about health reform. Namely, it’s essential to the country’s economic recovery and it won’t happen unless government leaders get support from a broad base of the public. “Health-care reform is no longer just a moral imperative — it’s a fiscal imperative,” he said.

We’ll have more from the meeting later. You can also watch it yourself at the newly launched healthreform.gov.

© 2009 Wall Street Journal

Rep. Keith Ellison and Sen. John Marty speak at health care reform forum

2009-03-05T06:49:00.000-08:00
South Side Pride March 2009

Rep. Keith Ellison and Sen. John Marty speak at health care reform forum

BY KIP SULLIVAN

On Saturday, Feb. 21, 50 to 60 people drove through four inches of freshly fallen snow to hear Rep. Keith Ellison (D-MN) and Sen. John Marty (DFL-Roseville) explain single-payer legislation pending in Congress and the Minnesota Legislature. The forum took place at the Communication Workers of America headquarters on Lake Street.

Sen. Marty began his presentation saying, “The easiest way to explain single-payer is to compare it to other public services like police and fire protection. If you go home after this forum and find your house is being burglarized, you’re going to call the police. Are the police going to ask you if you have burglary insurance? Of course not.”

He briefly explained the Minnesota Health Plan (MHP), a program that his
bill (SF 118/HF 135) would create. It would include all Minnesota residents, cover all necessary medical services, and maximize our choice of doctor. “There would be no preexisting condition exclusions,” he said. “For some insurance companies, being a woman is a preexisting condition.” He said one of the ways the MHP would lower administrative costs would be to give budgets to the state’s 134 hospitals. To illustrate how this saves money, he asked the audience to imagine what our schools would be like if we asked teachers to keep track of every expenditure on a per-student basis the way we ask hospitals to keep track of every little expenditure on a per-patient basis. “Do we ask teachers to keep track of every crayon students use so we can bill their insurance company? Do we ask them to report how much time they spent with this student and how much with that one? If we did that our teachers would be spending half their time on administration.”

Sen. Marty observed that SF 118 has now passed two committees in the Senate and currently has 28 co-authors in the Senate (nearly half the 67 members of the Senate) while nearly one-third of the House of Representatives has co-authored the companion bill (HF 135).

Rep. Ellison began his talk making the same point Sen. Marty had just made—that HR 676, the national single-payer bill, has 94 co-sponsors in the House of Representatives (it had 93 when the last session of Congress ended in December). “But the House leadership has not yet seen fit to give it a hearing,” he said. “We need maximum pressure on Congress if we’re going to get this bill heard,” he said. “We need to look outside our box of friends for support,” he observed. To illustrate why business needs single-payer, Rep. Ellison said, “The best thing we could do for General Motors is give them a single-payer system.” The audience laughed and applauded. Rep. Ellison noted that when he is knocking on doors, he finds the health care crisis is constantly on people’s minds. “Other issues, like the Iraq war and now the economy, might be the issue you hear about the most, but you always hear about the cost of health care,” he said. “It’s the political issue that never goes away.”

Kip Sullivan sits on the steering committee of the Minnesota chapter of Physicians for a National Health Program. Kip Sullivan, health systems analyst for the Greater Minnesota Health Care Coalition and author of “The Health Care Mess,” will speak on the American health care reform debate at Valley Community Presbyterian Church, 3100 Lilac Drive North, Golden Valley, at 6:45 p.m., Thursday, March 26. Sponsored by NW Neighbors for Peace. Free and open to the public. For more information email NWN4P@yahoo.com.

From Nick Coleman in the Star Tribune

2009-01-27T11:49:00.000-08:00

Nick Coleman: State's neediest face grim fate if budget cuts hit health care

By NICK COLEMAN, Star Tribune

Last update: January 18, 2009 - 7:38 AM

Dr. Elizabeth Frost is a family practitioner at St. Paul's West Side Community clinic. One day last week, she diagnosed a likely case of breast cancer in a 51-year-old uninsured woman too poor to pay for her exam. Fortunately, the state of Minnesota has a free cancer-screening program for women over 40 to help detect breast and cervical cancer.

But Frost worries that the program might disappear -- along with services like basic care for pregnant women -- in the face of a $5 billion state deficit. That's because Gov. Tim Pawlenty may propose budget cuts to health and human services programs just as rising unemployment places more demands on the system.

Cutting health care is the exact wrong idea, says Frost, who is co-chair of the Minnesota chapter of Physicians for a National Health Program. She says access to basic care already is decreasing every day.

She said she knows one low-income patient who needs an MRI and a knee injection in order to return to his job, but he hasn't been able to find a doctor who will treat him without an up-front $800 payment.

"People are no longer being allowed to work out payment plans, because doctors and clinics need the money up front," Frost says. "Which means no access for a lot of people. And more every day."

Frost and many other front-line health care providers worry that the state budget crisis may lead to further health care cuts that could lead to a disaster.

In his 4,000-word State of the State address Thursday, Gov. Tim Pawlenty devoted just 100 words to health and human services, and said even less. Other than promising to "protect all current health care eligibility for children," he offered no proposals. Yet health care costs are rising sharply and Pawlenty has hinted that his budget will include cuts in areas crucial to the health and welfare of a growing number of Minnesotans.

Article in TC Daily Planet -- Is Universal Coverage Enough?

2009-01-22T18:39:00.000-08:00
Is Universal Coverage enough?

by Ann Settgast, MD

The upcoming change in administration has brought optimism and hope to the American public. Now is the time to demand meaningful healthcare reform rather than a replay of past failures. As a physician, I know that offering a placebo in place of known effective treatment is unethical. Hence, while I applaud the good intentions of Senator Tom Daschle, the Healthcare for America Now (HCAN) coalition, and others, I advise against their proposals to extend a system that is fundamentally flawed. In these times of economic uncertainty and crisis, single payer is the only fiscally responsible option for reform…and it is the only solution that will actually work. Many physicians agree that the largest limitation to providing quality care to our patients rests in the structure of our current system. In an April 2008 survey in Annals of Internal Medicine, 59 percent of U.S. physicians said they would support government action to establish national health insurance.

Most Americans believe lack of health insurance is a “serious problem” (NPR/KFF survey, Feb 2008). Current reform proposals claim to be the way forward. However, expanding our flawed system will not solve the serious problems we face – rising costs and lack of coverage (for uninsured and underinsured). Unfortunately, having coverage in our system does not guarantee care. One-fourth of the insured go without needed care due to cost; three-fourths of individuals bankrupted by medical bills had insurance when they became ill. Is this a system worth perpetuating?

Reform efforts such as those proposed by HCAN and outlined by Senator Daschle maintain a central role for private insurance companies, and are thus doomed to fail because they cannot control costs. They increase coverage only by increasing cost. These proposals duplicate key elements of reform efforts that have consistently failed: Massachusetts in 1988; Oregon in 1989; Tennessee, Minnesota and Vermont in 1992; Washington State in 1993; and Maine in 2003. In each case, rising costs foiled the reform effort, and none durably decreased the number of uninsured. Similarly, the 2006 Massachusetts law, which represents a mandate model of reform, is threatened by rising costs. While the number of uninsured MA residents has fallen modestly, 14% of residents in 2007 remained uninsured at some point in the year. Many MA residents cannot afford the “required coverage”. A 56-year-old making $30,000 annually must spend $7,164 in premium and deductible alone. Today, hundreds of thousands of MA residents remain uninsured. Relying on government subsidies that cannot be sustained, and requiring people to buy insurance they cannot afford, is no solution. Such “reform” expands the role of wasteful private insurers, does nothing for the tens of millions underinsured, and relinquishes the colossal savings that would be achieved under single-payer.

Administrative costs in the U.S. health-care industry are a whopping 31% – more than double that of most industrialized nations. The administrative costs of our private insurers are drastically higher than those of our current single payer (Medicare administrative overhead is less than 2%). This excess is squandered in medically unnecessary activities such as marketing, underwriting, and profit-making. Providers also have unnecessarily high overhead as they struggle to deal with hundreds of different plans. By eliminating this waste, a single-payer system will save our country an estimated $350 billion a year – enough to provide comprehensive health care for all at no additional cost.

In conclusion, I urge the reader to be wary of doomed efforts that focus on lack of insurance and ignore the broader problems of access, affordability, and skyrocketing costs. Single-payer insurance is not socialized or government-run medicine. Care will be provided by private physicians and hospitals, just as it is now, but patients will have increased choice of providers because there will be no insurance meddling. They will also have comprehensive coverage coupled with freedom from the fear of financial ruin due to illness. H.R. 676, the U.S. National Health Insurance Act, has more than 90 co-sponsors in Congress – more than any other health reform proposal. Successful implementation will effectively fix our broken system.

Ann Settgast, MD, is the co-chair of Physicians for a National Healthcare Program – Minnesota Chapter. Originally published on 1/19/09

Rally for the Minnesota Health Plan

2009-01-17T10:28:00.000-08:00
Single payer advocates from across minnesota met to rally for the Minnesota Health Plan on January 5, 2009. About 300 supporters gathered in the state capitol rotunda. Here are PNHP Physicians Ann Settgast, MD and Lisa Nilles, MD

Star Tribune: Letter to Editor December 14, 2008

2008-12-24T23:07:00.000-08:00

Health care costs

Don't let misconceptions and myths block reform

How about some real solutions?

In "5 misconceptions about health care" (Opinion Exchange, Dec. 7) Shannon Brownlee and Ezekiel Emanuel minimize and belittle the potential savings from administrative waste in our health system. They underestimate the potential savings at 5 percent per year (other respected estimates range from 10 to 25 percent), and then say that the 5 percent, or $124 billion a year, is "not that much." Not that much!
Instead they say that savings can be found by instituting electronic medical records and eliminating "harmful care." I know physicians like their money, but will placing blame on them really cover the uninsured? And don't "EMRs" sound like another high-tech gizmo? The truth is there isn't a single-peer reviewed study that shows these solutions save money.

ELIZABETH FROST, MINNEAPOLIS

CO-CHAIR, PHYSICIANS FOR A NATIONAL HEALTH PLAN, MINNESOTA

Rochester Post-Bulletin 11/26/08

2008-12-02T21:26:00.000-08:00

Both sides: Single-payer universal health care is the way to go

11/26/2008 10:00:03 AM

Comments (0)

By Amy F. Isaacs

WASHINGTON -- It's no longer news that at least 47 million Americans lack health insurance, and an additional 50 million are "under-insured" -- meaning whatever ails you is excluded. But we seldom hear that private health insurance wastes $350 billion every year, enough to pay for high-quality comprehensive health care for everyone.

Nearly one-third of our health-care costs are eaten up by overhead: marketing, billing, profits, denying coverage, and hassling patients and doctors. While 30 cents of every dollar of health costs pays for overhead, Medicare costs 3 cents on the dollar. Today, rising health-care costs cause one-half of all personal bankruptcies, three-fourths of whom have insurance.

Politicians promise us "universal health care," a phrase now devoid of meaning. The government would help us buy private insurance, especially through employers. As the economy hemorrhages more than 200,000 jobs every month, insurance costs soar, and with employers large and small -- including state and local governments -- unable to afford to insure their employees, an employer-based system has become a non-starter.

In fact, relieving the auto and steel industries of the burden of providing health insurance for their employees and retirees would make those vital industries more competitive with industries around the world whose governments have assumed health-care costs. Besides, Americans want free choice of a doctor, rather than a free choice of an insurance company, each of whom offers a confusing array of benefits, deductibles, co-pays, annual and lifetime caps.

A single-payer system simply means government-financed, privately delivered health care: no deductibles, no co-pay. The Expanded and Improved Medicare for All Act, sponsored by Rep. John Conyers, D-Mich., and more than 90 fellow representatives in the 110th Congress is the answer.

Under the Conyers' bill, everybody would have a card to present to a health-care provider. No more hassle or cost. Doctors can already bill Medicare electronically. That would be their only "paperwork." There are other benefits for patients. For instance:

• The government would negotiate prices of prescription drugs.

• Electronic records would foster continuity of care and reduce medical errors.

• Complete data would be available so a professional board could determine best practices: what treatments work and which don't.

• Doctors would emphasize prevention.

• Hospitals would be paid based on a global budget negotiated to cover their costs, rather than current practice of billing for each aspirin and each test.

We know the powerful $500 billion-a-year insurance industry and the super-rich pharmaceutical industry -- reluctant to lose their bonanza -- will barrage the airwaves with ads to scare and confuse the public.

They'll argue that people will run to the doctor unnecessarily, that patients' bad practices are causing soaring costs. The data show otherwise. Rising costs are attributable to overuse of emergency rooms by people who have no family doctor or available clinic, by doctors over-ordering expensive technology, and by unnecessary surgery performed by for-profit hospitals.

In fact, Medigap policies purchased to cover unaffordable co-pays and deductibles are another insurance industry cash cow. Not to be forgotten, an insurance company's fiduciary responsibility is to its stockholders, not to patients. Insurance companies are the problem, not the solution.

In 2003 Barack Obama said a single-payer system was a good idea, but he feared it was not politically feasible. ADA members worked tirelessly for his election this November, and we agree with him that health care is a human right.

We believe that the American people will convince politicians that a single-payer system is politically feasible and an economic and moral imperative. With soaring personal bankruptcies and unemployment, state governments forced to cut back on our tattered safety net, the question is not whether we can afford to enact single-payer health care, it is whether we can afford not to.

Amy Isaacs is the national director of Americans for Democratic Action (www.adaction.org), America's largest and oldest independent liberal lobbying organization.

Pioneer Press -- Letter to the Editor 11-21-08

2008-11-23T19:33:00.001-08:00

Use opportunity to reform health care

As a family practice doctor who works with the uninsured in St. Paul, I have recently become involved in health care reform. I believe single-payer national health insurance is the only way to provide quality affordable care for all.

The U.S. Government Accountability Office has estimated that single-payer can save 10 percent of health costs overall — amounting to $300 billion annually. The savings come from slashing administrative waste.

As the economy worsens and we see our auto industry drowning in health care costs, the question becomes not how can we afford to have single-payer health care, but how can we afford not to have it?

Rahm Emanuel, chief-of-staff designate, said the economic crisis "provides the opportunity, as the president-elect has said repeatedly, to do things that Americans have pushed off for years." I believe single-payer may be one of those things, and the time is now to institute the change.

Elizabeth Frost, Minneapolis

Physicians support single payer -- Southside Pride

2008-11-17T21:19:00.000-08:00

Physicians support single payer

by Elizabeth Frost
published November 03, 08

I am a family practice doctor and work toward health care reform with a group called Physicians for a National Health Program. Recently I was able to meet with Minnesota Senator Linda Berglin about health care. I have a great deal of respect for Sen.Berglin because she has authored and ushered in Minnesota Care, which provides health insurance for many poor and working class residents, making Minnesota an excellent place to practice medicine.

However, Minnesota still has 400,000 people uninsured, and more than enough health horror stories. Private insurance is discriminatory by nature, which is why I support single payer health care: everybody covered all the time with one single plan. Currently there is an excellent bill in the Minnesota Legislature named the Minnesota Health Plan, sponsored by Senator John Marty. A full third of the house and senate signed on to the bill in its first year, but not Sen. Berglin.

My intention in meeting with Sen. Berglin was to ask her to sign on in support of single payer in Minnesota. She, however, informed me she had already voted for Sen. Marty’s bill, presumably during the bill’s first committee hearing on Feb. 18. I did not challenge her at the meeting because I assumed she would tell the truth, but reviewing the bill, I found that she had not. Later, by e-mail, Sen. Berglin admitted to me that she had not voted at all on Sen. Marty’s bill because she had left the room.

Sen. Berlin is a powerful leader in healthcare reform in Minnesota and I would like her to apologize for not telling me the truth. However, more than an apology I would like Sen.Marty’s bill to stand a chance in the Minnesota Senate in 2009. I would like Sen. Berglin in this coming year to put her money where her mouth is and to sign on to the Minnesota Health Plan, work with Sen. Marty to get it through committees, and rally other senators to support it.

Elizabeth Frost, M.D., is co-chair of Physicians for a National Health Program (PNHP) Minnesota.

Dr. Jim Letts and Senator John Marty in Mankato

2008-11-09T08:33:00.000-08:00
Democratic Sen. John Marty and a St. Paul physician talked about health care reform in Mankato Thursday.

By Mark Fischenich
The Free Press

MANKATO —
A state senator from Roseville and a physician from St. Paul drove to Mankato Thursday and spent two hours talking about a health care reform bill they know isn’t going to become law next year or the year after or probably the year after that.

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But Democratic Sen. John Marty, the chairman of the Senate Health Committee, is planning to do a lot of presentations like the one at St. John’s Episcopal Church over the next few years. And, more notably, he is scheduling more meetings with local Chambers of Commerce, hospital administration organizations and others who have traditionally opposed dramatic changes in American health care.

“We’ve got a three-to-four-year plan to educate people,” Marty said to an audience of about 30 people, most of whom seemed sympathetic to his plan.

That time frame also brings the end of the second term of Gov. Tim Pawlenty, who has made clear he won’t support Marty’s legislation.

A growing number of Democratic lawmakers have signed on, including 60 who were co-authors this year. And business organizations and other traditional skeptics of similar legislation are showing a willingness to listen, Marty said.

“I think they’re beginning to recognize the system is broken, something needs to happen,” he said. “... We’ve got a disaster on our hands.”

Ever-rising health care costs are straining employers’ budgets, pushing average Minnesotans into bankruptcy and leaving 400,000 residents without coverage. His proposal, the Minnesota Health Act, attempts to take Minnesota where most other industrial nations have gone — a health care system where everybody’s care is covered and a government-organized funding pool pays the bills.

Letts said doctors are increasingly supportive of the idea.

“Physicians are there, finally,” he said. “There’s enough frustration among health care professionals — nurses, physicians and such — that I think change is coming.”

The plan would provide full coverage of all medical care, including prescriptions, preventive care and other care provided by licensed professionals. The coverage would no longer be attached to employment, deductibles and co-payments would be eliminated, patients would be able to pick their doctor and clinic, and care couldn’t be denied for pre-existing conditions.

The treatment would be funded by taxes based on ability to pay and would be administered by an independent board.

Blue Earth County Commissioner Katy Wortel of Mankato opened the questioning by pointing out the idea’s long-standing political flaw.

“What you’re really talking about is a middleman — or somebody who’s making money — not making money,” Wortel said, asking how they would address the inevitable opposition from insurance companies, underwriters, hospital billing clerks and others whose livelihood would be eliminated.

“There is going to be some displacement,” Marty said, adding that the plan may eventually include provisions for helping with job retraining.

But the flip side is the cost savings from that displacement, he said.

Paperwork consumes about 30 percent of health care spending in America — compared to just more than 2 percent in Taiwan, which enacted a national health plan in 1995, according to Marty. Health care would cost less in Minnesota, and new businesses would be drawn to the state.

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Letts said sticking with the current system isn’t a realistic alternative in the long term.

“People can’t afford it,” he said. “Employers can’t afford it. That’s why we’re seeing a collapse. That’s why it’s going to fail.”

Beyond cost, there are health benefits that come with a publicly funded program that covers everybody and gets them necessary preventative care before their medical condition worsens.

“Less pain, suffering and death for people, that’s why we support it,” Letts said.

One woman in the audience recalled attending a similar meeting led by Paul Wellstone, who died six years ago last month.

While there’s been no obvious progress for a single-payer program in all those years, Marty said he’s not listening to those who say it’s politically unrealistic.

“Maybe we just need to redefine what’s politically realistic,” he said.

Details of the legislation are available at www.mnhealthplan.org.

Protests and Publicity during the week of the RNC

2008-11-01T18:52:00.000-07:00
Senator John Marty, author of the Minnesota Health Plan, the Minnesota single payer bill, with Elizabeth Frost, MD and co-chair PNHP Minnesota in orange, and Laura Blubaugh, Marty's legislative aid in blue. We are at the Ripple Effect concert on Tuesday September 2.

From left to right Dr. Caroline Toll, medical student Gillian Schivone, and Dr. Elizabeth Frost. We are all members of PNHP Minnesota steering committee.

Townhall Meeting with Keith Ellison August 11

2008-08-24T22:39:00.000-07:00

Congressman Keith Ellison of CD5 has supported the national single payer bill, HR 676, since its inception at the beginning of 2007. He is now joined by over 90 other house representatives, but is the only supporter in Minnesota. On Monday August 11 held a town hall meeting to discuss universal single payer health care, and how it can become a reality in Minnesota and nationwide. Dr. Ann Settgast, co-chair of PNHP Minnesota, helped lead the discussion. In the photo above Keith poses with Elizabeth Frost and Ann Settgast.

Article from TC Daily Planet

2008-08-24T22:34:00.000-07:00

More physicians support single-payer health care

By Kathlyn Stone , TC Daily Planet

May 12, 2008

Fifty-nine percent of U.S. physicians now support a federally administered health insurance fund that would guarantee health care coverage for everyone, according to a report published in the April 1 2008 issue of the Annals of Internal Medicine. The current support represents a 10 percent increase from a similar national survey in 2002. Among Minnesota physicians, the support for health care financing reform appears to be even higher and tied more specifically to a single-payer system.

Last year, Minnesota Medicine magazine reported its results from the first-ever random sampling of state-licensed physicians. Physicians were asked what type of health care financing structure they’d prefer among three choices: single-payer, health savings accounts (tax-free savings accounts to which individuals and employers contribute), and managed care (market-based private insurance plans). Sixty-four percent said a single-payer financing system would provide “the best health care to the greatest number of people for a fixed amount of money,” according to the Minnesota Medicine report.

A single-payer system would be a single plan managed and funded by just one entity, likely the government or a publicly accountable commission. Other universal health care plans currently under discussion would extend insurance coverage to more citizens through a combination of private, for-profit, non-profit and government organizations. A single-payer system would be less costly, say proponents, or more costly, according to opponents.

“Across the board, more physicians feel that our fragmented and for-profit insurance system is obstructing good patient care, and a majority now support national insurance as the remedy,” said Ronald Ackermann, co-author of the national study and associate director of the Center for Health Policy and Professionalism Research at Indiana University’s School of Medicine.

“I find the survey results energizing,” said Ann Settgast, a primary care physician in St. Paul, who along with Elizabeth Frost, another St. Paul physician, co-chairs the Minnesota chapter of Physicians for a National Health Program (PNHP). . “In five years (since the last survey) there’s been a dramatic 10 percent increase in positive responses. That shows a trend for sure.”

For more information or to request a PNHP-MN speaker contact pnhpminnesota@gmail.com.

PNHP-MN was formed last summer and has grown to 200 members. Most are in the Twin Cities but there’s growing representation from Duluth, Rochester and Mankato, Settgast said.
PNHP has about 15,000 members nationally, making it one of the largest medical associations in the country. A core belief of PNHP is that all people have a right to access high quality health care. Health care should be provided “equitably as a public service rather than bought and sold as a commodity,” according to the state chapter’s web site.

About 30 of the group’s more active members meet monthly and have spoken to civic, educational, and political organizations. In February PNHP-MN members testified in support of Sen. John Marty’s single-payer bill. Settgast said she’s “heartened” by the response the single-payer advocates have gotten after speaking with other physicians and joining in the public dialogue over health care reform. “We get a good reception,” added Settgast. “I don’t feel ‘fringe-y.’”

Until recent years, universal single-payer advocates were dismissed as being part of the fringe or ‘socialists,’ in a derogatory way. But as health care costs have risen out of the reach of millions more people, and disparities in health outcomes have grown between rich and poor and among racial and ethnic populations, public attitude has done an about-face.

In 2003, a single-payer “Medicare-for-all” type system drafted by Physicians for a National Health Program, was published in JAMA, the AMA journal. It was the impetus for the proposed National Health Insurance Act (HR 676) introduced in 2006 by U.S. Representatives John Conyers (D-Michigan) and Dennis Kucinich (D-Ohio).

PNHP-MN is taking out a full-page ad in the May issue of Minnesota Physician that asks colleagues to sign on to a resolution supporting HR 676, and encourage more Minnesota physicians to join the state chapter.

Even with a clear majority of support from citizens and growing physician support, a national health care program may come from incremental enactment through individual states rather than through federal legislation. HR 676 is stagnant with 88 co-sponsors. No new action has been taken on the bill since February 2007 when it was referred to two subcommittees on health.

None of the leading presidential candidates supports a single-payer or Medicare-for-all type health care system at this time. The Association of Health Care Journalists has a summary of the Democratic and Republican candidates’ plans on its web site. (When asked months ago if it planned to include all presidential candidates health care plans, including declared Green Party candidate Cynthia McKinney’s, AHJC president Len Bruzzese indicated he would bring it before the board for a decision. As of today, McKinney’s views are still absent from the site. Ironically, the health care proposals of candidates who have dropped out of the presidential race are still featured.)

As the public grows more impatient with government gridlock over health care, umbrella organizations like the Minnesota Universal Health Care Coalition with 15 member organizations (including PNHP-MN) are being replicated in state after state. Everybody In, Nobody Out, managed by North Carolina community organizer Dennis Lazof, maintains a database of citizens groups in each state.

Kathlyn Stone is an independent journalist in St. Paul. She maintains a health and science news site at www.fleshandstone.net She can be reached at stonekat@comcast.net

From Southside Pride

2008-05-19T17:09:00.000-07:00

Rigged health care commissions circumvent democracy–again

by JOEL ALBERS

Proposed solutions to the health care crisis have reached a crossroads, with essentially two paths that Minnesota and the U.S. can follow. One path views health care as a market commodity, in which health care is for sale. Patients are also consumers who must shop around, compare prices and quality of care, and buy insurance. That is if you can afford it. If you cannot, you are uninsured. And therein lies the crisis.

The other path views health care as a public good: government-funded through taxes, like education, social security, Medicare and roads. With everybody in one big pool (creating economies and efficiencies of scale), represented by a single-payer, health care would be universal, comprehensive, a human right, based on need, and free at the household level. As in the rest of the world, cost is essentially out of the picture.

In this legislative session, like in others before it, the Minnesota Senate and House have each passed major health care bills based on the market commodity model described above. The bills are now in conference committee where their differences will be worked out. The House bill, HF 3391, is sponsored by Rep. Tom Huntley (DFL-Duluth) and the Senate bill, SF 3099, is sponsored by Senator Linda Berglin (DFL-Mpls). As may be expected, these bills were fully backed by HMO health insurers and big business.

The Minnesota Health Plan, bill SF 2324, (a Single-Payer bill—a government-funded approach, and, according to surveys, backed by most Minnesotans), was scuttled shortly after the legislative session began, only passing through one committee. Year after year this scenario is replayed resulting in a worsening of the health care crisis.

What’s behind this contradictory trend in which insurance companies and big business circumvent democracy, and what can be done about it? A major factor is rigged, handpicked Task Forces, currently, the “Health Care Transformation Task Force,” whose recommendations became the basis for the aforementioned Huntley and Berglin bills.

Here’s the mechanism of how it works. The so-called Health Care Transformation Task Force was intentionally created by the 2007 Legislature and signed by Governor Pawlenty last May. This allowed the governor to appoint (handpick) all members of the Task Force, including its co-chairs, Rep. Tom Huntley (DFL-Duluth) and Human Services Commissioner Cal Ludeman who also serves as the chair of Governor Pawlenty’s Health Cabinet (also handpicked). Rep. Huntley, in turn became a chief author of the aforementioned bill.

Examining the composition of the 13-member Health Care Transformation Task Force reveals most members represent, not you and me, but corporate health insurance companies and big business: Medica HMO, Park Nicollet, Mayo Clinic, Definity (HSA, Health Savings Accounts), Minute Clinic, General Mills and the Carlson Companies. Only two Task Force members are health care practitioners, both physicians, yet with potential business conflicts of interest; one is former medical director of HealthPartners HMO; the other is a fellow for the Center for the American Experiment (conservative “free market” think tank).

The two remaining Task Force members appear to be more community-based, representing the Citizens League and a major labor union, yet are far from it. In fact, last year the Citizens League convened its own 26 member “Citizens League Medical Facilities Study Committee” charged with examining the expansion of medical facilities such as hospitals in Minnesota. Again, very few citizens or health practitioners. As for the labor union representative from AFSCME Council 6, he sat on the 1992 Minnesota Health Care Commission, and helped it pave the way for the takeover of Minnesota health care by “managed care” HMOs, a market-based approach that called for universal coverage in Minnesota by July 1, 1997.
Previous commissions similarly handpicked and unrepresentative of Minnesotans include: the MN Medical Association Health Care Task Force of 2005, the MN Mental Health Action Group of 2005, the MN Citizens Forum on Health Care Costs (also known as the Pawlenty-Durenberger Commission) 2004, and the MN Health Care Access Commission of 1989.

It would be naive to think these Task Forces are simply oblivious of the gold standard solution to the health care crisis: the Single-Payer, government-funded approach. Many of us have explicitly presented the evidence, including exhaustive studies, public surveys and focus groups in Minnesota, nationally, and internationally. The data are quickly dismissed.

So what can we do to reverse this disturbing state-of-affairs in which rigged Task Forces and Commissions essentially undermine democracy?

A more democratic participatory alternative would be to hold open public hearings. Although this occurred in 2004, the hearings lacked openness with permission to speak only about the problem, not the solution, and with major time limits to testimony.

Another solution is to demand that the composition of Task Forces represent Minnesotans, including people of color, community-based health care reform organizations, and especially health care practitioners and patients. And most importantly, the prohibition of business or financial conflict of interest, as is clearly the case with all previous Minnesota Health Care Commissions, since 1989.
Our community-based organization, Universal Health Care Action Network of Minnesota, is responding by coordinating the formation of a Multidisciplinary Health Practitioner Work Group. The task will be to counter the usual “ official” Minnesota Health Care Commissions by drafting public policy statements, which advance a progressive framework for fundamental health care reform.
Similarly, communities can form their own parallel “Peoples Health Care Commission.”

And finally, when our elected or appointed officials are unaccountable to the public, the public has a right to hold demonstrations, pickets and other important and respected forms of protest, such as civil disobedience. As was said during the civil rights movement (and the right to health care has indeed been called the civil rights issue of the 21st century), “We are the ones we’ve been waiting for”.

Joel Albers is a member of the Universal Health Care Action Network of MN, a grassroots health care reform resource center and action network.

Health Care Reform Letters in Star Tribune

2008-04-14T09:31:00.000-07:00
Check out these two editorial letters by PNHP-Minnesota members. They are referencing an editorial in support of the Berglin/Huntley reform bills.

Letters to the editor for Sunday, April 6

April 5, 2008

HEALTH-CARE REFORM

First compare options

Your March 30 editorial eloquently pleads with Democrats and Republicans to work together, bridge the bipartisan divide and actually get something done in health care reform this year. I support this idea.

Your error, however, is in your analysis of the bill. Proponents say it will cut costs a whopping 20 percent, but it won't. The bill is modeled after the "Massachusetts Connector" system which is currently failing because of increased costs, and the proponents in Minnesota can't offer any other actual data on potential cost savings.

Before we spend $47 million implementing poorly designed reform during a recession year, I feel we should look at the options more closely. I support Sen. John Doll's comparative cost analysis bill, which studies the major reform bills in the Legislature. I personally believe single payer is the only way to provide quality affordable health care, but why not compare the options first?

ELIZABETH FROST, M.D., MINNEAPOLIS

Open up the debate
It is easy to agree that the insurance industry interferes, but Dr. Denis Cortese seems to attribute that entirely to it being a mix of private and public, in a way that does not provide enough incentive to the private (earlier) insurance carriers to take the longer view of health (benefits will be reaped by a later carrier or Medicare). He assumes that we can find ways to realign the incentives so that the private insurance carriers will put the patients first. Most studies that I have reviewed suggest that one can improve care with some interventions, but they rarely save more than the intervention costs.

He completely ignores the much more cost-effective change, which is to simply extend the traditional Medicare to everyone. Medicare already has the longer view. [In contrast to the employer-based nonsystem now, where one may be forced to go to new physicians and hospitals every time the employer changes insurance carriers.] Medicare overhead is about 2 percent vs. about 20 percent for insurance carriers.

Cortese asserts: "Nobody is saying a single-payer system .... Nobody I have heard of is talking about system-engineering in health care to redesign the way we provide care." But that is because he is considering only the current positions of the leading three presidential candidates. Why should we be restricted to those cautious positions, seemingly crafted to avoid upsetting the large donors -- especially the medical insurance industry?

JOHN T. (JACK) GARLAND, M.D.,

MINNEAPOLIS

Nationwide Support for National Health Plan

2008-03-11T20:53:00.001-07:00
A recent poll shows that 65% of Americans support single-payer. Check it out below.
Several other polls from 2007 support these findings.

Associated Press-Yahoo Poll
Interview dates: December 14 - 20, 2007

14. Which comes closest to your view?

34% - The United States should continue the current health insurance system in which most people get their health insurance from private employers, but some people have no insurance

65% - The United States should adopt a universal health insurance program in which everyone is covered under a program like Medicare that is run by the government and financed by taxpayers

2% - Refused / Not Answered

15. Do you consider yourself a supporter of a single-payer health care system, that is a national health plan financed by taxpayers in which all Americans would get their insurance from a single government plan, or not?

54% - Yes

44% - No

2% - Refused / Not Answered

Minnesota Physicians Support Single Payer

2008-03-11T20:39:00.000-07:00
Daily Planet
February 27, 2008
Most Minnesota doctors like single-payer health care, academic study
finds
By Andy Birkey

Dr. Dick Adair, a 65-year-old physician, said that the current system
is not only having an impact on patients, but also on physicians.
"The financial burden of caring for uninsured people is driving some
doctors out of primary care and into better-paying specialties, at a
time when we need more primary care doctors," he said.

In his years as a physician, he has seen a sharp change in how
physicians look at health care. "Having lunch with other doctors used
to mean listening to conservatives griping about the government. Now
lunchroom talk is that single-payer would be a good idea," said Adair.

A recent survey through the University of Minnesota and St. Olaf
College found that 64 percent of Minnesota's physicians support a
single-payer system much like the Minnesota Health Plan. Another 25
percent said that health savings accounts were the way to go, and
only 12 percent thought that the current system of managed care was
adequate.

On a national level, (Dr. Elizabeth) Frost said that a single-payer
system would be ideal. "I support a single-payer system specifically,
instead of a universal insurance patchwork like [Sen. Hillary
Clinton] and [Sen. Barack Obama], because it makes so much more
sense," she said. "The problem with the bureaucracy of the myriad
insurance companies is that each differs from each other, and their
ultimate goal is to deny claims and save money." In a single-payer
system, "the ultimate goal would be to provide not deny."

(Dr. Ann) Settgast agreed. "As a physician, my job would become
simpler as I could make medical decisions based on my expertise and
the patients' best interests — not based on regulations [from
insurance companies] that often do not have these interests in mind,"
she said. "The single-payer solution is the only choice that makes
sense given my motivation to provide the highest-quality care to each
of my patients."

http://www.tcdailyplanet.net/article/2008/02/25/most-minnesota-
doctors-single-payer-health
-care-academic-study-finds.html

Nick Coleman Column -- Minnesota Health Plan

2008-03-11T20:13:00.000-07:00

Nick Coleman: Health care ills close to heart of riled legislator with a mission

By NICK COLEMAN, Star Tribune

February 11, 2008

Shelley Madore has lived through the health care crisis. Even though she had health insurance, Madore was nearly bankrupted when her kids became ill. And the financial and emotional strains of the ordeal helped lead to the end of her marriage, too.

But Madore didn't take her troubles lying down. She stood up. And ran for election. And won. Now, she hopes to change a rotten system from the top.

Madore, 45, is a DFLer from Apple Valley who ran for the state House of Representatives in 2006 after encountering the indifference of legislative leaders to people in her situation. At the time, Madore and her husband, Paul, were earning about $50,000 a year and struggling to make the payments on their modest home and the $908 monthly premium on their health insurance.

The family's financial well-being was devastated when Madore's daughter, Erica, who was having trouble walking, received a long-overdue $25 X-ray. Until then, Madore said, her doctor suggested that Erica, 9 at the time, was having psychological problems, and he refused to order X-rays. After the Madores went to another doctor, out of their insurance network, an X-ray was done. It showed a tumor pressing on Erica's spinal cord. The operation that followed cost $60,000. Madore learned the price tag when the hospital asked her to pay it.

"But I have insurance," Madore said. "The company says it won't pay for the operation," the hospital replied. "You will have to pay it yourself."

Millions of Americans are one serious illness away from bankruptcy. The Madore family (son Jason is autistic), knows what living on the edge is like.

The only way they could pay for Erica's operation (she is 17 now), was to apply for assistance under a program limited to families with less than $3,000 in cash assets. Madore, working as an advocate for special-needs families, became disgusted with the system and went to the state Capitol to talk with legislators about fixing it.

That's how she met a lawmaker who inspired her. By royally ticking her off.

When Madore told the guy (he's no longer in office) that many families are forced to pay hundreds per month for supplemental insurance policies, he said such policies are a discretionary expense, much like his decision to pay for the cost of his son's hockey ice time.

"I went through the roof," Madore says. "I told him, 'This is wrong, and some day I'm going to come up here and change the system.' He looked at me and said, 'Good luck with that, dear.' Well, that was all I needed. I went home and said, 'I'm running for the Legislature.'"

Madore won the District 37A seat. On Monday, she was part of a group of DFL legislators -- many first-term lawmakers like herself -- who proposed making health care affordable, and accessible, for everyone.

At least 400,000 Minnesotans have no medical insurance; another million or more are under-insured or have policies, like the Madore family, that work only until there is a medical emergency.

The plan to be introduced by Madore and her fellow DFLers is called the Minnesota Health Plan. Its backers say that providing equal access to affordable health care would save hundreds of millions by encouraging disease prevention and reducing the staggering costs of the health care bureaucracy, while providing a safety net to keep families from falling into bankruptcy.

Patients would still choose their doctors, but payments would be based on ability to pay. The DFL's "single-payer" plan, while popular with consumers and physicians, is opposed by many in the for-profit health care industry. So it is likely to face fierce opposition.

But don't underestimate the determination of a ticked-off single mom named Shelley.

"The system is nuts," she says. "If you have a medical emergency, you get tapped out. We need access to health care that is affordable, portable and can never be taken away."

Does Madore worry she will be criticized? Not a chance.

"I can't wait for somebody to call me a welfare mom," she says. "That's what we do every day to thousands of people who need help -- 'It's welfare; it's taking advantage.'

"No, it's not. It's hard-working people. People like me, who think they have insurance until something happens. Then, instead of helping, we ridicule them.

"Well, that's going to stop."

Nick Coleman • ncoleman@startribune.com

© 2008 Star Tribune. All rights reserved.

Single Payer Plan -- from the Minnesota Monitor

2008-03-11T20:10:00.000-07:00

Single-payer health plan could create savings, more choices for Minnesotans

by: Andy Birkey, Minnesota Monitor

Tue Feb 12, 2008 at 11:12:18 AM

Several members of the Minnesota Legislature have embarked on a mission to build political support for the Minnesota Health Plan, a proposal that would create a central entity to manage the health insurance of every Minnesotan. The proponents of the plan say it would reduce health insurance premiums, provide universal coverage, reduce health care costs in the state by 20 percent, provide greater freedom of choice, end employer-tied insurance and increase preventative health.

This weekend, legislators took the plan to seven Minnesota cities: Duluth, Bemidji, Northfield, Winona, Hibbing, Brainerd and Mankato. The plan is ambitious and would fundamentally change how health insurance is managed in Minnesota, but proponents say that change is welcome and needed in a system that needs a lot of work.

Rep. Shelley Madore, DFL-Apple Valley, spoke about her experiences at a press conference at the State Capitol on Monday and while touring the state. Two of her children were diagnosed with disabling medical conditions, and after one underwent a $60,000 surgery, she was told it wasn't covered by her insurance plan.

"For those Minnesotans that think they are insured, I challenge them to go back and read their health insurance policy and see what is not covered, because insurance is great until you really need it. And that's the lesson that I learned and the reason I decided to run for the state Legislature."

The Minnesota Health Plan would essentially take health insurance out of the private sector and have the state run the system. Everyone would pay premiums according to their ability to pay.

"One of the problems that our rural hospitals have is that under the current system, unlike what is being proposed here, we have so many different payment rates depending on who's paying," Sen. Mary Olson, DFL-Bemidji, told a group gathered in that city. "The government is not paying enough for poor people's health care, which is why it is so hard for them to get access to health care.
"But basically it's not the government paying those bills, it's taxpayers who are paying those bills. In order to raise those rates, you have to raise taxes to pay for them."

Sen. John Marty outlined the ways the plan, which already has the support of one-fourth of the Legislature, would save money for both the government, clinics and health care consumers.

"The plan would save money though administrative efficiency. It avoids insurance company marketing and underwriting costs. It saves doctors who have to have three to four billing clerks in every clinic. It saves money by price negotiation. It saves money through prevention and early intervention. It saves money by ending the technology arms race; not every corner clinic needs an MRI machine."

Madore and Rep. David Bly, DFL-Northfield, said that not only are there cost savings to be had in a centralized insurance system, but there are benefits outside that system as well, including greater clinic and doctor choice and more flexibility in career choice.

"This is a public-private partnership, not a state-run medical system," said Bly. "The insurance plans that you have are often networked, and they don't allow you to go outside the network to see the doctor you want to see. And people change jobs and have a new system and have to see a doctor they've never seen before. We want people to have those kinds of choices in the clinic or doctor they want to go to."

Madore said that for many disabled Minnesotans, who constitute 14 percent of Minnesota's adult population under age 65 and are often denied coverage due to preexisting condition clauses, the plan would lead to greater independence. "We haven't addressed the need to move these people out of poverty and into working jobs and allowing them to be able to stay in jobs," she said. "We have people with late onset diagnosis of things like Parkinson's and MS. People are forced to leave their jobs in their forties." For many, health insurance doesn't cover many needs and people are forced to quit their job, sell off their assets -- sometimes even their homes -- so that they can qualify for government aid and get the health care they need.

"They cannot contribute back as a taxpayer and become classified as what is called health care welfare recipients," said Madore. "I do believe when we allow health care to not be tied to employment, self-determination is brought back and we will reduce a significant cost in social programs."

The added side effect of health insurance not being tied to employment means more freedom for employers as well. "I think you'll see Minnesota will become a job magnet," she said. "People will be able to determine what they want to do with their lives" as they won't have to stay at a certain job or in a particular career just to keep health benefits.

Marty said that while they think they have a great proposal, it will take a few years to catch on. In the meantime, the legislators are open to looking at short-term options as well and proposals that can have a similar impact on cost savings, choice and increasing prevention.

More information on the bill can be found at www.mnhealthplan.org .

Minnesota Health Act -- Kare 11 News

2008-03-11T19:54:00.000-07:00
See Senator John Marty and Dr. Ann Settgast in this clip on the Minnesota Health Act.

Kare 11 News Clip

Minnesota Health Act -- Star Tribune February 12

2008-03-11T19:45:00.000-07:00

DFLers advance health insurance plan

By PAT DOYLE , Star Tribune

February 11, 2008

A bold plan to provide health insurance coverage for all Minnesotans through a government run program was advanced today by DFL legislators, who say they expect to wage a three or four year battle for such a system.

The proposed Minnesota Health Plan was touted as the most effective way to transfer savings resulting from lower insurance overhead and other costs to provide coverage for an estimated 400,000 uninsured Minnesotans.

The effort is being led largely by new House members, who say they are responding to numerous complaints about health insurance while campaigning in 2006.

"Health care was either number one or number two as a primary concern," said Rep. David Bly, DFL-Northfield.

The single-payer plan will compete with less dramatic proposals for health coverage reform during the upcoming legislative session. Some longtime DFL proponents of insurance overhaul favor universal health insurance that stops short of a single-payer system.

Brian McClung, a spokesman for Gov. Tim Pawlenty, said the governor "is opposed to government-run health care" and is working with a bi-partisan task force on other plans.

While critics of a single-payer plan say it could reduce patient choice and innovation, supporters of the Minnesota Health Plan say it would allow people to choose their own doctors and hospitals.

© 2008 Star Tribune. All rights reserved.

KFAI Evening News 2-12-08

2008-03-11T19:36:00.000-07:00
Senator John Marty and Dr. Ann Settgast interviewed on KFAI evening news on February 12, 2008. It provides a nice brief overview of single payer and introduces the single payer legislation in Minnesota, the Minnesota Health Act. Follow this link: http://www.kfai.org/node/9239