The Social Medicine Portal

For-profit insurers put profits over health, in more than one way

(From PNHP.org)

For profit insurers put profits over health in more than one way, and now that the Patient Protection and Affordable Care Act has made all but a few American residents their captive audience they are in for a blast.

Just weeks after the passage of the Act, that will dramatically increase the number of Americans covered by private health insurers, Harvard researchers detailed the extent to which life and health insurance companies are major investors in the fast-food industry.

Although fast food can be consumed responsibly, research has shown that fast-food consumption is linked to obesity and cardiovascular disease, two leading causes of death, and contributes to the poor health of children. The evidence is so compelling that as part of the new law more than 200,000 fast-food and other chain restaurants will be required to include calorie counts on their menus, including their drive-through menus.

A new article on insurance company holdings, published online in the April 15 issue of the American Journal of Public Health, shows that U.S., Canadian and European-based insurance firms hold at least $1.88 billion of investments in fast-food companies.

“These data raise questions about the opening of vast new markets for private insurers at public expense, as is poised to happen throughout the United States as a result of the recent health care overhaul,” says lead author Dr. Arun Mohan.

Among the largest owners of fast-food stock are U.S.-based Prudential Financial, Northwestern Mutual and Massachusetts Mutual Life Insurance Company, and European-based ING.

U.S.-based Northwestern Mutual and Massachusetts Mutual Life Insurance Company both offer life insurance as well as disability and long-term care insurance. Northwestern Mutual owns $422.2 million of fast-food stock, with $318.1 million of McDonald’s. Mass Mutual owns $366.5 million of fast-food stock, including $267.2 in McDonald’s.

Holland-based ING, an investment firm that also offers life and disability insurance, has total fast-food holdings of $406.1 million, including $12.3 million in Jack in the Box, $311 million in McDonald’s, and $82.1 million in Yum! Brands (owner of Pizza Hut, KFC and Taco Bell) stock.

New Jersey-based Prudential Financial Inc. sells life insurance and long-term disability coverage. With total fast-food holdings of $355.5 million, Prudential Financial owns $197.2 of stock in McDonald’s and also has significant stakes in Burger King, Jack-in-the-Box, and Yum! Brands.

The researchers also itemize the fast-food holdings of London-based Prudential Plc, U.K.-based Standard Life, U.S.-based New York Life, Scotland-based Guardian Life, Canada-based Manulife and Canada-based Sun Life. (See table; all data current as of June 11, 2009.)

“Our data illustrate the extent to which the insurance industry seeks to turn a profit above all else,” says Dr. Wesley Boyd, senior author of the study. “Safeguarding people’s health and well-being take a back seat to making money.”

Mohan, Boyd and their co-authors, Drs. Danny McCormick, Steffie Woolhandler and David Himmelstein, all at the Cambridge Health Alliance and Harvard Medical School, culled their data from Icarus, a proprietary database of industrial, banking and insurance companies. Icarus draws upon Securities and Exchange Commission filings and news reports from providers like Dow Jones and Reuters. In addition, the authors obtained market capitalization data from Yahoo! Finance.

The authors write, “The health bill just enacted in the Washington will likely expand the reach of the insurance industry. Canada and Britain are also considering further privatization of health insurance. Our article highlights the tension between profit maximization and the public good these countries face in expanding the role of private health insurers. If insurers are to play a greater part in the health care delivery system they ought to be held to a higher standard of corporate responsibility.”

Several of these same researchers, all of whom are affiliated with Physicians for a National Health Program, have previously published data about the extent to which the insurance industry is invested in tobacco. They say that because private, for-profit insurers have repeatedly put their own financial gain over the public’s health, readers in the United States, Canada and Europe should be wary about insurance firms’ participation in care.

What Frontline missed, and health care justice advocates should know

Oh yeah! The progressive, single payer community did look forward to the screening of the Public Broadcasting Service (PBS) Frontline production “Obama’s deal”, frustrated as we were by our voice having been buried in a misleading, media-backed “debate” that portrayed all opponents of the “Patient Protection and Affordable Care Act” as right-wing lunatics “against reform” – yes, the usual trick “you’re with us or with the terrorists”.

And to their credit, Frontline did a terrific job of documenting the countless back-room deals struck by the White House and Congress with Big Pharma and Big Insurance. As the production illustrated, these deals chipped away whatever progressive features the Act may have initially had, and turned it into a weapon of mass destruction of the pockets of ordinary folks who already barely make ends meet, and into an extraordinary sweet deal that will substantially increase the political and economic power of for-profit insurers for years to come. Unsurprisingly of course, given that the Act was almost literally dictated by WellPoint Inc., as the Frontline production pointed out.

Disappointingly, however, Frontline did not live up to its promise. While it did reveal some of the “realities of American politics, the power of special interest groups and the role of money in policy making”, it omitted showing viewers just what “Obama’s deal” had sacrificed, and what single payer advocates were being dragged to jail for, as they entered the meetings of the Senate Finance Committee chaired by health care czar Max Baucus. Rather, it merely portrayed them as yet another disaffected group within “President Obama’s liberal base”, which had to be appeased so that our president could move on with the serious stuff — “reforming” healthcare.

But it is precisely what the deal sacrificed that matters. Because single payer advocates, including many doctors such as Margaret Flowers, risked arrest, and were arrested, for standing up for a right to health care, through a publicly-financed and publicly delivered single payer system, that was being sacrificed at the altar of special interests, even as President Obama asserted, with a straight face, that “all options (for health care reform) are on the table”.

Now, could the reason for sacrificing a right to health care be that our charismatic president received at least ten times the money that his designated health care czar, Max Baucus, received from the very industries they were supposed to rein in? We don’t know, but the hypothesis is not implausible, and Frontline producers would have done their viewers a service had they explored this or any other plausible and alternative to the mainstream hypothesis further. In so doing they would have spoken truth to power, the least we can expect from progressive mass media.

Americans have by now gotten used to having the best Congress (and Presidency) “that money can buy”. Let us not be forced to put the progressive media into an equivalent category — “it’s the best media money can buy”.

What were you thinking about when you chose to become a doctor?

I don’t know about you, but  I could not help but asking myself that question when hearing Amy Goodman’s show Democracy Now this morning about compensations of executives in the health insurance industry.

Not that there is anything to be surprised about, given how close these folks are to major policy decisions in US health care. As the Firedoglake website pointed out last year, it is not even a secret that the original Senate Finance Committee bill, a descendant of which was recently signed into law with the ambitious name of Patient Protection and Affordable Care Act, was authored by a former Wellpoint VP, so these guys know what they are doing. And since Congress released the first of its health care bills on October 30 of the past year, health care stocks have risen by almost 30%.

But it gets better (for private insurers, that is…). So take a big sip of that morning coffee, and read on!

WellPoint CEO Receives 51 Percent Salary Increase

It appears that 2009 was a good year for the CEO of the private health insurance company WellPoint. Angela Braly’s compensation package soared by 51 percent last year. She earned $13.1 million, up from $8.7 million in 2008 At least three other WellPoint executives received compensation increases of as much as 75%.

Single payer anyone?

New York Times continues cost-cutting campaign with “doctors’ thoughts”

Note:
It would have been nice if the New York Times had bothered ask a nationally representative sample of doctors about how costs of health care should be kept at bay for the benefit of patients. But of course the answers might not have helped sustain the propaganda campaign in support of a driver’s insurance model of health care.

By Kate Randall (originally posted here).
29 March 2010

In keeping with its campaign in support of Obama’s recently passed health care legislation and its agenda of cost cutting, the New York Times carried an article Saturday by Lesley Alderman headlined, “Doctors Offer Thoughts on Cutting Health Care Costs.”

The article takes as a given that the health care overhaul is a genuine social reform, whose effect will be to provide “substantial” benefits to the general population. It bemoans the fact, however, that the new legislation “does not tackle head-on the staggering cost of health care in the United States.”

In fact, the Obama-promoted legislation is aimed first and foremost at cutting costs for corporations and the government. It will slash hundreds of billions from the Medicare program for the elderly, and contains numerous cost-cutting mechanisms to ration and reduce care for ordinary Americans. This is well known by the Times editors. However, these cuts are seen as only a first step in a campaign to limit testing and treatments for the majority of Americans.

The entire framework of the health care “reform” is not to be challenged. Nor is the fact that insurance company and health care industry profits will by all accounts be boosted by the plan. But the ultimate question for patients, the author argues, is “How can the country reduce health care costs while not compromising quality?”

Alderman is not speaking here about reducing premiums, co-pays and deductibles for working families. There are no restrictions in Obama’s plan on what insurers can charge for coverage—and numerous studies have shown that these payments will actually increase.

No, the Times’ aim here is to promote the cost-reducing features of the health care bill for big business and the government and offer advice on how they might be strengthened. The author cynically attempts to palm off the suggestions of a select group of “doctors on the medical front lines” as a balanced cross-section of medical professionals.

It is notable that in the (“edited and condensed”) comments quoted, none of these doctors openly oppose the health care legislation; none openly promote nationalized health care, a single-payer system or even a government-run “public option.” Where appropriate, Alderman also helpfully notes how the Obama plan will advance the generally regressive proposals presented by this selection of physicians.

Jacques Moritz, M.D., director of gynecology at St. Luke’s-Roosevelt Hospital Center in New York, offers the first suggestion: insuring for catastrophes only. Dr. Moritz states, “When you buy auto insurance, you don’t insure yourself for every dent and nick—you insure yourself for serious accidents. This is the way the health system should work.”

He says that the current insurance model “doesn’t reward patients for being healthy, it rewards them for being sick”—as if patients now are getting sick on purpose just so they can take advantage of insurance payouts. Likening the health of a human being to dings on an auto body is a poor analogy, but one that serves a definite purpose. Patients should be discouraged from seeking treatments for supposedly non-catastrophic medical conditions, and the insurers would be rewarded by not paying out for them.

In health care, however, it is generally impossible to determine beforehand what is “catastrophic” and what is not. Is a chest pain an early signal of heart problems or is it simply a muscle ache? Is a persistent headache the result of stress or a brain tumor? The impact of the doctor’s suggestion, enthusiastically promoted by the Times, would be to prevent those who cannot afford to pay from getting tests and consultations aimed at answering these and many similar questions.

Next, James A. Reiffel, M.D., professor of clinical medicine and director, electrocardiography laboratory, Columbia University Medical Center, New York, argues for tort reform, something long campaigned for by Congressional Republicans and supported by Obama. Dr. Reiffel says, “Some doctors often order tests to confirm a suspected diagnosis—even when the suspected diagnosis is likely correct with a high degree of certainty—out of concerns regarding the potential for malpractice suits in our current litigious climate.”

The effect would be to prevent patients and their families from seeking legal and financial redress for injuries and deaths caused by medical errors. Alderman notes that the Obama plan already makes a step in that direction, including a provision awarding “five-year grants to selected states to develop alternatives to current tort litigation.” Again, the impact is to encourage doctors to stop giving supposedly “unnecessary” tests.

Dr. Lisa Bernstein, internist and associate professor in the department of medicine at Emory University School of Medicine in Atlanta, Georgia, advocates “spending adequate time gathering information and using actual research data to guide judicious ordering of tests and prescribing of treatments.” This is known in the medical community as utilization of “comparative effectiveness research.”

The Times notes that the new legislation calls for the creation of the Patient Centered Outcomes Research Institute. The goal of this panel is to identify treatments that have not been shown to provide adequate levels of positive patient outcome—i.e., they may have benefited what they consider an insignificant number of patients.

While the function of this body is clearly aimed at targeting treatments and services for rationing, the Times laments the fact the “institute’s findings could not be construed as mandates though, or used to deny coverage.”

Under the subheading “Stop Overtreating,” the article quotes Dr. H. Gilbert Welch, who says, “There are some people who would benefit from more medical care, but there are many more who are getting too much.” Dr. Welsh is a professor of medicine at the Dartmouth Institute of Health Policy and Clinical Practice in Lebanon, New Hampshire, publisher of the Dartmouth Atlas of Health Care.

The WSWS has analyzed the Dartmouth Atlas study in depth. (See “The Dartmouth Atlas of Health Care study: Shoddy science in support of health care cuts” ) Its methodology has been promoted by the Obama administration as a justification for reducing and rationing care.

Among those who are “overtreated,” according to Welch, are those who are dying (“for whom our aggressive care can be inhuman”) and the healthy, “in whom we feel increasingly compelled to look hard for things to be wrong.” Welch bemoans the fact that “screening scans, for instance, find more small cancers and early heart disease.” Presumably, it would be better if cancer and heart disease were only discovered in its late stages.

Welch also worries that “contracted definitions of what’s normal label more people as having disease, such as hypertension and diabetes.” These people should be denied treatment, Welch implies, even if doing so can improve their living conditions and potentially save their lives.

In a September 2008 speech, Obama budget director Peter Orszag, then director of the Congressional Budget Office, hailed Dartmouth Atlas, asserted there is “little evidence that extra spending gets us anything in terms of reduced mortality rates or higher quality.” There is nothing accidental in the Times dropping in this quote from Dr. Welch, and it also gives the lie to the suggestion that this is an ordinary cross section of doctors.

Finally, Ms. Alderman quotes Edward Hallowell, a psychiatrist practicing in New York City and Massachusetts, who states, “What’s in jeopardy in medicine—for a host of reasons—is the human connection between doctor and patient.”

Dr. Hallowell’s sentiments undoubtedly reflect a widespread concern among health professionals who experience firsthand strains between doctors and their patients. He says, “Doctors, patients and insurers alike should work together to recreate the familiarity, the warmth, the trust and the friendly alliances that used to define patient-caregiver relationships.”

Under the for-profit system of medical care in the United States, however, which is upheld and enshrined by the Obama health care legislation, these relationships are assured to erode even further, as patient costs rise and services are limited on the basis that life-saving treatments are “unnecessary” or have not been proven “cost-effective.”

Is the new health care bill “an attack on wealth inequality”?

Is the new health care bill “an attack on wealth inequality”, as New York Times reporter David Leonhardt asserts? For those who are about to uncork the champagne, my advice is to hold off, take a step back, and analyze the “big picture” with a healthy dose of skepticism.

It may help to read, and ponder about, the op-ed below by Barry Grey. And if words like “socialism”, “class struggle”, etc., make the reader uncomfortable, my suggestion is to go beyond word choices and focus on the argument instead.

It is well worth examining in some detail, because it does a good job of pulling apart the campaign of deception about health care reform led by the corporate media, and it highlights features of the recent “health care overhaul” that there are strong reasons to be concerned about, and are likely to have huge implications, and not necessarily positive, for the welfare of Main Street.

Assuming one agrees with Grey’s analysis of this campaign of deception, one has to admit that it still requires a stroke of genius to lead millions to believe that an individual obligation to buy a private product, a for-profit health insurance policy, with subsidies if necessary from your own money and with vague promises to rein on the manufacturer’s “worst practices”, is  something that would have made Karl Marx jealous.

Yet this is precisely what New York Times reporters Robert Pear and David Leonhardt argue that the bill signed today by President Obama is all about: it is no less than  “the most sweeping social legislation in decades” and “the federal government’s biggest attack on economic inequality since inequality began rising more than three decades ago”.

It is even more concerning that the next step towards “greater social equality”  may be an attack on Social Security. This program, announces the New York Times, “now stands as the likeliest source of the sort of large savings needed to bring projected annual deficits to sustainable levels, many budget analysts agree.”

And these “savings” are necessary because, as Times reporter Jackie Calmes suggests,  they would “immediately reassure global markets fretful that the United States’ debt is already its highest since World War II...[sending] “a very important signal to the world.”

Savings? To whom? Global markets and important signals? Of what sort? How does this euphoria translate into any intelligible improvement in the much eroded quality of life of millions of America is hard to say, but worth asking about.

Obama health bill sets the stage for assault on Medicare and Social Security

Barry Grey

24 March 2010

The passage of the Obama administration’s health care bill has been greeted with a wave of media commentary hailing the measure as a milestone in progressive social reform and a political triumph for Barack Obama.

“A historic first step,” editorialized the Los Angeles Times. “Health Care Reform, at Last” was the headline of the New York Times’ editorial. As always, the revving up of the American media to overwhelm and manipulate popular consciousness has been impressive.

If anything, the major organs of international finance capital have been even more effusive. Financial Times columnist Gideon Rachman published a commentary in which he writes, “By pushing through a social reform that eluded generations of presidents from Teddy Roosevelt to Bill Clinton, Mr. Obama can now point to a genuinely historic achievement.” The Financial Times editorial board published a similar piece, under the headline “Obama secures his place in history.”

Behind the celebrations of the health care overhaul lies a definite perspective. The authors of these commentaries see the legislation as a major step in confronting profound problems facing American and world capitalism. They are hailing what they consider a breakthrough in reining in massive US deficits that are destabilizing the world financial system.

It has for decades been deemed politically impossible to attack basic entitlement programs in the US, such as Social Security and Medicare, which account for an enormous and rising portion of the federal budget. Now, with Obama’s health care plan, the stage has been set for slashing these programs. This is the reason for the general jubilation in media and financial circles.

The claim that a genuinely progressive social reform has been dispensed as a gift from above flies in the face of the whole of American history. This is a country where every significant social reform has been the outcome of decades of the most bitter and bloody struggles against a ruling class that savagely resists social progress.

The enactment of such reforms has always followed brutal state repression and been associated with martyrs to the cause who were hunted down, jailed or murdered.

Slavery was abolished only by a Civil War that raged for four years and cost the lives of 620,000 soldiers and an undetermined number of civilians.

The eight-hour day was the result of mass strikes in the 1870s and 1880s that culminated in the Haymarket Massacre and the hanging of key leaders of the eight-hour movement.

The suffragettes endured repeated beatings and jailings in their battle for the right of women to vote.

Official recognition of the right to form industrial unions in America was the outcome of a 60-year struggle that began in the 1870s and continued even after Franklin Roosevelt recognized the right in 1934. It involved general strikes in major US cities, including the 1934 strikes in Toledo, Minneapolis and San Francisco.

In struggles such as the Flint sit-down strike, workers occupied factories and faced off against police and troops in industrial battles that verged on civil war. Ten workers were gunned down in cold blood and many others were wounded by Chicago police in the 1937 Memorial Day massacre.

It was in the context of such mass working class struggles fueled by the Great Depression that Roosevelt enacted Social Security.

The enactment of Medicare in the 1960s was the byproduct of the mass mobilization of African-Americans and their allies in the civil rights movement of the 1950s and 1960s, in which hundreds of thousands marched in the face of killings and terror by vigilantes backed by the state. By the time of the passage of Medicare, the civil rights struggle had been joined by an upsurge of militant labor struggles and the initial eruption of the most oppressed sections of the working class in urban uprisings.

The right of 18-year-olds to vote was secured as a result of the mass movement against the Vietnam War.

In every case, the victories for social reform represented the frightened response of the ruling class to mass movements from below. And in every case, these victories were partial and limited, diluted with all sorts of caveats, and containing the seeds of their eventual undoing—due to the limited political perspective imposed on the insurgent movements by their reformist leaderships.

The moment the working class relaxed its pressure, the gains were watered down or eliminated.

In stark contrast to this historical experience, Obama’s health care plan has been enacted in the absence of a mass movement—indeed, in the face of mounting popular distrust and hostility. The final push for the bill came after the Democratic candidate was massively defeated in January’s special Senate election to fill the seat vacated by the late Edward Kennedy in Massachusetts.

That defeat was the result of growing disillusionment with Obama and the Democratic-led Congress, which have done nothing while millions have been thrown out of their homes, millions more have had their light and heat turned off, personal bankruptcies have broken all previous records, and wage-cutting—encouraged by the government’s Auto Task Force—has become epidemic.

The same administration whose policies have encouraged a further growth in social inequality and the continued erosion of existing social programs has now, it is claimed, handed down a historic piece of progressive legislation.

Amidst the official jubilation, no one has asked an obvious question: If the Obama administration dropped all of those provisions deemed “progressive” and “liberal”—such as the public option—in order to gain Republican support, why were they not restored when it became clear that the Republicans would offer no support and the final bill would be a purely Democratic measure?

There is another question. In what, precisely, does Obama’s success in passing health care “reform” consist? Why has he succeeded where previous Democratic administrations failed?

The basic answer is that discussions of health care reform previously assumed either some form of nationalization or significant provisions to rein in the power of the health care industry. Obama, however, has not only rejected any such measures, he has worked out his overhaul in the closest consultation with the insurance, pharmaceutical and hospital companies. The same corporate giants will continue to exert unfettered control over the health care system.

Far from the health care bill being an exception to the historical rule, it could be enacted only because of the absence of a mass movement of working people and under conditions of the collapse of the old organizations such as the trade unions. It is the product of a political system in which broad sections of the population have been effectively disenfranchised and become alienated from the entire political establishment.

Neither of the two big business parties has any substantial base of popular support. Politics has become little more than the artificial creation of public opinion, involving an unprecedented level of media manipulation.

This social and political vacuum gives the ruling class a degree of latitude it would otherwise not have to impose legislation that in the past would have been considered unacceptable. Immense resources have been devoted to pushing through Obama’s health care bill, but there has been nothing approaching a serious public discussion in which the details of the measure are examined. The people have had no say and do not know what this legislation will mean for them.

In the form of the current administration, the American people have become the victims of a colossal fraud, in which Obama, capitalizing on his carefully crafted popular image, is carrying out policies that previously would have been deemed unfeasible.

The US ruling class is playing the long game. It is seeking to impose a regime of economic rationalization that has been worked out between the White House, Congress and big business.

The dire consequences of this overhaul for the broad masses of the population will become clear over time. They are indicated, however, in some of the commentaries by supporters of the legislation. The Washington Post, for example, speaks openly in its editorial of the “opportunity” to slash costs by rationing care to the general population.

“It means,” the newspaper writes, “establishing pilot programs to reward quality over quantity—keeping people healthy rather than administering more tests. It means holding hospitals, doctors and others accountable… to minimize unnecessary or conflicting care.”

The repeated claims that those who are satisfied with their existing health plans have nothing to fear are not believable. In the first place, existing plans are constantly being cut back by employers, private insurers or both, a process that will only be accelerated under the health care bill. More and more people will be forced into plans that provide far fewer services, under which they will be compelled to pay out of pocket for drugs, tests and procedures beyond a bare-bones minimum.

The overall strategy underlying the health care bill is indicated by the New York Times, which writes in a front-page article published Tuesday that “central to the health care changes are hundreds of billions of dollars in reductions in Medicare spending over time.” The newspaper goes on the declare that the victory on health care sets the stage for an assault on Social Security, the bedrock social program that currently provides (highly inadequate) pension benefits to 51 million Americans over the age of 65.

“Proponents of acting soon,” writes the Times, “also argue that changes to benefits or taxes… would immediately reassure global markets fretful that the United States’ debt is already its highest since World War II. An agreement on Social Security ‘would send an important signal to the world,’ said Robert D. Reischauer, a former Congressional Budget Office director.”

As the consequences of these policies become more clear, the disgust and anger of working people will deepen. They will resist in ever growing social struggles. What is critical is that these struggles be guided by a new political perspective.

The entire experience of Obama’s health care overhaul demonstrates once again the critical importance of the development of a Marxist leadership in the working class and the fight for a socialist perspective. Universal, quality health care as with any other social advance is possible only on the basis of the building of a mass socialist movement of the working class.

Why does the New York Times support the health care bill?

To readers of the Social Medicine Portal, here goes an excellent analysis of the “liberal media”‘s position on health care reform, warning ordinary Americans to hold off in uncorking the champagne, even as New York Times editors celebrate the bill as a triumph on behalf of “hard-working Americans”.

The New York Times and the Obama health care plan

By Kate Randall
23 March 2010

The New York Times weighed in predictably on Monday with praise for passage of the Obama health care plan. The editorial appearing the morning after the US House vote—titled “Health Care Reform, at Last”—caps a yearlong campaign by the newspaper to promote the legislation.

In keeping with that effort, the piece gushes, “Barack Obama put his presidency on the line for an accomplishment of historic proportions.” The newspaper’s editors argue that the legislation is “a triumph for countless Americans who have been victimized or neglected by their dysfunctional health care system.”

The piece provides misinformation and half-truths about what is actually contained in the bill in a cynical attempt to portray it as a monumental reform crafted with the interests of working families in mind. The analysis is deliberately vague on details, while making sweeping generalizations as to the expected impact of the legislation.

As the representatives of what passes for the liberal establishment in the United States, the New York Times has played a key role in promoting Obama’s health care agenda and characterizing it as a progressive reform. In fact, the Times represents those privileged sections of the ruling elite who stand to profit most from its cost-cutting features and the gutting of health care for ordinary Americans.

In this latest piece lauding passage of the bill, they take their cue from Barack Obama, who stated Sunday night that the legislation represents “another stone firmly laid in the foundation of the American Dream.” The Times argues dramatically, “Over time the reforms could bring about sweeping changes in the way medical care is delivered and paid for. They could ultimately rival Social Security and Medicare in historic importance.”

When the editorial begins to break down the features of the plan, however, even on the basis of the Times’ timeworn brand of convoluted reasoning, it is apparent that the bill has nothing in common with these genuine pieces of reform legislation. While significant tangible benefits were gained through these federally funded programs, the new health care legislation will cut government spending and reduce care and services for the vast majority of Americans.

Social Security and Medicare were wrested from the ruling establishment as a result of great social struggles on the part of working men and women. But the Obama health care plan is being imposed from above by that very ruling elite, with no input from the American people. Its features bear no relation to genuine reform, but in fact comprise a retrograde package of cutbacks and rationing that will serve to boost the profits of the health care industry.

The Times hails the plan for providing what it describes as “near-universal coverage.” After noting that the “United States is the only advanced industrial nation that does not provide or guarantee health care coverage for virtually all of its citizens,” they intone, “It is a moral obligation to end this indefensible neglect of hard-working Americans.”

The reality is that the bill has nothing in common with universal health care, something Obama pledged to fight for in his presidential bid. An estimated 23 million people will be left uninsured by 2019, including about a third who are undocumented immigrants and barred from coverage.

About 16 million of those newly insured will be dumped into the cash-starved Medicaid program. Another 24 million will obtain coverage through purchasing it on the insurance “exchanges.” These exchanges will not include even a fig leaf of reform in the shape of a public option, a feature ditched long ago by Obama in a backroom deal with the private insurance companies. As the president was at pains to emphasize last night, the bill “is not the government-run system some feared.”

Under the subheading “Insurance Reforms,” the editorial asserts, “The legislation would rein in many of the insurance industry’s worst practices.” The practices listed include rejecting applicants for pre-existing conditions, dropping sick people from coverage, and capping annual or lifetime benefits.

The Times then notes that reform of these insurance practices “cannot be achieved unless nearly all Americans are required to have coverage, so the costs can be spread among the healthy and the sick.” Precisely. This patient mandate will require individuals and families to purchase insurance or pay a penalty, funneling billions of dollars into the insurance industry’s coffers, in effect forcing the insured to finance the insurers’ reform of their own “worst practices.”

It is notable that the editorial fails to mention that the Health Insurance Rate Authority—a proposal floated by Obama before his bipartisan health care summit as a potential brake on skyrocketing premiums—has been eliminated from the bill. While the Times suggests that the plan will stop insurers from charging “exorbitant rates,” it provides no evidence of any mechanism in the bill that would actually do this because none exists.

The section of the editorial titled “A Start at Cost Control” gets down to the real meat of why the Times has been a consistent cheerleader of the Obama health care overhaul. It concerns the proposed tax on so-called Cadillac insurance plans, and is valuable to quote at some length:

“The legislation will impose an excise tax in 2018 designed to drive employers and their workers away from the highest-cost insurance policies, which typically provide generous benefits at little out-of-pocket cost to the workers. Health economists consider the excise tax a very strong cost-control measure, because if workers have to pay more of the cost themselves, they and their doctors are apt to think more carefully about whether a test or procedure is really needed” (emphasis added).

In other words, millions of workers, including a large number of unionized workers who receive insurance under company-sponsored plans, will see their benefits cut and the out-of-pocket expenses increased. In the drive to cut corporate costs, a crackdown is to be initiated against plans that provide such “generous benefits” and that encourage people to seek “unnecessary” tests and procedures.

The editorial then goes on to allude vaguely to a major cost-cutting component of the Obama plan, which the newspaper endorses, noting, “The reform measure will establish an independent board to push approaches that work into widespread use in Medicare and ultimately, by force of example, the private sector.”

The board to which they so favorably refer is the “Independent Payment Advisory Board,” an unelected body of presidential appointees that will wield sweeping powers to reduce costs and services and rewrite Medicare regulations. Changes proposed by this panel can only be overruled by a super-majority vote in Congress.

While chiding Republican leaders “who see opportunities to gain seats in the elections,” the Times makes no analysis of why the Republicans hope to make political gain by opposing legislation that supposedly benefits the majority of the population. In fact, the Republicans are seeking to capitalize on growing opposition to the plan among significant sections of the population who rightly view the legislation with mistrust, a skepticism that is bound to grow as the real implications of the bill become clearer in the coming period.

The Times, which claims to be a staunch defender of abortion rights, also fails to mention the wretched deal reached with the most right-wing sections of the Democratic Party in the final push to get the votes needed in the House to pass the legislation. Despite the already severe restrictions in the bill placed on the legally protected right to abortion, Obama agreed to sign a last-minute executive order confirming that no federal funds would be used for abortions under the terms of the legislation.

While the editorial characterizes the health care legislation as a triumph for “hard-working Americans” that will have the effect of reining in the “worst practices” of the insurance companies, another take on the situation was provided in the paper’s Business section.

An article headlined, “In Health Care Reform, Boons for Hospitals and Drug Makers,” explains that the plan would result in “millions more Americans buying private health insurance” who would be “better able to pay for their hospital stays, doctor’s visits, prescription drugs and medical devices.”

Drug makers, the article notes, “have the most clear reason to celebrate the legislation … they can look forward to tens of billions of dollars in additional revenue as more people with insurance visit doctors and fill prescriptions.”

Indeed, US stocks rebounded on Monday following the health care vote, hitting fresh 17-month highs lifted by health care-related stocks. Pharmaceutical shares surged, with Pfizer leaping 1.42 percent to $17.15 and Merck adding 0.63 percent to hit $38.30.

Among the insurers, Aetna gained 0.52 percent, hitting $34.64, and Cigna was up 0.54 percent at $37.28.

The author also recommends:

An attack on health care in the guise of reform
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Once again: The New York Times and Obama’s attack on health care
[17 November 2009]

Bad and good news: Comparing single payer health care with the reconciliation bill

A letter from Dr. Quentin Young, founding member of Physicians for a National Health Program

March 22, 2010

Dear colleagues and friends,

We have some good news and some bad news.

The bad news is that the president’s health plan, which was drafted by the insurance and pharmaceutical industries, will leave about 23 million Americans uninsured and over 100 million Americans underinsured nine years after implementation.  Here is how single payer compares with the reconciliation bill soon to be signed and declared the law of the land.

Activists are encouraged to send our information to their local media contacts and physician colleagues.

The good news is that there is growing awareness that the bill won’t work, and, sooner rather than later, we need single-payer national health insurance.  As noted by Harvard economist Dr. William Hsiao, the architect of Taiwan’s successful health reform, “You can have universal coverage and good quality health care while still managing to control costs.  But you have to have a single-payer system to do it.”

What you can do:

1. Talk to the press.  Please forward the following press release, chart, and key PNHP research findings to your local media with a cover note that you would be willing to be interviewed (if you are!).

2. Publish opinion pieces in the medical and lay press.  Use the following materials (recycle our prose as you wish!) for letters to the editor, op-eds, and other articles. PNHP communications director Mark Almberg can help with editing and submitting articles for publication.  Mark@pnhp.org

3. Deliver grand rounds, or invite a PNHP speaker.  PNHP will have new slides on health policy in the Obama era and the reconciliation bill soon.  Please contact Dave Howell at Dave@pnhp.org if you would like a PNHP speaker or would like a copy of our new slide set when it comes out.

Because of the enormous power of the insurance and drug companies, we in PNHP have always known that ours is a long-term struggle.  Of the women who participated in the Seneca Falls convention, only two survived to see women win the right to vote.  Susan B. Anthony was not not one of them, but her final words on her deathbed were “failure is impossible.”  We agree.

In memory of the 45,000 Americans who die annually for lack of health insurance, and in memory of the many tireless activists for single-payer national health insurance and health care as a human right who died this year, including Dr. Linda Farley, Dr. David Prensky, Dr. John Shearer, Dr. Bud Goodrich, PNHP staffer Nicholas Skala, and others, PNHP will continue the struggle.

With your help, failure is impossible.

In solidarity,

Quentin Young

The health care “overhaul”: A false promise of reform and a step in the wrong direction

For Immediate Release
March 22, 2010

Contact:
Oliver Fein, M.D.
Steffie Woolhandler, M.D., M.P.H.
David Himmelstein, M.D.
Margaret Flowers, M.D.
Mark Almberg, PNHP, (312) 782-6006, mark@pnhp.org

The following statement was released today by leaders of Physicians for a National Health Program, www.pnhp.org. Their signatures appear below.

As much as we would like to join the celebration of the House’s passage of the health bill last night, in good conscience we cannot. We take no comfort in seeing aspirin dispensed for the treatment of cancer.

Instead of eliminating the root of the problem – the profit-driven, private health insurance industry – this costly new legislation will enrich and further entrench these firms. The bill would require millions of Americans to buy private insurers’ defective products, and turn over to them vast amounts of public money.

The hype surrounding the new health bill is belied by the facts:

• About 23 million people will remain uninsured nine years out. That figure translates into an estimated 23,000 unnecessary deaths annually and an incalculable toll of suffering.
• Millions of middle-income people will be pressured to buy commercial health insurance policies costing up to 9.5 percent of their income but covering an average of only 70 percent of their medical expenses, potentially leaving them vulnerable to financial ruin if they become seriously ill. Many will find such policies too expensive to afford or, if they do buy them, too expensive to use because of the high co-pays and deductibles.
• Insurance firms will be handed at least $447 billion in taxpayer money to subsidize the purchase of their shoddy products. This money will enhance their financial and political power, and with it their ability to block future reform.
• The bill will drain about $40 billion from Medicare payments to safety-net hospitals, threatening the care of the tens of millions who will remain uninsured.
• People with employer-based coverage will be locked into their plan’s limited network of providers, face ever-rising costs and erosion of their health benefits. Many, even most, will eventually face steep taxes on their benefits as the cost of insurance grows.
• Health care costs will continue to skyrocket, as the experience with the Massachusetts plan (after which this bill is patterned) amply demonstrates.
• The much-vaunted insurance regulations – e.g. ending denials on the basis of pre-existing conditions – are riddled with loopholes, thanks to the central role that insurers played in crafting the legislation. Older people can be charged up to three times more than their younger counterparts, and large companies with a predominantly female workforce can be charged higher gender-based rates at least until 2017.
• Women’s reproductive rights will be further eroded, thanks to the burdensome segregation of insurance funds for abortion and for all other medical services.

It didn’t have to be like this. Whatever salutary measures are contained in this bill, e.g. additional funding for community health centers, could have been enacted on a stand-alone basis.

Similarly, the expansion of Medicaid – a woefully underfunded program that provides substandard care for the poor – could have been done separately, along with an increase in federal appropriations to upgrade its quality.

But instead the Congress and the Obama administration have saddled Americans with an expensive package of onerous individual mandates, new taxes on workers’ health plans, countless sweetheart deals with the insurers and Big Pharma, and a perpetuation of the fragmented, dysfunctional, and unsustainable system that is taking such a heavy toll on our health and economy today.

This bill’s passage reflects political considerations, not sound health policy. As physicians, we cannot accept this inversion of priorities. We seek evidence-based remedies that will truly help our patients, not placebos.

A genuine remedy is in plain sight. Sooner rather than later, our nation will have to adopt a single-payer national health insurance program, an improved Medicare for all. Only a single-payer plan can assure truly universal, comprehensive and affordable care to all.

By replacing the private insurers with a streamlined system of public financing, our nation could save $400 billion annually in unnecessary, wasteful administrative costs. That’s enough to cover all the uninsured and to upgrade everyone else’s coverage without having to increase overall U.S. health spending by one penny.

Moreover, only a single-payer system offers effective tools for cost control like bulk purchasing, negotiated fees, global hospital budgeting and capital planning.

Polls show nearly two-thirds of the public supports such an approach, and a recent survey shows 59 percent of U.S. physicians support government action to establish national health insurance. All that is required to achieve it is the political will.

The major provisions of the present bill do not go into effect until 2014. Although we will be counseled to “wait and see” how this reform plays out, we cannot wait, nor can our patients. The stakes are too high.

We pledge to continue our work for the only equitable, financially responsible and humane remedy for our health care mess: single-payer national health insurance, an expanded and improved Medicare for All.

Oliver Fein, M.D.
President

Garrett Adams, M.D.
President-elect

Claudia Fegan, M.D.
Past President

Margaret Flowers, M.D.
Congressional Fellow

David Himmelstein, M.D.
Co-founder

Steffie Woolhandler, M.D.
Co-founder

Quentin Young, M.D.
National Coordinator

Don McCanne, M.D.
Senior Health Policy Fellow

******

Physicians for a National Health Program (www.pnhp.org) is an organization of 17,000 doctors who support single-payer national health insurance. To speak with a physician/spokesperson in your area, visit www.pnhp.org

“There is still time for real reform, Mr. President”: An Open Letter to President Obama on Health Care Reform

By Margaret Flowers, M.D.

January 28, 2010

President Barack Obama|
1600 Pennsylvania Avenue
Washington, D.C. 20500

Dear President Obama,

I was overjoyed to hear you say in your State of the Union address last night:

“But if anyone from either party has a better approach that will bring down premiums, bring down the deficit, cover the uninsured, strengthen Medicare for seniors, and stop insurance company abuses, let me know.”

My colleagues, fellow health advocates and I have been trying to meet with you for over a year now because we have an approach which will meet all of your goals and more.

I am a pediatrician who, like many of my primary care colleagues, left practice because it is nearly impossible to deliver high quality health care in this environment. I have been volunteering for Physicians for a National Health Program ever since. For over a year now, I have been working with the Leadership Conference for Guaranteed Health Care/ National Single Payer Alliance. This alliance represents over 20 million people nationwide from doctors to nurses to labor, faith and community groups who advocate on behalf of the majority of Americans, including doctors, who favor a national Medicare-for-All health system.

I felt very optimistic when Congress took up health care reform last January because I remember when you spoke to the Illinois AFL-CIO in June, 2003 and said:

“I happen to be a proponent of a single-payer universal health care program.” [applause] “I see no reason why the United States of America, the wealthiest country in the history of the world, spending 14 percent of its Gross National Product on health care cannot provide basic health insurance to everybody. And that’s what Jim is talking about when he says everybody in, nobody out. A single-payer health care plan, a universal health care plan. And that’s what I’d like to see. But as all of you know, we may not get there immediately. Because first we have to take back the White House, we have to take back the Senate, and we have to take back the House.”

And that is why I was so surprised when the voices of those who support a national single-payer plan/Medicare for All were excluded in place of the voices of the very health insurance and pharmaceutical industries which profit off the current health care situation.

There was an opportunity this past year to create universal and financially sustainable health care reform rather than expensive health insurance reform. As you well know, the United States spends the most per capita on health care in the world yet leaves millions of people out and receives poor return on those health care dollars in terms of health outcomes and efficiency. This poor value for our health care dollar is due to the waste of having so many insurance companies. At least a third of our health care dollars go towards activities that have nothing to do with health care such as marketing, administration and high executive salaries and bonuses. This represents over $400 billion per year which could be used to pay for health care for all of those Americans who are suffering and dying from preventable causes.

The good news is that it doesn’t have to be this way. You said that you wanted to “keep what works” and that would be Medicare. Medicare is an American legacy of which we can feel proud. It has guaranteed health security to all who have it. Medicare has lifted senior citizens out of poverty. Health disparities, which are rising in this nation, begin to disappear as soon as patients reach 65 years of age. And patients and doctors prefer Medicare to private insurance. Why, our Medicare has even been used as a model by other nations which have developed and implemented universal health systems.

Mr. President, we wanted to meet with you because we have the solution to health care reform. The United States has enough money already and we have the resources, including esteemed experts in public health, health policy and health financing. Our very own Dr. William Hsiao at Harvard has designed health systems in five other countries.

I am asking you to meet with me because the solution is simple. Remove all of the industries who profit off of the American health care catastrophe from the table. Replace them with those who are knowledgeable in designing health systems and who are without ties to the for-profit medical industries. And then allow them to design an improved Medicare-for-All national health system. We can implement it within a year of designing such a system.

What are the benefits of doing this?

* It will save tens of thousands (perhaps hundreds of thousands) of American lives each year, not to mention the prevention of unnecessary suffering.

* It will relieve families of medical debt, which is the number one cause of bankruptcy and foreclosure despite the fact that most of those who experienced bankruptcy had health insurance.

* It will relieve businesses of the growing burden of skyrocketing health insurance premiums so that they can invest in innovation, hiring, increased wages and other benefits and so they can compete in the global market.

* It will control health care costs in a rational way through global budgeting and negotiation for fair prices for pharmaceuticals and services.

* It will allow patients the freedom to choose wherever they want to go for health care and will allow patients and their caregivers to determine which care is best without denials by insurance administrators.

* It will restore the physician-patient relationship and bring satisfaction back to the practice of medicine so that more doctors will stay in or return to practice.

* It will allow our people in our nation to be healthy and productive and able to support themselves and their families.

* It will create a legacy for your administration that may someday elevate you to the same hero status as Tommy Douglas has in Canada.

Mr. President, there are more benefits, but I believe you get the point. I look forward to meeting with you and am so pleased that you are open to our ideas. The Medicare-for-All campaign is growing rapidly and is ready to support you as we move forward on health care reform that will provide America with one of the best health systems in the world. And that is something of which all Americans can be proud.

With great anticipation and deep respect,

Margaret Flowers, M.D.

Congressional Fellow, Physicians for a National Health Program

Please join Dr. Flowers in urging the President to meet with advocates of real reform (improved Medicare for all) by calling the White House at 202-456-1111.

Tell them, “I’m letting you know that improved Medicare for all (HR 676) is better than the health bill proposed by Congress. Meet with Dr. Flowers and the Leadership Conference for Guaranteed Health Care about why.”

For more information relevant to President Obama’s health care related comments in his first State of the Union:

Going Down the Same Old Tunnel, By Steffie Woolhandler and David Himmelstein

How many angels can dance on the tip of a pin? A comment on the New York Times’ Economix blogpost “Is Community Rating in Health Insurance Fair”?

With all the respect that Professor Reinhardt deserves, the question he poses in the New York Times’ Economix blogpost, “Is ‘Community Rating in Health Care Fair”?, is bogus – perfect economic nonsense, morality aside.

His own 2003 paper, “It’s the prices, stupid”, lay out why we have the highest health care costs in the world: it is, critically, because we pay the highest prices on the planet for services and goods that cost a fraction elsewhere. Additionally, as the professor surely knows, another big chunk is wasted by for-profit insurers’ pushing paper around to make sure that they can get away with paying as little for our medical needs as their campaign contributions will afford.

Not to mention the fact that because we are hopelessly divided as a nation into a gazillion pools and plans, we fail to cross-subsidize in publicly useful ways, namely, very broadly and randomly, so that the system can be financially sustainable. Even for-profit insurers cross-subsidize, but in their case they do so to make sure that they enroll the healthier (and cheaper) “customers”, so that they can bring increasingly handsome profits to shareholders. And they dump the sicker and poorer on increasingly strained public plans (and then blame Medicare or Medicaid for their “financial unsustainability”).

So if rather than insisting on “uniquely American solutions”, such as leaving to for-profit insurance the task of financing health care for the majority of Americans, we did what every industrialized nation in the world has done, namely, ban profit from the financing of medically necessary services (yes, even the Swiss, as of 1996, have concluded that “it’s the profit, stupid”), and move to a social insurance system, the scenario, indeed the prices, painted by professor Reinhardt would never occur, so the question would be moot: both group A and B members in his thought experiment would be very happy, I suspect, cross-subsidizing whoever happens to be sick at any given moment, at dirt prices (compared to what we Americans pay), and both groups would likely feel this is fairer than subsidizing health insurance shareholders and CEO’s fat paychecks. No less importantly, they would know that we (or our children) can follow the jobs of our dreams (or even start a business!), rather than limit ourselves to those that include “health benefits” (whose numbers are decreasing as we speak).

Put another way, everybody would benefit from substantially lower health care prices, none of us would see our health care money go to financing wasteful paper-pushing, and cross-subsidization would occur for the benefit of the overall public good, in the same way that it does for any number of other things, such as Fire Departments, public schools, or National Defense. And what is more, we would finally enjoy the freedom to choose what really matters: our doctors or medical establishments, rather than from within those euphemistic lists of “preferred providers”.

Everybody would benefit, that is, except from those who make a living either at the expense of Americans’ health or by sponsoring Orwellian health care debates tantamount to those in the Middle Ages attempting to establish the number of angels that can dance on the tip of a pin.

And do not believe those who tell you that it is your fault because of your unhealthy lifestyles: Britons spend a fraction of what we do — 95% of them never see a medical bill in their lives – yet there isn’t a shred of evidence that they go more often to the gym or eat more broccoli than we do (however recommendable broccoli and exercise might otherwise be).  And neither can “technology” or “aging population” be the whole story: if not, ask the Japanese, who use far more technology than we do, visit doctors substantially more often, and are substantially older than we are, yet pay 50% of what we pay.

Finally, don’t believe in those who tell you that social insurance is “politically unfeasible” either: when Otto von Bismarck started social insurance in Germany back in 1883, he did not do so because he was a socialist, but rather to defeat socialism, because he believed that “the social insecurity of the workers makes them a peril to the state”.

We can’t expect meaningful change from politicians or experts:

It’s really up to us.