Archive for the 'Critiquing Corporate Health' Category
Add a comment August 8th, 2010 by Claudia Chaufan
Published in the Santa Cruz Sentinel, Sunday August 8, 2010
As Medicare celebrated its 45th anniversary July 30, the White House sent its present: a Deficit Commission, composed by some of the very folks who were unable, or unwilling, to see the $8 trillion housing bubble that brought the financial system to a halt. Nope. It’s no joke: these folks are now at the forefront of the campaign to “save” Medicare and the budget.
But, does Medicare need to be saved? Let’s do a little history.
When Medicare was signed into law by President Lyndon Johnson, almost overnight millions of seniors, and later disabled Americans, were able to meet their health care needs, and rates of poverty among them dramatically decreased. Eventually, Medicare added benefits, laid the foundation of studies of health care quality, and provided a model of administrative efficiency still unmatched by for-profit insurers. Today, Medicare meets the health care needs of over 45 million Americans.
To be sure, aging baby boomers will add pressure to Medicare, and the program can be improved: rather than allowing dubious “Advantage” plans, benefits in traditional Medicare could be expanded; gaps, now covered through Medigap policies, a source of profit for insurers yet a financial burden for seniors, could be eliminated; the Kafka-esque Part D could be dumped and Medicare could be allowed to use its huge purchasing power to negotiate prices directly with drug companies, rather than banned from doing so; and doctors’ payments could stop being subject to flawed accounting formulas liable to political manipulation.
But all this is a far cry from the privatizing trends pushed by Congress and President Obama, who famously has said that when it comes to the deficit, “everything is on the table,” including the two bedrocks of America’s social safety net, Social Security and Medicare.
So if everything is on the table, how about saving Medicare by expanding it to include everyone living in America? How about replacing the insane patchwork of thousands of plans and paper-pushing designed not to provide access to care, but to undermine it, with a single paying public agent? Over $400 billion could be saved with this move alone, without adding a dime to overall costs. This amount would generously cover all — not “near” all — the uninsured, and improve the coverage of a growing number of Americans who must settle for skimpy policies and unaffordable out-of-pocket costs that drag thousands to bankruptcy annually.
And whatever taxes were needed to finance Medicare-for-All would be generously offset by eliminating increasingly unaffordable out-of-pocket costs and premiums. American families and individuals would see their health care costs precipitously fall and their health care fears vanish. Imagine the change this move would unleash — Americans no longer worried that their dream jobs offer no “health benefits” and businesses finally able to compete internationally with countries guaranteeing public health care.
There is nothing to “wait and see” about the Orwellian Patient Protection and Affordable Care Act signed into law this past March. Close to a century of failed experiments with for-profit insurance for everybody but the most vulnerable among us, who are dumped on taxpayers’ shoulders, should suffice. While millions continue to suffer and die unnecessarily, we already pay for universal health care yet not get it.
Let’s not be misled by propaganda and demand our legislators support a financially sustainable and socially just, publicly funded, privately delivered, universal health care system — a single payer national health program. It’s not too late to do things right. Let’s not take no for an answer so that we can soon sing together “Happy Birthday, Medicare for All!”
Claudia Chaufan received her medical degree in Argentina and her doctorate in sociology at UC Santa Cruz. She is an assistant professor of Sociology and Health Policy at the Institute for Health and Aging at UC San Francisco and vice president of Physicians for a National Health Program — California.
Add a comment July 2nd, 2010 by Claudia Chaufan
Posted in Physicians for a National Health Program (PNHP blog) on Friday, Jul 2, 2010
By Claudia Chaufan MD, PhD
In a recent issue in the New England Journal of Medicine, economist Jonathan Gruber praises the Patient Protection and Affordable Health Care Act (PPACA) as a “step in the right direction,” even as he expresses a healthy skepticism about PPACA’s capacity to control escalating health care costs, which he recognizes as “key to the long-term viability of our health care system.” Gruber also argues that there is “shortage of evidence” regarding which approach will meet Americans’ health care needs while controlling costs; therefore there is “no consensus” on what works [1].
Had Gruber looked beyond the U.S. borders, however, he would have found plenty of evidence. For instance, he would have found that U.S. consumption of health care as measured by critical indicators — per capita annual doctor visits, length of stay following heart attacks, or length of stay following normal childbirth – is no greater than the OECD average, and therefore cannot justify the extraordinary level of U.S. spending [2].
He would also have found that U.S. prices for medical care commodities and services are significantly higher than in other nations and constitute a key determinant of U.S. overall spending [3]. And had he looked into why this is the case, Gruber would have found that US high prices are determined by the exceptionally high administrative overhead caused by the system’s fragmented, public-private financing [4] and by the comparatively limited market power of American patients vis-à-vis their counterparts in countries with national health systems where the government negotiates prices with drug and medical device companies [5]. And he might have concluded that PPACA will do predictably little to change all this.
Moreover, the international literature would have shown the author the extraordinary international consensus around nonprofit financing to cover medically necessary services [5].
But what about the dramatic expansion of coverage promised by PPACA? Is this not a step in the right direction? The problem is that insurance coverage, as desirable as it may be, is not health care, but just a means to that end. And the U.S. system is notorious for providing coverage without care. High co-pays and deductibles are significant obstacles to access. Nor does health insurance offer financial security: nearly 78 percent of personal bankruptcies in 2007 that were linked to medical debt involved persons who were insured at the onset of their illness or injury [6]. PPACA, by allowing the sale of premiums for policies that will cover only 60 percent of health expenses [7], will do predictably little to change this state of affairs.
There is, however, an alternative proposal whose financial and policy soundness are based on decades of international experience and evidence. It would improve and expand Medicare to include all residents in the nation or in one state. That alternative may have to wait until PPACA unravels, as it predictably will [8].
President Obama argued that a model of reform as that implemented by PPACA would allow Americans to build on “what works” [9] – a decades-long experience with employer-sponsored for-profit health insurance. Maybe paradoxically, however, PPACA will unravel as employers realize that it is cheaper to pay a fine than pay for increasingly more expensive and inadequate policies, and employees enter the individual health exchanges implemented by the new law and find them so expensive that they “clamor for a nationalized health care system” [10].
References
1. Gruber, J., The Cost Implications of Health Care Reform. N Engl J Med: p. NEJMp1005117.
2. Peterson, C.L. and R. Burton, U.S. Health Care Spending: Comparison with Other OECD Countries. 2007. Order Code RL34175(September 17): p. http://assets.opencrs.com/rpts/RL34175_20070917.pdf (Accessed November 10 2007).
3. Anderson, G.F., et al., It’s The Prices, Stupid: Why The United States Is So Different >From Other Countries. Health Affairs, 2003. 22(3): p. 89-105.
4. Woolhandler, S., T. Campbell, and D.U. Himmelstein, Costs of Health Care Administration in the United States and in Canada. The New England Journal of Medicine, 2003. 349(August 21): p. 768-75.
5. White, J., Competing solutions: American health care proposals and international experience. 1995, Washington D. C: The Brookings Institution.
6. Himmelstein, D., U. , et al., Medical Bankruptcy in the United States, 2007: Results of a National Study. The American Journal of Medicine, 2009. 122(8): p. 741-746.
7. Dorgan, B., The Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act. http://dpc.senate.gov/dpcdoc-sen_health_care_bill.cfm, 2010. Democratic Policy Committee.
8. Angell, M., Is the House Health Care Bill Better than Nothing? Physicians for a National Health Program, 2010: p. http://www.pnhp.org/news/2009/november/is_the_house_health_.php (May 17, 2010).
9. The New York Times, Obama’s Health Care Speech to Congress. 2009: p. http://www.nytimes.com/2009/09/10/us/politics/10obama.text.html?_r=1&pagewanted=print (Date accessed September 12, 2009).
10. Helderman, R., Gingrich in Va.: A Republican Congress could defund health care law. 2010: The Washington Post. p. http://voices.washingtonpost.com/virginiapolitics/2010/05/former_speaker_of_the_house.html.
Claudia Chaufan, M.D., Ph.D., is assistant professor at the Institute for Health and Aging at the University of California, San Francisco. She teaches sociology of health and medicine, sociology of power, public health, comparative health care systems and sociological theory. Dr. Chaufan is also vice president of Physicians for a National Health Program-California (http://pnhpcalifornia.org/).
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Add a comment April 15th, 2010 by bronxdoc
The most recent edition of Social Medicine, our on-line academic journal has just been published. We will post a short description of the articles later this week, but wanted to share the lead editorial entitled: Rebuilding the US Health Left. We would be most interested in comments from readers of the Portal.
Rebuilding the US Health Left
Matthew R. Anderson, MD, MS, Lanny Smith, MD, MPH, and Victor W. Sidel, MD
With this issue Social Medicine begins a series of invited papers on the topic: “Rebuilding the US Health Left.” In this editorial, we will outline our vision for this series.
We undertake this project aware that our good friend and mentor, Dr. Walter Lear, one of the leading health activists of the 20th century, lies critically ill. Walter was the creator and custodian of the US Health Left Archives, a collection that is now with the University of Pennsylvania library. The collection reminds us of the important role Left health care workers played in US history throughout the 20th century. They advocated for a national health program (Committee on the Costs of Medical Care, Physicians Forum, Medical Care Section/APHA, HealthPAC, Physicians for a National Health Program, National Physicians Alliance), provided international solidarity (American Soviet Medical Society, international brigades during the Spanish Civil War, Central American Solidarity Movement, Committee to Help Chilean Health Workers, Doctors for Global Health), traced the connections between disease and social class (Sigerist Circle, Spirit of 1848 Caucus/APHA), fought for workers’ health (Councils for Occupational Safety and Health; Occupational Health and Safety Section/APHA) participated in anti-war movements (Medical Committee for Human Rights, Physicians for Social Responsibility, International Physicians for the Prevention of Nuclear War, Peace Caucus/APHA), created new models of health care delivery (Health Cooperatives, Prepaid Health Maintenance Organizations, Community Health Centers, National Health Service Corps, Free Clinics), were central to the struggle for women’s rights (Planned Parenthood, Physicians for Repro-ductive Choice and Health), supported the civil rights movement both in medicine and in the broader society (National Medical Association, Medical Committee for Human Rights), played key roles in the movement for gay rights (ACT-UP, Gay & Lesbian Medical Association, Lesbian, Gay, Bisexual, and Transgender Caucus/APHA), challenged traditional models of medical education (Student Health Organizations, AMSA, Residency Program in Social Medicine), and worked in many, many other fields.
It is not by chance that “leftie” physicians were specifically targeted during the McCarthy era. Tragically, the repression of progressive ideas within the medical community had a chilling impact during the 1950’s when many progressive physicians were blacklisted and some saw their careers ruined. Organized medicine – through the AMA – made its peace with the nascent medical-industrial complex, becoming ever more conservative and eschewing the social values that had informed much of the medical community in the earlier parts of the century. By 1961, the AMA’s Women’s Auxiliary (composed of doctor’s wives) participated in “Operation Coffeecup” during which they met to listen to Ronald Reagan discuss “the evils of socialized medicine”; their goal was to defeat an early version of Medicare.
– to read the rest, please click here. And please leave us your comments.
posted by Matt Anderson
1 Comment March 24th, 2010 by Claudia Chaufan
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.
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.
Add a comment January 28th, 2010 by Claudia Chaufan
For Immediate Release: 1/28/10
January 28, 2010
Leno’s Single Payer Health Insurance Legislation
Wins Senate Vote 22 to 14
California OneCare Campaign
Reveals Massive Netroots, Grassroots Campaign
By a vote of 22 to 14, the California Senate today passed historic reform legislation, SB 810, that calls for sweeping changes in the financing of health care.
Under the bill, authored by Senator Mark Leno (SF), all residents would be covered by a true universal health care system, which would pay for all needed health services utilizing a “single payer” insurance system. Most residents would be required to pay into the system and all would be covered, with no additional co-pays, deductibles or exclusions for pre-existing conditions.
Comprehensive reform. Under SB 810, private insurance companies would be replaced by one non-profit health insurance fund. All services, including prescription medications and equipment would be paid by the single fund – hence the term “single payer”. All California residents will be covered with comprehensive, universal coverage for all necessary health care including doctors, hospital, medications, mental health, medical equipment, dental, eye care and more. Under the SB 810 legislation, hospitals anddoctors would continue to operate privately, while insurance would be financed publicly..
SB 810 is expected to be revenue neutral to the state and cost most businesses and residents less for the most comprehensive health care reform plan ever offered Americans.
A strategic Plan to WIN. Sponsors of the bill applauded the Senators who supported this victory and outlined coalition plans for a massive multimedia grassroots educational campaign to pass the bill through the Assembly later this year.
One key component of the campaign will be an historic multimedia advertising campaign that will feature a new 30-second TV spot every day for a year starring celebrities, political leaders, health care activists and victims. Some 60 spots have already been produced, featuring Lily Tomlin, Paula Poundstone, Elliot Gould, Ed Begley, Valerie Harper, Connie Stevens, Tracy Newman, Ken Howard, Ed Asner, Sheila Kuehl and more. Supporters will be invited to submit their own versions.
Massive Grassroots Education. Kicking off on March 1, the 365-day ad and grass roots organizing campaign will gain momentum during the most tumultuous political period in decades, including a key state primary and the November election for Governor, Senate and Assembly seats. The goal of the campaign is to achieve passage and approval of the legislation by a two-thirds super majority of legislators in order to pass the financing legislation to implement the legislation. Similar single payer bills were passed twice by a 62% majority of the California legislature only to be vetoed by Governor Schwarzenegger.
Californians will be invited to get active on line or join neighborhood events to educate others about the benefits of this major reform of our health care system. Leaders expect that California’s success with a single payer system will lead other states to adopt it as well.
California OneCare and the 365 Ad Campaign are a project of Health Care for All-California and supported by single payer advocacy groups nationwide.
DONATE TO GET SINGLE PAYER, UNIVERSAL HEALTH CARE IN CALIFORNIA. Please support the California OneCare 365 Ad Campaign. Help us produce a new thirty-second ad supporting single-payer health care on websites and television throughout California every day for one year. Click here to donate.
For more information, contact:
Andrew McGuire, Executive Director,
Health Care forAllCalifornia and the California OneCare Campaign
Phone: 415.215.8980
Ali Bay (California Senate)
916 651-4003
Add a comment January 13th, 2010 by Claudia Chaufan
From California OneCareNow, Campaign for single payer bill SB810
The campaign for single payer health care reform in California got a “shot in the arm” in Sacramento Monday and a report about it became the top recommended blog on Daily Kos. Busloads of California Health Professional Student Alliance members–medical, nursing, public health and allied health students–marched to the Capitol steps and joined a crowd of about a thousand supporters for a raucous rally for single payer. Blogger “Shockwave” attended the rally and posted his report about it on Daily Kos yesterday morning. It quickly become the #1 recommended blog on the influential progressive website. Read his report on Daily Kos, “Shockwave” is a Health Care for All-California member and a California OneCare supporter.
The video featured in the blog was created by California OneCare Campaign Co-Chair, Don Schroeder. The video is available on YouTube.
Featured speaker at the rally was Senator Mark Leno, principle author of SB 810, the California Universal Health Care Act that will begin its way through the legislature later this month. The bill, dubbed California OneCare, has passed twice before, only to be vetoed by Governor Schwarzenegger. It is expected to pass again by late summer. One goal of the California OneCare Campaign is to make sure the governor signs it this time. If he doesn’t, the goal is to override a veto with a two-thirds “healthy majority” in the legislature next year.
The event organizer and MC was JB Fenix, California Physicians’ Alliance Fellow, who was joined at the podium by Chris Scannell from the USC Medical School, and Lea Rosemurgy from the UCSF School of Nursing. Additional speakers at the rally included Deborah Burger, RN, Co-President of the California Nurses Association/National Nurses Organizing Committee, James Kahn, MD, President of the California Physicians’ Alliance, Allan Clark, Alliance President of the California School Employees Association, Nan Brasmer, President, California Alliance of Retired Americans, and Andrew McGuire, Executive Director of Health Care for All-Calfifornia and the California OneCare Campaign.
DONATE TO GET SINGLE PAYER, UNIVERSAL HEALTH CARE IN CALIFORNIA. Please support the California OneCare 365 ad campaign. Help us produce a new thirty-second ad supporting single-payer health care on websites and television throughout California every day for one year. Click here to donate.
Add a comment January 7th, 2010 by Claudia Chaufan
I must confess that I was disappointed to see Dr. Gawande’s mantra that more or more expensive care is not necessarily better care go unchallenged even by the otherwise outstanding Amy Goodman’s Democracy Now! Unchallenged, that is, when this rather obvious (or at least very reasonable) observation was presented as the critical explanation for why the United States spends more in health care, per person, than any other country in the world, even as it leaves millions uninsured or underinsured, leads thousands to bankruptcy, and allows 45,000 — 15 times the number murdered in 9/11 — to die for lack of health insurance. Nor was he challenged when he presented his views on Massachusetts as a sound model for health care reform, even as he granted that the program had “failed to control costs”. In fairness to the interviewers, Dr. Steffie Woolhandler’s statement that the center of the Massachusetts program did not hold was shown briefly. Yet to the already confused listener or viewer, the showcase of “opposing expert views” must have felt like the usual “he said, she said” — not awfully enlightening and at best leading to skepticism about both positions.
So back to Dr. Gawande, it appears that he is smart enough to realize that certain forms of payments, like fee for service, lead practitioners to provide more care (which sometimes, but by no means always, may be unnecessary), whereas salaried doctors do not have that incentive (incidentally, salaried doctors are the norm in “socialized medicine” type systems). And yet, Gawande is not perspicacious enough to ask himself why is it that Canada, Taiwan, France, or Japan, where fee for service reigns supreme, still spend a fraction of even what our cheapest and best run hospitals do. While I am not arguing in favor of fee for service — quite the contrary, I, like many, agree that it is at least a very inefficient and administratively burdensome form of payment — I am just pointing out that given this rather banal observation, it is clear that fee for service cannot be the whole story of our high health care costs.
At any rate, had Gawande (or his interviewers) asked this critical question, rather than continuing in the all too American exercise of navel-gazing by comparing one (low-cost) American hospital with another (high cost) American hospital, he might have studied a well-run, or even the best run, American hospital’s costs against the costs of some hospital in other countries. And he surely would not have failed to see, as it appears he has, that even Switzerland, that comes second after the United States in health care costs (even if Swiss costs are substantially lower, by around 40%, than the U.S.’s), and has “private insurers”, bans profit making from the financing of medically necessary care. Right! It’s the financing, stupid!
The same is the case with the health care of all other industrialized economies. So even when Europeans, or the Japanese, talk about “private” insurers in health care they rarely, if ever, mean “for profit” insurers. Private insurers are essentially tightly regulated subsidiaries of government, and if they are ever caught “cherry-picking” they are forced to transfer some of their money to another insurer that covered sicker patients or, as the Swiss do, lower their premiums during subsequent months, unimaginable in the America private health insurance scenario.
Admittedly, some readers might puzzle: “Why would insurers even be in business if not to become filthy rich?” Well, at least one reason is that if they do a good job and attract many members, then they can sell for profit insurance for the “over and above” services (private hospital rooms, cosmetic surgery, etc.). And to note, when Swiss insurers, who prior to 1994 were pretty much like American insurers, failed to meet their part of the social contract (i.e. were becoming filthy rich at the expense of everybody else’s suffering), they got their lesson: price controls and mandated benefits that they had to provide at no profit if they wanted to remain in business.
And had Gawande delved into the politics of health care (and not merely the Pollyannaish version of its history), he surely would not have failed to discover that the coming into being of the National Health Services (NHS) was anything but a “historical accident” (and if it was, then anything can be, and the expression is meaningless). It is surely true that the physical structures, the public hospitals, were “already there” after WWII, a war during which hospitals had been built that provided publicly funded medical care for servicemen. Yet it is equally true, and arguably much more important, that around 1948 there was a confluence of critical political forces, not the least of which was the landslide victory of Labor over the Conservative Party.
How did this unexpected victory happen, despite the popularity won by Conservative British Prime Minister Winston Churchill as a “war leader”? It appears that as “national security” concerns subsided and hunger and unemployment began to take their toll over an impoverished population, Britons concluded that Labor, not Conservatives, would be more inclined and capable to guarantee “bread and butter” issues — what were increasingly seen as basic social rights, such as full employment, income security, public education, and health care. Popular demand for guaranteed basic rights was further strengthened by the success of socialist British Minister of Health Aneurin Bevin to secure the support of the medical establishment: in a masterful move, Bevin decided that offering well paid practitioners who agreed to join the NHS generous salaries would free them “from the necessity to drum up business from rich clients to pay for their basic income” (Glennerster 2007: 51). So if the birth of the NHS was a “historical accident”, it was certainly a very complex one.
So Gawande’s conclusion, given the glaring omission in his theory, is unsurprising: it is U.S. doctors, and their “culture”, the source of our high costs – doctors, that is, who respond to a perverse systems of incentives, which according to Gawande, is the way U.S. doctors are paid: more for doing more yet not better.
Now, while doctors may certainly be part of the problem, and while paying more for doing more, even if it is not good and frequently not necessary, is obviously a bad thing, why Gawande chooses to ignore the critical and obvious fact that no other industrialized economy, and many industrializing ones (like Taiwan) leaves over 70% of its population (even if Gawande has only counted 50%) at the mercy of profit seekers when it comes to financing medically necessary care is anybody’s guess. (Elsewhere I have laid out, and many other excellent policy analysts, like PNHP doctor Don McCanne, have, why the only way to eliminate financial barriers to medically necessary care is treating health care as a social right and financing it collectively, through a tax-based or social insurance system, incidentally the only way to allow the choices that matter – of doctors and medical establishments, not “health plans” or “preferred providers” lists).
But maybe had Gawande acknowledged the obvious, I suspect that his New Yorker article, where he insists that whether insurance is public or private (we are not told whether the profit motive matters) is not that important after all, would not have never become “required” reading in the White House. Indeed, he even might have been kicked out of the sanctuaries where our health care future is being written (or cooked!), as was the case with many brave doctors (Dr. Margaret Flowers comes to mind), who keep on insisting that our politicians do what we pay them to do: put ordinary people’s welfare before corporate interests and profits.
Add a comment December 23rd, 2009 by Claudia Chaufan
A national organization of 17,000 physicians, Physicians for a National Health Program, who favor a single-payer health care system, called on the U.S. Senate today to defeat the health care legislation presently before it and to immediately consider the adoption of an expanded and improved Medicare-for-All program.
Because of the urgency of the matter, we feel it is important to reproduce the letter in its entirety.
Click here to sign a petition demanding the Senate to drop the bill and pass real health care reform.
To the Members of the U.S. Senate:
It is with great sadness that we urge you to vote against the health care reform legislation now before you. As physicians, we are acutely aware of the unnecessary suffering that our nation’s broken health care financing system inflicts on our patients. We make no common cause with the Republicans’ obstructionist tactics or alarmist rhetoric. However, we have concluded that the Senate bill’s passage would bring more harm than good.
We are fully cognizant of the salutary provisions included in the legislation, notably an expansion of Medicaid coverage, increased funds for community clinics and regulations to curtail some of private insurers’ most egregious practices. Yet these are outweighed by its central provisions – particularly the individual mandate – that would reinforce private insurers’ stranglehold on care. Those who dislike their current employer-sponsored coverage would be forced to keep it. Those without insurance would be forced to pay private insurers’ inflated premiums, often for coverage so skimpy that serious illness would bankrupt them. And the $476 billion in new public funds for premium subsidies would all go to insurance firms, buttressing their financial and political power, and rendering future reform all the more difficult.
Some paint the Senate bill as a flawed first step to reform that will be improved over time, citing historical examples such as Social Security. But where Social Security established the nidus of a public institution that grew over time, the Senate bill proscribes any such new public institution. Instead, it channels vast new resources – including funds diverted from Medicare – into the very private insurers who caused today’s health care crisis. Social Security’s first step was not a mandate that payroll taxes which fund pensions be turned over to Goldman Sachs!
While the fortification of private insurers is the most malignant aspect of the bill, several other provisions threaten harm to vulnerable patients, including:
* The bill’s anti-abortion provisions would restrict reproductive choice, compromising the health of women and adolescent girls.
* The new 40 percent tax on high-cost health plans – deceptively labeled a “Cadillac tax” – would hit many middle-income families. The costs of group insurance are driven largely by regional health costs and the demography of the covered group. Hence, the tax targets workers in firms that employ more women (whose costs of care are higher than men’s), and older and sicker employees, particularly those in high-cost regions such as Maine and New York.
* The bill would drain $43 billion from Medicare payments to safety-net hospitals, threatening the care of the 23 million who will remain uninsured even if the bill works as planned. These threatened hospitals are also a key resource for emergency care, mental health care and other services that are unprofitable for hospitals under current payment regimes. In many communities, severely ill patients will be left with no place to go – a human rights abuse.
* The bill would leave hundreds of millions of Americans with inadequate insurance – an “actuarial value” as low as 60 percent of actual health costs. Predictably, as health costs continue to grow, more families will face co-payments and deductibles so high that they preclude adequate access to care. Such coverage is more akin to a hospital gown than to a warm winter coat.
Congress’ capitulation to insurers – along with concessions to the pharmaceutical industry – fatally undermines the economic viability of reform. The bill would inflate the already crushing burden of insurance-related paperwork that currently siphons $400 billion from care annually. According to CMS’ own projections, the bill will cause U.S. health costs to increase even more rapidly than presently, and budget neutrality is to be achieved by draining funds from Medicare and an accounting trick – front-loading the new revenues while delaying most new coverage until 2014. As homeowners seduced into balloon mortgages have learned, pushing costs off to the future is neither prudent nor sustainable.
We ask that you defeat the bill currently under debate, and immediately move to consider the single-payer approach – an expanded and improved Medicare-for-All program – which prioritizes the advancement of our nation’s health over the enhancement of private, profit-seeking interests.
Oliver Fein, M.D., President
David U. Himmelstein, M.D., Co-founder
Steffie Woolhandler, M.D., M.P.H., Co-founder
Physicians for a National Health Program
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Physicians for a National Health Program (www.pnhp.org) is an organization of 17,000 doctors who advocate for single-payer national health insurance. To contact a physician-spokesperson near you, visit www.pnhp.org/stateactions or call (312) 782-6006.
3 Comments December 23rd, 2009 by Claudia Chaufan
So experts like Paul Krugman recommend that “we” progressives “take a deep breath”, set our ideological quibbles aside, and “pass the health care bill” (“Pass the Bill”, December 17, 2009, A. 35).
Not that Krugman thinks that the bill is good. Far from that, he grants that it is “way short of ideal” — that, indeed, the senators who crafted it may be motivated “largely by a desire to protect the interests of insurance companies” or, in the case of Senator Lieberman, by “sheer spite”. He further grants that in some cases, such as in financial matters, there is little to lose by letting die a bill that waters down financial reform to the point of meaninglessness. And yet, he fails to see that health care is in this respect no different from finance.
Remarkably, and his Nobel Prize in Economics notwithstanding, Krugman reasons fallaciously. He tells us that the case of the Senate (or House) bill is comparable to Social Security, a social insurance system that, while born “imperfect”, has become the bedrock of retirement stability for Americans.
But the healthcare bills are not social insurance – and Krugman should know this much. Social insurance systems are cooperative systems of savings, whose primary goal is to meet a basic need, and where profit plays no role. This is for instance the case of single payer health care, a Medicare for All type system that pools risk widely and is financed through a fixed and predictably affordable proportion of everybody’s income, and whose goal is to eliminate financial barriers to medically necessary care.
In contrast, both the Senate and House bills are blatant sellouts to corporate interests that, as Rep. Eric Massa compellingly argued, will “enshrine in law the monopolistic powers of the private health insurance industry” by making it a federal crime, for the first time in American history, to not buy their products.
Maybe it is Krugman who should learn from history. If he did, he would learn that Otto von Bismarck, first chancellor of the German Empire, implemented the first government-sponsored social insurance system (back in 1883) not because he cared about the welfare of workers (at least not necessarily) but rather because he considered their social insecurity to be “a peril to the state”. Bismarck had learned that much from the (failed) 1848 Revolutions and the Paris Commune, which showed him that distressed workers meant business.
History would also teach Krugman that the British government implemented “socialized medicine” heeding the advice of a lord and in the aftermath of WWII, with an economy in shambles and confronted with the danger of great social unrest. Or he might learn that more recently Taiwan passed single payer health care (from scratch, basically) because the party with a Parliamentary majority would have otherwise been voted out of office by an opposition that supported single payer.
Were Mr. Krugman able to learn from history he would learn that no major progressive legislation tending to greater social justice and equity passed without a fight, elsewhere or in the United States. He would also learn that what makes legislation politically feasible is not what politicians are willing to do – it never has been – but rather the cost of their not doing what their constituents demand.
Yes, I suspect that if Krugman learned from history his “message to progressives” would be quite different.
1 Comment December 9th, 2009 by bronxdoc
This week’s edition of the Lancet (12/5/2009) features a letter to the editor about US health care reform written on behalf of the US People’s Health Movement. We were very pleased that the Lancet chose to feature a quote from the letter on their cover:
“The health-care reform process exposes how corporate influence renders the US government incapable of making policy on the basis of evidence and the public interest.”
The text of the letter can be read at this link.
American exceptionalism?
One of the many curious things about the current health care reform debate in Washington is the extent to which the US is considered to be outside of the community of nations. We are judged by our own standards and can learn only from our own experiences. This phrase is neatly captured in the desire for a “uniquely American solution” to health care. (See our prior posting about “misleading messaging” and the failure of health care reform).
But what are we to say about a health care “solution” that will deny women abortions, deny care to undocumented workers and their families, not provide universal health care, and not recognize a right to health? What are we to say about a health care system delivered up to the insurance companies and big Pharma? Isn’t this really just a “uniquely corporate solution” to health care?
In the letter we suggest something different:
There is no excuse for the USA not to adopt a system like any of those in many other countries that cover everyone and control costs—systems that better integrate public health and individual medical care. Without such a system, comprehensive primary health care will not be implemented, nor will the social determinants of health be effectively addressed.
The belief in US exceptionalism must be laid to rest. People living in the USA are as entitled to the right to health as others, and the USA should be accountable to the same standards as any other country.
The People’s Health Movement (PHM) was established in December of 2000 in Bangalore to keep alive the goal of “Health Care for All.” It is an organization of activists, academics, and grass roots organizations from around the world. The website of the US circle of the PHM is at http://www.phm-usa.org/
posted by Matt Anderson, MD (a co-signator)
