The Social Medicine Portal

Medicare for All Rally – San Francisco, February 25, 2010

I ask you to you join the Medicare for All Rally, tomorrow February 25, 2010 in San Francisco!  This is an important time to be active and let President Obama know about Health Policy that really works!

At 10 AM outside the San Francisco Federal Building  (90  7^th St., between Market and Mission – Civic Center BART/MUNI) join activists from the California Physicians Alliance, California Alliance for Retired Americans, Gray Panthers, and Single Payer Now to let President Obama know that we want Medicare for All.

This will be a Sidewalk Summit to tell President Obama that the policy that meets his goals of bringing down premiums, bringing down the deficit, covering the uninsured, strengthening Medicare, and stopping insurance company abuses, is Improved Medicare for All.

On Thursday in Washington, DC, President Obama is meeting with Republicans and Democrats to search for solutions to our healthcare crisis.  But once again the president and congress are not including any discussion of the only real solution to America’s health care problems – expanding and improving Medicare to cover everyone in America.

For further information:

Single Payer Now

415-695-7891

The White House does not answer letters on Single Payer

The following letter was sent to the White House on Feb. 9, two days after President Obama announced his plans to convene a bipartisan summit on health reform on Feb. 25 in Washington. Unsurprisingly, even if disappointingly, we’re still waiting for an answer.

February 9, 2010

President Barack Obama
The White House
1600 Pennsylvania Avenue NW
Washington, DC  20500

Dear Mr. President,

Physicians for a National Health Program, an organization of 17,000 doctors who support single-payer national health insurance, respectfully requests that you invite one or more of our representatives to participate in your White House health care session on Feb. 25.

We note that in your call for the meeting you urged Republicans, Democrats and health policy experts to gather, go over all the options and “walk through them in a methodical way so that the American people can see and compare what makes the most sense.”

We would like to offer several of our members as health policy experts for this important task.

As you may know, two key research studies that helped drive the health reform process forward this past year – one in the American Journal of Public Health that found 45,000 deaths annually are linked to lack of health insurance, another in the American Journal of Medicine that found 62 percent of personal bankruptcies are linked to medical bills and illness – were the work product of Harvard Medical School research teams guided by PNHP co-founders Drs. David Himmelstein and Steffie Woolhandler.

Drs. Himmelstein and Woolhandler, who are also primary-care physicians in Cambridge, Mass., have had several other groundbreaking studies published in our nation’s leading medical journals, including one in the New England Journal of Medicine that shows administrative costs consume 31 percent of U.S. health spending, most of it unnecessary. They have also frequently testified before Congress on their research. We urge that you invite them to participate in the Feb. 25 meeting.

The presence of Dr. Margaret Flowers, our congressional fellow, would also enhance the meeting. Dr. Flowers, a Maryland pediatrician, has met with numerous members of Congress and testified before two congressional committees last year about the urgent need for single-payer health reform.

Finally, we ask that you invite our president, Dr. Oliver Fein, to participate. Dr. Fein, an internist and professor of clinical medicine and clinical public health in New York City, attended the March 5 White House Summit on health care. He is a past vice president of the American Public Health Association.

Detailed biographies and contact information for each of these doctors are available upon request. Please feel free to call me (312-782-6006) or e-mail me (ida@pnhp.org) should you need any additional information.

Waves of Change: Developing Physician Leadership in our Practices, Communities, and Nation

Our friends from the National Physicians Alliance (see prior postings) have passed on an invitation to their 5th annual meeting to be held March 13-15, 2010 in Long Beach, Califonia.  For information and registration, please click on this link.  To give readers of the Portal a sense of what some physician activists are up to, we are reprinting some of the conference schedule:

Leadership Development: Developing Skills to Lead as the Landscape of Health Care Changes

From national health care reform to community advocacy to clinical practice, physician leadership and engagement has never been more vital to the health of the nation. Recent successful examples have also demonstrated the benefits of physician leadership, advocacy, and engagement with community partners. This track will provide resources for communication, management and advocacy skills, civic engagement, community collaboration, and other tools that physicians can apply in a variety of settings. Community members are welcome to join and learn more about physician engagement. Session to include:

Advancing Health Care Through Civic Engagement
Kim Alexander, President, California Voter Foundation Carmela Castellano-Garcia, President CEO, California Primary Care Association Marc Wetherhorn, National Advocacy Director, National Association of Community Health Centers

Messaging, Media & Communications
Bob Crittenden, MD, MPH , Executive Director, The Herndon Alliance

Effectively Engaging with Your State Legislatures & Its Members
Progressive States Network – Speaker TBA

Educating State Legislators, Advancing Health Care Reform: Tools Physicians Can Use to Engage & Inform State Legislators About Federal HC Reforms
Progressive States Network – Speaker TBA

Models for Physician Leadership and Community Engagement
Bill Jordan, MD, MPH, NY Action Network – National Physicians Alliance
Aaron Fox, MD, MPH, NY Action Network – National Physicians Alliance

Issues on the Horizon: 2010 & 2012 Elections
Kim Alexander, President, California Voter Foundation
Serena Kirk, Senior Policy Advocate, California Primary Care Association

Practice Innovations: Practicing Medicine in a Changing World

What will the practice of medicine look like in ten years? How will reform change the way the average physician will practice medicine? This will be an instructive and interactive track will address these complex questions and many others by focusing on the following three areas: 1) Evidence Based Medicine (EBM), 2) Practice structure and financing, and 3) Information and Communications Technology. Sessions to include:

Evidence-based Medicine & Clinical Guidelines
Colin Kopes-Kerr, MD, JD, MPH, The Permanente Medical Group

Healthcare Planning and Strategy
Kevin Fickenscher, MD, CPE, FACPE, FAAFP, Perot Systems

Approaches in Chronic Disease Management
Susan Snyder, MD

High Quality Care for Disadvantaged Populations
L. Gordon Moore, MD

National Health Policy: Avenues for Involvement in Advocacy to Enhance our Country’s Health

With the potential passing of federal health care reform legislation a “wave of change” will alter the landscape of public health and healthcare in America. The National Health Policy Track aims to educate and mobilize physicians on the healthcare reform debate of 2009 and future directions for reform. Sessions to include:

Reforms that Reduce Costs Without Reducing Quality of Care
Thomas Rice, PhD, Professor, Department of Health Services; Vice Chancellor, Academic Personnel
UCLA School of Public Health

Political Solutions to the Obesity Epidemic
Deborah Cohen, MD, MPH, Senior Natural Scientist, Rand Corporation

Outcomes of Health Care Reform: Review of the Policy Debate
Josh Derr, Manager, Mayo Clinic Health Policy Center

Health Care Reform: Impact on Women
National Women’s Law Center – Lisa Codispoti, Senior Counsel

Federal Health Care Reform: How Physicians Can Help Their States Access Upcoming Opportunities & Resources
Progressive States Network – Speaker TBA

Global Health: Workforce Issues in an Ever-Evolving Global Health Landscape

The world has never been smaller, nor have global issues of health been more of a concern for physicians and advocates alike. With health care workers migrating to the Unites States for better opportunities, a shortage in these critical areas ensues. What can physicians do to ensure that we are thinking globally in our efforts to improve the health of our patient, our community and our world? Sessions to include:

The Global Workforce Crisis-Is US the Problem or Solution?
Richard Scheffler, PhD, University of California, Berkeley
Kate Tulenko, MD, MPH, Deputy Director at Capacity Plus/ IntraHealth
Health Policy Specialist at World Bank

International Health Workforce Issues
Amy Hagopian, MHA, PhD, Health Alliance International, University of Washington

In the Wake of the Storm: On the Ground in Haiti
Susan Partovi, MD, Professor UCLA School of Medicine
Director Homeless Healthcare Los Angeles

Trade and Health: The Impact of Health Worker Migration
Michelle Forzley, JD, MPH

Nuclear Non-Proliferation: The Physicians Role in Advocating Peace
Bob Dodge, MD, Physicians for Social Responsibility, Los Angeles

California Health Policy: Experiences & Experiments in State Policy and its Nationwide Influence

California has long been at the forefront of the ever-changing face of healthcare. Its struggles are often those of other states around the country, and the innovations and experiments in health care delivery have offered guidance to the rest of the nation, whether in success or in failure. With the ongoing budget crisis in the state and the potential impact of impending national health legislation, adding to other internal debates about border health, malpractice, medical marijuana, and disaster preparedness, now as ever, California will be watched by the nation. In the California health track we hope to stimulate learning, debate and exchange of ideas around these and other issues relevant to patients, providers, and policy-makers. Sessions to include:

Issues facing Community Health Clinics and the Underserved & Minority Populations
Michael R. Cousineau, PhD, Director Community Health and Family Medicine University of Southern California Castulo de la Rocha, JD, President & CEO AltaMed Medical Services

A ‘Reformed Single Payer’ in the Current Reform Era
E. Richard Brown, PhD, Director, UCLA Center for Health Policy Research Professor, UCLA School of Public Health, Principal Investigator, CHIS

Border States and the Uninsured: Immigration Issues for Health Care Reform
Michael Rodríguez, MD, MPH, Sr. Researcher, UCLA Center for Health Policy Research Professor, UCLA Department of Family Medicine
Krysten Sinema, MSW, Arizona State Legislator
Progressive States Network – Speaker TBA

Addressing Disparities Through Health Reform
National Women’s Law Center

Healthcare Crisis in a Bankrupt State: Can California Still Lead?
Herb Schultz, MPP, Senior Health Policy Advisor to the Governor
Sara Rogers, Health Legislative Advisor to Senator Mark Leno

Coordinating Across State Lines: Opportunities Presented by Health Care Reform
Progressive States Network – Speaker TBA

posted by Matt Anderson, MD

“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

Single Payer Universal Health Care Bill Clears Senate in California

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

What the New York Times won’t tell you: Huge rally in Sacramento in support of single payer universal health care

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.

It’s the financing, stupid! A second opinion on Atul Gawande’s “Cost Conundrum”.

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.

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.

California Health Professionals Student Alliance calls you to join in the health care solution

Last day to register for Lobby Day 2010

Location: Sacramento State University and California Capitol Building, Sacramento, CA

All – Inclusive in Registration Fee:

Registrants from Southern California:

• Roundtrip Luxury Cruiser Bus to Sacramento event

ALL Registered Participants:

• Hotel Suites in Embassy Suites, Sacramento
• Meals (Sunday Lunch; Monday Breakfast and Lunch) — all except Saturday night on the town
• Training Materials and Expert Training in Lobbying and Health Advocacy Skills
• Networking with Health Professional Students from all over CA
• Hearing Exciting Guest Speakers from Health Professional, Medical, Legislative Spheres
• And More!

Relevance to Your Healthcare Career

• This timely event will bring together about 600 health professional students from California to become involved in current healthcare reform and advocate for the coverage of all Californians, directly with our elected legislators in Sacramento, for the fifth year in a row.

• The two-day event includes: Training Day featuring collaboration between health professional student leaders, physicians, public officials and health policy experts to work towards a future of an effective and just health delivery system. On day two, pre-arranged Lobby Day legislative visits put it all into action!

• Enjoy this exciting conference to learn about Single Payer Healthcare and the California Universal Healthcare Act, CA Senate Bill 810 (SB 810).

• See and discuss what SB 810 will do for our future patients and how it will improve the health and financial health for all Californians and us as future healthcare providers.

• We will also educate about current national reform bills, and how SB 810 is relevant within those frameworks. More details to come from our confirmed speakers.

Goals of the Day

• This will prepare you for active participation and leadership of a legislative visit team.

• You will emerge from this CAHPSA Lobby Day weekend as an advocate who is able to do outreach and head advocacy in your community to promote support for Single-Payer Healthcare among your colleagues in your health professional or pre-health professional academic institution, on campus in general, and in your network and community.

• You’ll be prepared to present the facts in the face of organized political opposition to meaningful healthcare reform

Conference Programming

TRAINING DAY: Sunday, January 10, 2010, Sacramento State University, CSUS Union

11:00 – 12:00 Registration and Box Lunch (included in Registration Fee).

12:00 – 12:10 Welcome by Lobby Day Team.

12:10 – 12:20 Martha Penry, CSEA Area Director, “Welcome to Lobby Day”

12:30 -  1:20 Wendell Potter, Former health Insurance Executive, Senior fellow on Health Policy, The Center for Media and Democracy.

1:30  -  2:20 Richard Quint, MD, MPH, Board of Directors for California Physicians’ Alliance, UCSF Emeritus health Sciences Clinical Professor, “Single Payer 101″

2:30  -  3:20 Sara Rogers, Senior Health Policy Staffer to Senator Leno, “All about SB 810″

3:30  -  4:20 William Skeen, MD, MPH, Legislative Advocacy Consultant and Expert, “How to Frame your Argument and Talk to your Legislator”

4:40  -  5:50 Breakut Sessions – “Arguments for and Against SB 810, Planning your legislative Visit”

6:00 – 6:45 Michael Wilkes, MD, Director of global Health and Professor of Medicine, former Vice Dean of Medical Education at UC Davis, Reviewer of JAMA, Lancet, NEJM, “Our Role as Healthcare Providers and Social Responsibility”

7:00pm Dinner at River City and Hardrock Cafe (not included in Registration Fee)

LOBBY DAY: Monday, January 11, 2010, Embassy Suites, and Capitol Building, North Steps

7:00  -   9:00 Sumptuous Breakfast (included in Registration Fee)

9:00  -  10:00 Lobby Day Teams meet for final practice of Legislative Visits.

10:00 – 10:45 Box Lunch (included in Registration Fee)

10:45 – 11:00 Gather outside Embassy Suites for march

11:00 – 12:00 March through Downtown Sacramento to CA Capitol Building Rally

.    12:00 -  1:00 Giant Rally on NORTH steps of California Capitol Building

.    1:00  -  4:30 Legislative Visits with your Senator or Assemblymember in Capitol Building

5:00 Return Home: Buses to Southern California depart from Capitol Building area

Registration Fee: All this for the low fee of only $45.

Registration is open to all Healthcare Professional Students of all disciplines and degree programs, including pre-Health Professional Students, graduates, friends and supporters of CAHPSA and Single-Payer Healthcare Reform.

Locations

• TRAINING DAY: CSU Sacramento, University Union
• LOBBY DAY: Embassy Suites, 100 Capitol Mall; Capitol Building, North Steps
• DINNER: River City Brewing, 545 Plaza Ave., and Hard Rock Cafe, 545 Sacramento St.

Travel arrangements

• Charter Bus from Southern California to Sacramento and return. (included in Registration Fee)
• Carpoolers will have parking on the Sacramento State University campus.
• The closest airport is Sacramento.
• Charter Bus service to all activities within Sacramento area: Night on the Town, March, and return from Legislative Visits. (included in Registration Fee)

Housing

Shared hotel rooms and suites for all at the Embassy Suites Hotel, downtown Sacramento (included in Registration Fee)

Additional Events: Sunday, January 10, 2010 (Optional, not included in Registration Fee):

• Night On the Town in the Capital, including dinner. Please join us for a Capital Special Social at River City and Hardrock Cafe (not included in registration fee) on the evening of Sunday, January 10th.  Details to follow.
• Limited scholarships available. If you need financial assistance, please contact CaPA.Fellow@PNHP.org with the following information: name, school, educational program, reason for need and amount you are able to pay.

Questions? Contact the planning team for this conference:

• Lobby Day Chair: Chris Scannell, scannell@usc.edu
• CaPA Fellow: JB Fenix at CaPA.Fellow@PNHP.org

The Case for Reform? Which Reform?

In closing 2009, the editors at the New York Times make a “case for (health care) reform”. They build their case on the well documented fact that millions in America are uninsured, that the for profit insurance sector is getting richer as more and more Americans go bankrupt because they cannot pay their medical bills, and that the “political timing is right” because the Democrats have the House, the Senate and the White House.

But the question remains, will “reform” Democrats-style save the day? And how exactly will it do it, and on the back of whom?

The best rebuttal of the New York Times position (which in this case reflects the position of the Democrat majority and the White House) that I could find was written by Dr. Don McCanne, senior policy analyst at Physicians for a National Health Program. Dr. McCanne argues compellingly that “the Times doesn’t get it”. It is well worth reading in its entirety.

The only point I can add to this otherwise brilliant analysis of the bill is that it is important to not lump “opponents of reform” in the same bag. And one should be weary of those who talk about “enemies of reform”, using emotionally loaded terms to substitute for good arguments and relevant evidence.

After all, there could be disagreements about whether administering aspirin to a patient is the right thing to do or not, but one person may argue that aspirin is the wrong thing to do because aspirin is never useful, and they would be wrong – it is very useful for some things — while another may argue that aspirin is useless because the patient has cancer, and they would be right – aspirin is useless in the treatment of cancer.

So while Radical conservatives argue that reform Obama/Congress style is bad because it would get “big government” between patients and doctors, the Medicare for All, single payer community argues that the House and Senate bills are bad because they will lock us in the grip of for-profit health insurers for years to come, by making it a federal crime not to buy their products (and even subsidizing with taxpayer money the buying of their products), while failing to control costs, and leaving millions uninsured or underinsured.

So is there another way to think about reform? Of course there is. It is called social insurance and it has been adopted beginning in the late 19^th century by every other industrialized economy with the glaring exception of us (yes, U.S.!).

The time to demand real change and to increase the cost on our representatives of not listening to ordinary Americans has come, and it is now.

Health care students in California can still join single payer advocates in Lobby Day, on Monday January 11. For more information and to sign-up for the two-day event click here.