{news} Comments on Hillary Clinton's "American Health Choices Plan": ongoing need for single payer

Tue Sep 18 10:16:29 EDT 2007

Two essays on health reform/ 2008 election:

-Dr.Don Canne works with Physicans for a National Health Program (PNHP) which supports a Canadian-style, single payer health care system, which is not what any of the Democratic (or Republican) candidates endorse, including Clinton.  Hillary's plan is followed by Don's comments.

-Dr. Steffie Woolhandler and Dr. David Himmelstein co-founded PNHP.  They give some history/update on US health reform and need for single payer.

Justine

==========================================

Hillary for President
September 17, 2007
The American Health Choices Plan: Ensuring Affordable, Quality, Health
Care for All Americans

Today, Hillary Clinton unveiled the third part of her plan to ensure that
all Americans have affordable, quality health insurance.  Her American
Health Choices Plan covers every American - finally addressing the needs
of the 47 million uninsured and the tens of millions of workers with
coverage who fear they could be one pink slip away from losing their
health coverage.

Providing a Choice of Insurance Plans

The American Health Choices Plan preserves existing health insurance and
offers new choices to those with insurance and to the 47 million people in
the United States without insurance.  It ensures portability so that
Americans do not lose coverage when they change or lose their jobs. 
Americans will have three options:

1) Keep Current Health Care Coverage: Americans who are satisfied with the
coverage they have today can keep it.

2) A Choice of Health Plan Options: Businesses, employees, and the
uninsured will have the option of buying group insurance through a new
Health Choices Menu.  This Menu will give all Americans the same set of
insurance options that their Member of Congress has. Without creating new
bureaucracy, the Menu will be part of the Federal Employee Health Benefit
Program (FEHBP), which includes numerous, high-quality private health
insurance options.

3) A Choice of a Public Plan Option: In addition to the array of private
insurance choices offered, the Health Choices Menu will also provide
Americans with a choice of a public plan option, which could be modeled on
the traditional Medicare program, but would cover the same benefits as
guaranteed in private plan options in the Health Choices Menu without
creating a new bureaucracy.  The alternative will compete on a level
playing field with traditional private insurance plans.

Promoting Shared Responsibility

Hillary Clinton's American Health Choices Plan is based on the principle
of shared responsibility. This plan ensures that all who benefit from the
system contribute to its financing and management.  Specifically,
responsibilities include:

 Insurance and drug companies: For insurers, to end discrimination based
on pre-existing conditions or expectations of illness and ensure high
value for every premium dollar; and for drug companies, to offer fair
prices and accurate information;

 Individuals: To get and keep insurance in a system where insurance is
affordable and accessible;

 Providers: To work collaboratively to provide high-quality care;

 Employers: To contribute to health coverage, with large firms required to
provide health insurance or contribute to the cost of the system, and
small businesses offered tax incentives to continue or begin to offer
coverage;

 Government: To ensure that health insurance is always affordable through
investments in tax credits and the safety net so that coverage is never
again a crushing financial burden; to improve the quality performance of
the system; and to end the upward cost spiral of the system that
threatens our health and economy.

Ensuring Affordable Health Coverage for All

1) Ensuring Premium Affordability Through Refundable Tax Credits

2) Limiting Premium Payments to a Percentage of Income

3) Promoting Shared Responsibility for Large Employers

4) Creating Small Business Tax Credit

5) Strengthening Medicaid and the State Children's Health Insurance
Program to Serve All Low-Income Individuals

6) Creating a Retiree Health Legacy Initiative

http://www.hillaryclinton.com/feature/healthcareplan/americanhealthchoicesplan.pdf

Comment:  Hillary Clinton's proposal "preserves existing health
insurance," and includes the responsibility of individuals "to get and
keep insurance" through the current private insurance market, or through a
"Health Choices Menu" of private FEHBP-type plans, or through a
Medicare-type public program.

Thus her proposal is an individual mandate to purchase private insurance
that is no longer affordable for average-income individuals, or to
purchase a public plan that will be even more expensive because of adverse
selection.

To make the plans affordable for individuals, she would use a combination
of refundable tax credits and a cap on premiums at a percentage of income.
Assuming that the plans would provide adequate benefits and adequate
protection against financial hardship, the increased spending through the
tax system would be exponentially more than the estimates in her plan. And
most of the proposed savings to pay for these increases are largely
nebulous, and some of those measures would actually increase costs.

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

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

Many will try to contrast the differences in the Clinton, Obama and
Edwards proposals, but they are all basically the same. In spite of their
rhetoric, they have each made the protection and enhancement of the
private insurance plans a higher priority than patients.
_______________________________________________
http://www.boston.com/news/globe/editorial_opinion/oped/articles/2007/09/17/health_reform_failure/ 
Boston Globe September 17, 2007

In 1966 - just before Medicare and Medicaid were
launched - 47 million Americans were uninsured. By
1975, the United States had reached an all time low of
21 million without coverage. Now, according to the
Census Bureau's latest figures, we're back where we
started, with 47 million uninsured in 2006 - up 2.2
million since 2005. But this time, most of the
uninsured are neither poor nor elderly.

The middle class is being priced out of healthcare.
Virtually all of this year's increase was among
families with incomes above $50,000; in fact, two-
thirds of the newly uncovered were in the above-$75,000
group. And full-time workers accounted for 56 percent
of the increase, with their children making up much of
the rest.

The new Census numbers are particularly disheartening
for anyone hoping for a Massachusetts miracle. In the
Commonwealth, 651,000 residents are uninsured, 65
percent more than the figure used by state leaders in
planning for health reform. Their numbers came from a
telephone survey done in English and Spanish. But that
misses people who lack a land-line phone - 43.9 percent
of phoneless adults are uninsured, according to other
studies.

It also skips over the 523,000 non-English speakers in
Massachusetts whose native language isn't Spanish (e.g.
Portuguese, Chinese, or Haitian-Creole), another group
with a high uninsurance rate. In contrast, the Census
Bureau goes door-to-door for its survey and has
translators for almost every language. It gets a more
complete picture.

In sum, Massachusetts health reform planners have been
wishing away a quarter of a million uninsured people.
Recent Patrick administration claims that health reform
is succeeding are based on cooked books. According to
the state's figures, almost half of the previously
uninsured gained coverage under the health reform bill
by July 1. But according to the Census Bureau, the new
sign-ups amount to less than one-quarter of the
uninsured. Moreover, it's likely that much of that gain
has already been wiped out by shrinking job-based
coverage - a longstanding and nationwide trend.

Why has progress been so meager? Because most of the
promised new coverage is of the 'buy it yourself'
variety, with scant help offered to the struggling
middle class. According to the Census Bureau, only 28
percent of Massachusetts uninsured have incomes low
enough to qualify for free coverage. Thirty-four
percent more can get partial subsidies - but the
premiums and co-payments remain a barrier for many in
this near-poor group.

And 244,000 of Massachusetts uninsured get zero
assistance - just a stiff fine if they don't buy
coverage. A couple in their late 50s faces a minimum
premium of $8,638 annually, for a policy with no drug
coverage at all and a $2,000 deductible per person
before insurance even kicks in. Such skimpy yet costly
coverage is, in many cases, worse than no coverage at
all. Illness will still bring crippling medical bills -
but the $8,638 annual premium will empty their bank
accounts even before the bills start arriving. Little
wonder that barely 2 percent of those required to buy
such coverage have thus far signed up.

While the middle class sinks, the health reform law has
buoyed our state's wealthiest health institutions.
Hospitals like Massachusetts General are reporting
record profits and enjoying rate increases tucked into
the reform package. Blue Cross and other insurers that
lobbied hard for the law stand to gain billions from
the reform, which shrinks their contribution to the
state's free care pool and will force hundreds of
thousands to purchase their defective products.
Meanwhile, new rules for the free care pool will
drastically cut funding for the hundreds of thousands
who remain uninsured, and for the safety-net hospitals
and clinics that care for them. (Disclosure - we've
practiced for the past 25 years at a public hospital
that is currently undergoing massive budget cuts.)

Health reform built on private insurance isn't working
and can't work; it costs too much and delivers too
little. At present, bureaucracy consumes 31 percent of
each healthcare dollar. The Connector - the new state
agency created to broker coverage under the reform law
- is adding another 4.5 percent to the already sky-high
overhead charged by private insurers. Administrative
costs at Blue Cross are nearly five times higher than
Medicare's and 11 times those in Canada's single payer
system. Single payer reform could save $7.7 billion
annually on paperwork and insurance profits in
Massachusetts, enough to cover all of the uninsured and
to upgrade coverage for the rest of us.

Of course, single payer reform is anathema to the
health insurance industry. But breaking their
stranglehold on our health system and our politicians
is the only way for health reform to get beyond square
one. __________

Dr. Steffie Woolhandler and Dr. David Himmelstein co-
founded Physicians for a National Health Program and
are primary care doctors at Cambridge Hospital.

(c) 2007 The Boston Globe 

-------------- next part --------------
An HTML attachment was scrubbed...
URL: <https://pairlist10.pair.net/mailman/private/ctgp-news/attachments/20070918/201610a3/attachment.html>