(Albany) Single Payer New York, a coalition of doctors, nurses, labor, faith, and community groups, called today upon President-elect Barack Obama to propose a single payer universal health care system for the U.S. Obama has asked Americans to hold house meetings on health care during the last two weeks of December.
The groups urged Obama to reject a Massachusetts style plan that mandates that individuals purchase health insurance.
“America is at a crossroads and the people elected you to be an agent of change. You possess the power to make health care a right in America. Americans deserve the health benefits offered to the people of every other country in the industrialized world—all medically necessary care and freedom from the fear of economic ruin due to illness. The bottom line is that single payer is the one proposal that guarantees quality, affordable health care to every American. This would also be a great benefit to our economy in our time of crisis, helping to control costs for taxpayers, consumers and employers,” said Mike Keenan, President of the Troy Area Labor Council and health care advocate for the Capital District Area Labor Federation.
Single payer merely means that one program pays all bills, like Medicare does for senior citizens. It eliminates the paperwork, high administrative costs and profits of the for profit private insurance system. An article in the New England Journal of Medicine concluded the single payer approach would save $350 billion a year in costs; somewhat smaller savings estimates have been made by the Congressional Budget Office. A study done for the State of California estimated that a state single payer plan would reduce health costs by $38 billion annually over a ten year period.
The group also urged Governor David Paterson to provide leadership at both the state and national level in achieving single payer universal health care. As a State Senator, Paterson was a long-time sponsor of single payer legislation. The state is expected to complete its long-delayed study on how best to provide quality health care to all New Yorkers in the next few weeks. Single payer is one of the models being studied.
President-elect Obama has also been a supporter of single payer health care in the past and touted its benefits during his election campaign. While he said recently that he would enact single payer if he was “starting from scratch,” he has cited the concern that many individuals work for insurance companies and instead has proposed smaller incremental steps that maintains a large role for private, for-profit health insurance. During the campaign he said he would provide subsidies to individuals and to small businesses owners that offer their workers coverage, while enacting an insurance mandate to require parents to obtain coverage for their children. Sen. Daschle, who was named today as Secretary of Health and Human Service as well as head of the new White House Office of Health Reform, praised single payer in his book Critical: What We Can Do About the Health Care Crisis but said that he is “not willing to sacrifice worthy improvements on the altar of perfection.”
The federal single payer bill (HR 676) has gained the support of 94 representatives in the US House, 480 union bodies, 39 state AFL-CIO’s (including NY’s), 117 Central Labor Councils, 20 international unions, the US Conference of Mayors, the Houses of Representatives in Kentucky, New Hampshire and NY (State Assembly), and hundreds more cities, counties, faith groups and organizations. New York congressional sponsors include Engel, Hinchey, Maloney, McNulty, Nader, Owens, Rangel, Serrano, Towns, Weiner and Velazquez. Newly elected congressional members Tonko and Massa have also stated they will sponsor HR 676. HR 676 does address Obama’s concern by providing funding to help retrain insurance workers for new jobs, including in the universal health care field.
In the NYS legislature, 85 members of the State Assembly have sponsored single payer (A7354) and 15 Democratic members of the State Senate (S3107). The Assembly also passed a resolution this year in support of HR 676. Sen. Breslin sponsored a similar resolution in the state Senate but that was not voted upon.
A recent national survey by Indiana University of 2,193 doctors found almost 60% in favor of national health insurance (NHI) -- a 10 percent increase in support since 2002. A March 2007 poll by CBS/ NY Times found that 64 percent of respondents said the government should guarantee health insurance for all; 27 percent said it should not. An overwhelming majority in the poll said the health care system needed fundamental change or total reorganization.
“America’s health care system is in deep trouble. Nearly 50 million Americans are currently without health insurance, more than 75 million went without insurance for some length of time within the past two years, and tens of millions more have inadequate coverage. More than 18,000 Americans die annually due to a lack of insurance,” stated Mark Dunlea, Executive Director of the Hunger Action Network of NYS. A 2008 study published in the journal Health Affairs concluded that as many as 101,000 deaths a year could be prevented by ensuring that all patients receive quality care in a timely manner.
The U. S. spends 16% of gross domestic product (GDP) on health care ($7,129 per capita), twice what any other industrialized nation spends, yet ranks 37th in performance according to the World Health Organization. We lag behind other industrialized countries in life expectancy and infant mortality. Health care bills cause over 50% of bankruptcies — and three out of four of those bankrupted by medical bills had health insurance.
The reason the US spends more and gets less than the rest of the world is because we have a patchwork system of for-profit payers. Private insurers necessarily waste health dollars on things that have nothing to do with care: overhead, underwriting, billing, sales and marketing departments as well as huge profits and exorbitant executive pay. Doctors and hospitals must maintain costly administrative staffs to deal with the bureaucracy. Combined, this needless administration consumes one-third (31 percent) of Americans’ health dollars.
The groups urged President-elect Obama to reject the idea of mandating that individuals purchase insurance. The recent insurance mandate in Massachusetts is already running into problems due to higher taxpayer costs than anticipated; inadequate coverage being offered; and many residents deciding to pay the penalty rather than buying insurance they can’t afford.
“Any plan that keeps the profit-making insurance companies in the mix will add layers of bureaucracy, will not be able to control costs, and will fail in the noble effort to bring good care to all,” said Tom Blandy, representing the Capital District chapter of MoveOn.Org.
Two major trade lobbies, America’s Health Insurance Plans and the Blue Cross-Blue Shield Association, have said they would be willing to end their disgraceful practice of excluding people from coverage based on their health or age. In exchange, they want the federal government to force uninsured Americans to buy private insurance. This mandate would result in significant additional profits for insurance companies.
Rose Anne DeMore, the head of the California Nurses Association, recently wrote that “It’s time for our national government to stop getting carried away with financial bailouts for big industries, especially when it comes to some of the most-profitable and least-responsible companies: the health-insurance giants. A mandate for individuals … would be a massive bailout for one of the most merciless industries in America - and one that’s already rolling in cash. The 18 biggest insurers reported $16 billion in profit last year. Now, in exchange for promising the coverage they should have provided all along, these insurers are demanding additional billions of dollars in profit from people who would face fines or other penalties if they didn’t hand over the cash.”
“We’ve done many experiments tweaking private health insurance. It doesn’t work. Two decades of state level reform efforts have demonstrated that mandate plans don’t reduce costs or the number of uninsured. They add bureaucracy and regulation, not healthcare value. We’ve done an experiment with national health insurance. It works. Medicare is not perfect, but Americans with Medicare are happier with their insurance than those with private insurance. Doctors have less hassle getting paid by Medicare than by private insurers,” added Dr. Paul Sorum, Chairperson of the Capital District chapter of the Physicians for a National Health Program.
Variants of the mandate model, first proposed by Richard Nixon, were passed with great fanfare in Massachusetts (1988), Oregon (1989) and Washington State (1993). All failed. As costs soared, legislators backed off from enforcing the mandates or funding new coverage for the poor. Massachusetts' recent reform, which largely excuses employers from the mandate but imposes steep fines on the uninsured, appears poised to follow a similar path. Of the middle-income uninsured who are required to pay the full premium for coverage, few have signed up. Meanwhile, the state has already announced a $147 million shortfall in funding for subsidies for the poor.
“We can’t afford to include bloated administrative overhead and profit in universal coverage. Administrative costs in the for-profit health insurance system consume nearly one-third of our health care spending. We will never have enough money to provide everyone with decent care until we eliminate private insurance, the main source of waste and inadequate coverage,” said Dr. Richard Propp, Chair of the Capital District Alliance for Universal Health Care. “Single payer reduces administrative costs and provides an infrastructure to supports chronic disease management, an emphasis on primary care and the use of electronic medical records. The fragmented private insurance system created the perverse incentives which have set us so far behind other countries in these areas. Mandate proposals preserve the fragmentation,” Propp concluded.
Among the dozens of groups helping to create Single Payer New York are: New York State Nurses Association, Troy Area Labor Council, Capital District Area Labor Federation, AFL-CIO, Hunger Action Network of New York State, Tompkins County Health Care Task Force, Capital District Alliance for Universal Health Care, Health Care-NOW, Albany Presbytery, various chapters of the Physicians for a National Health Program, League of Women Voters of Saratoga County, Long Island Coalition for a National Health Plan, Rochester Interfaith Health Care Coalition, Green Party of NYS, and New York StateWide Senior Action.
Under a single-payer system, all Americans would be covered for all medically necessary services, including: doctor, hospital, long-term care, mental health, dental, vision, prescription drug and medical supply costs. Patients would regain free choice of doctor and hospital, and doctors would regain autonomy over patient care.
Physicians would be paid fee-for-service according to a negotiated formulary or receive salary from a hospital or nonprofit HMO / group practice. Hospitals would receive a global budget for operating expenses. Health facilities and expensive equipment purchases would be managed by regional health planning boards.
A single-payer system would be financed by eliminating private insurers and recapturing their administrative waste. Modest new taxes would replace premiums and out-of-pocket payments currently paid by individuals and business. Costs would be controlled through negotiated fees, global budgeting and bulk purchasing.
