Apple Eating Notes

Vt. health care bill heads to the Senate - WCAX.COM Local Vermont News, Weather and Sports-

2011-03-27T07:22:00.000-07:00

Vt. health care bill heads to the Senate - WCAX.COM Local Vermont News, Weather and Sports-

Nuclear versus geothermal. Why is there even a debate?

2011-03-27T06:56:00.000-07:00

It seems to me that all of the recents events would ramp up the discussion about geothermal energy at Tennessee Valley Authority. I have done a little extra researching and hae seen some really hopeful advancements in geothermal technology. One article written by the number crunchers at Oregon's Pike Research came out with a new report showing that geothermal energy capacity, thanks to an increased level of investment, could more than double by 2020. Geothermal resources can be tapped to provide a clean and steady base load of electricity production — without weather-dependent fluctuations. Projects such as U.S. Geothermal's Neal Hot Springs development in eastern Oregon have attracted large investments, including a $96.8 million loan guarantee from the U.S. Department of Energy finalized late last month. That new report from Colorado-based Pike Research maps out "a high-growth scenario with a 134 percent increase in total geothermal capacity between 2010 and 2020." That scenario would more than double the current 10.7 gigawatt capacity to 25.1 gigawatts. A more conservative scenario would "increase capacity by 34 percent to 14.3 gigawatts." One gigawatt would power about 600,000 homes. While geothermal power sources are located around the world, seven countries represent 88 percent of the world market, and the United States is the global geothermal leader with 3.1 GW of installed capacity, according to Pike Research calculations. So it bothers me that Tennessee Valley Authority wants to build more nuclear power plants. I applaud TVA for not including new construction of coal-fired plants in its plan and for idling the most polluting of existing coal-fired plants. It is, of course, to avoid high costs of complying with stricter new air-quality regulatory standards. But thanks anyway! However, TVA's plan to expand nuclear-generated power is a move in the wrong direction. Like coal, oil and natural gas, nuclear power is not a renewable source of energy. Like fossil fuels, it too has a long and troubled supply chain. However, the most troubling issue for me is the storage of spent fuel. We continue to store large quantities of radioactive materials at sites designed for temporary storage because we have no designated long-term storage. Like the plant at Fukushima, we are storing the spent fuel on-site, in cooling ponds or dry caskets outside the containment area. We must have a viable, safe option for the long-term (as in millenniums) storage before we continue to produce additional sources of radioactive waste. Another issue with nuclear power relates to costs. There are enormous start-up, operating and decommissioning costs. Private investors are unwilling to invest in the absence of government loan guarantees due to the high risks associated with nuclear power. So if things don't work out, the taxpayers pay the bills; if things go well, the investors reap the profits. We take all the risks and the billionaires have a no-lose situation. Let's be smart and invest in solar, wind, geothermal, tidal and other truly sustainable sources of energy instead.

Survey: Nine Million More Americans Added to Ranks of Uninsured in Recession | Crooks and Liars

2011-03-21T23:28:00.000-07:00

Survey: Nine Million More Americans Added to Ranks of Uninsured in Recession | Crooks and Liars

The US Government is contracting with software companies to spy through social media

2011-03-20T02:21:00.000-07:00

What is single payer?

2011-03-19T15:29:00.001-07:00

What is single payer?

Single-payer national health insurance is a system in which a single public or quasi-public agency organizes health financing, but delivery of care remains largely private. Under a single-payer system, all Americans would be covered for all medically necessary services, including: doctor, hospital, preventive, long-term care, mental health, reproductive health care, 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.

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Is national health insurance ‘socialized medicine’?

No. Socialized medicine is a system in which doctors and hospitals work for and draw salaries from the government. Doctors in the Veterans Administration and the Armed Services are paid this way. The health systems in Great Britain and Spain are other examples. But in most European countries, Canada, Australia and Japan they have socialized health insurance, not socialized medicine. The government pays for care that is delivered in the private (mostly not-for-profit) sector. This is similar to how Medicare works in this country. Doctors are in private practice and are paid on a fee-for-service basis from government funds. The government does not own or manage medical practices or hospitals.

The term socialized medicine is often used to conjure up images of government bureaucratic interference in medical care. That does not describe what happens in countries with national health insurance where doctors and patients often have more clinical freedom than in the U.S., where bureaucrats attempt to direct care.

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Won’t this result in rationing like in Canada?

The U.S. already rations care. Rationing in U.S. health care is based on income: if you can afford care, you get it; if you can’t, you don’t. A recent study by the prestigious Institute of Medicine found that 18,000 Americans die every year because they don’t have health insurance. Many more skip treatments that their insurance company refuses to cover. That’s rationing. Other countries do not ration in this way.

If there is this much rationing, why don’t we hear about it? And if other countries ration less, why do we hear about them? The answer is that their systems are publicly accountable, and ours is not. Problems with their health care systems are aired in public; ours are not. For example, in Canada, when waits for care emerged in the 1990s, Parliament hotly debated the causes and solutions. Most provinces have also established formal reporting systems on waiting lists, with wait times for each hospital posted on the Internet. This public attention has led to recent falls in waits there.

In U.S. health care, no one is ultimately accountable for how the system works. No one takes full responsibility. Rationing in our system is carried out covertly through financial pressure, forcing millions of individuals to forgo care or to be shunted away by caregivers from services they can’t pay for.

The rationing that takes place in U.S. health care is unnecessary. A number of studies (notably a General Accounting Office report in 1991 and a Congressional Budget Office report in 1993) show that there is more than enough money in our health care system to serve everyone if it were spent wisely. Administrative costs are at 31% of U.S. health spending, far higher than in other countries’ systems. These inflated costs are due to our failure to have a publicly financed, universal health care system. We spend about twice as much per person as Canada or most European nations, and still deny health care to many in need. A national health program could save enough on administration to assure access to care for all Americans, without rationing.

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Who will run the health care system?

There is a myth that with national health insurance the government will make the medical decisions. But in a publicly financed, universal health care system, medical decisions are left to the patient and doctor, as they should be. This is true even in the countries like the U.K. and Spain (or in U.S. systems like the VA) that have socialized medicine.

In a public system, the public has a say in how it’s run. Cost containment measures are publicly managed at the state level by elected and appointed agencies that represent the public. This agency decides on the benefit package and negotiates doctor fees and hospital budgets. It also is responsible for health planning and the distribution of expensive technology. Thus, the total budget for health care is set through a public, democratic process. But clinical decisions remain a private matter between doctor and patient.

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What about medical research?

Much current medical research is publicly financed through the National Institutes of Health. Under a universal health care system this would continue. For example, a great deal of basic drug research, for example, is funded by the government. Drug companies are invited in for the later stages of “product development,” the formulation and marketing of new drugs. AZT for HIV patients is one example. The early, expensive research was conducted with government money. After the drug was found to be effective, marketing rights went to the drug company.

Medical research does not disappear under universal health care system. Many famous discoveries have been made in countries with national health care systems. Laparoscopic gallbladder removal was pioneered in Canada. The CT scan was invented in England. The treatment for juvenile diabetes by transplanting pancreatic cells was developed in Canada.

It is also important to note that studies show that, in the U.S., the number of clinical research grants declines in areas of high HMO penetration. This suggests that managed care increasingly threatens clinical research. Another study surveyed medical school faculty and found that it was more difficult to do research in areas where high HMO penetration has enforced a more business-oriented approach to health care.

Finally, it appears that the increasing commercialization of research is beginning to slow innovation. Drug firms’ increasing reliance on contract research organizations (and for-profit ethical-review boards) has coincided with a sharp drop in innovative new drugs and a spate of “me-too” drugs - minor variations on old drugs that offer little benefit other than extended patent life.

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Won’t this just be another bureaucracy?

The United States has the most bureaucratic health care system in the world. Over 31% of every health care dollar goes to paperwork, overhead, CEO salaries, profits, etc. Because the U.S. does not have a unified system that serves everyone, and instead has thousands of different insurance plans, each with its own marketing, paperwork, enrollment, premiums, and rules and regulations, our insurance system is both extremely complex and fragmented.

The Medicare program operates with just 3% overhead, compared to 15% to 25% overhead at a typical HMO. Provincial single-payer plans in Canada have an overhead of about 1%.

It is not necessary to have a huge bureaucracy to decide who gets care and who doesn’t when everyone is covered and has the same comprehensive benefits. With a universal health care system we would be able to cut our bureaucratic burden in half and save over $300 billion annually.

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How will we keep costs down if everyone has access to comprehensive health care?

People will seek care earlier when chronic diseases such as hypertension and diabetes are more treatable. We know that both the uninsured and many of those with skimpy private coverage delay care because they are afraid of health care bills. This will be eliminated under such a system. Undoubtedly the costs of taking care of the medical needs of people who are currently skimping on care will cost more money in the short run. However, all of these new costs to cover the uninsured and improve coverage for the insured will be fully offset by administrative savings.

In the long run, the best way to control costs is to improve health planning to assure appropriate investments in expensive, high-tech care, to negotiate fees and budgets with doctors, hospital and drug companies, and to set and enforce a generous but finite overall budget.

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How will we keep doctors from doing too many procedures?

This is a problem in any system that reimburses physicians on a fee-for-service basis. In today’s health system, another problem is physicians doing too little for patients. So the real question is, “How do we discourage both overcare and undercare?”

One approach is to carefully control new capital expenditures. Once a hospital or imaging center purchases a multimillion-dollar CT scanner, it will try to generate enough scans to pay off the fixed cost. Explicit health planning should be done to assure that expensive machines and facilities are sited where they are needed and not where they are redundant and likely to generate overuse.

Another approach is to compare physicians’ use of tests and procedures to their peers with similar patients. A physician who is “off the curve” will stand out. A related approach is to set spending targets for each specialty. This encourages doctors to be prudent stewards and to make sure their colleagues are as well, because any doctor doing unnecessary procedures will be taking money away from colleagues.

In addition, expert guidelines by groups like the American College of Physicians, etc., can help shape professional standards - which will certainly change over time as treatments change. This really gets to the heart of “how do you improve the quality of health care,” which is a longer topic. Suffice it to say that single-payer, universal coverage provides a framework for achieving thoughtful quality improvement.

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What will happen to physician incomes?

On the basis of the Canadian experience under national health insurance, we expect that average physician incomes should change little. However, the income disparity between specialties is likely to shrink.

The increase in patient visits when financial barriers fall under a single-payer system will be offset by resources freed up by a drastic reduction in administrative overhead and physicians’ paperwork. Billing would involve imprinting the patient’s national health program card on a charge slip, checking a box to indicate the complexity of the procedure or service, and sending the slip (or a computer record) to the physician-payment board.

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How will we keep drug prices under control?

When all patients are under one system, the payer wields a lot of clout. The VA gets a 40% discount on drugs because of its buying power. This “monopsony” buying power is the main reason why other countries’ drug prices are lower than ours. This also explains the drug industry’s staunch opposition to single-payer national health insurance.

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Why shouldn’t we let people buy better health care if they can afford it?

Whenever we allow the wealthy to buy better care or jump the queue, health care for the rest of us suffers. If the wealthy are forced to rely on the same health system as the poor, they will use their political power to assure that the health system is well funded. Conversely, programs for the poor become poor programs. For instance, because Medicaid doesn’t serve the wealthy, the payment rates are low and many physicians refuse to see Medicaid patients. Calls to improve Medicaid fall on deaf ears because the beneficiaries are not considered politically important. Moreover, when the wealthy jump the queue, it results in longer waits for others. Studies in New Zealand and Canada show that the growth of private care in parallel to the public system results in lengthening waits. Additionally, allowing the development of a parallel, private system for the wealthy means the creation of a permanent lobby for underfunding public care. Such underfunding increases the demand for private care.

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What will be covered?

All medically necessary care would be funded through the single payer, including doctor visits, hospital care, prescriptions, mental health services, nursing home care, rehab, home care, eye care and dental care. We also advocate a sharp increase in public health funding.

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What about alternative care, will it be covered?

Alternative care that is proven in clinical trials to be effective will be covered. For example, spinal manipulation for some lower back conditions would be covered. Antioxidant vitamins would be covered for people with macular degeneration, but not for the general population (where they appear to be harmful). In general, coverage decisions will be made by the health care planning board or another public body. New kinds of treatments will be added to the benefits package over time as they are shown to be effective, including “alternative” treatments. Similarly, ineffective or harmful care can be removed from the benefits package, such as high dose epo for cancer.

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Can a business keep private insurance if they choose?

Yes and no. Everyone has to be included in the new system for it to be able to control costs, reduce bureaucracy, and cover everyone. In Canada, businesses can purchase additional private insurance that covers things not covered by the national plan (e.g. private rooms, orthodontia, etc.). However, we support a comprehensive benefit package for the single-payer program that would eliminate the need (and most demand) for supplemental coverage.

Insurance companies would not be allowed to offer the same benefits as the universal health care system, a restriction contained in the traditional Medicare program. Allowing such duplication of coverage weakens and eventually destabilizes the health care system. It undermines the principle of pooling the risk. Health care systems act as universal insurers. At any one time the healthy help pay for those who are ill. If private insurers are allowed to cherry-pick the healthy, leaving the public health care system with the very sick, the system will fail.

This, in fact, is what we see happening to Medicare through the Medicare Advantage program. The government pays Medicare HMOs 13% more than it pays traditional Medicare, yet the HMOs care for a healthier mix of seniors. This is leading to privatization of Medicare and funding shortfalls for the traditional Medicare program.

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What will happen to all of the people who work for insurance companies?

The new system will still need some people to administer claims. Administration will shrink, however, eliminating the need for many insurance workers, as well as administrative staff in hospitals, clinics and nursing homes. More health care providers, especially in the fields of long-term care, home health care, and public health, will be needed, and many insurance clerks can be retrained to enter these fields. Many people now working in the insurance industry are, in fact, already health professionals (e.g. nurses) who will be able to find work in the health care field again. But many insurance and health administrative workers will need a job retraining and placement program. We anticipate that such a program would cost about $20 billion, a small fraction of the administrative savings from the transition to national health insurance.

PNHP has worked with labor unions and others to develop plans for a jobs conversion program with would protect the incomes of displaced clerical workers until they were retrained and transitioned to other jobs.

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How will we contain costs with the population aging?

Studies show that aging of the population accounts for only a small fraction of the increases in health costs. Japan and Europe are already facing the problem of an aging population head-on and are doing fine. They have a much higher percentage of elderly than we do, and still spend far less on health care.

The best way to approach this is to regard it as a societal problem, one that needs a solution with everyone in mind. Germany and Japan recently adopted single-payer long-term care systems to cover the long-term care needs of the elderly at home and in specialized housing. Germany is pioneering a program that pays family members to care for the elderly at home.

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What about ERISA? Doesn’t it stand in the way of states implementing universal health care plans?

No. ERISA (the Employees Retirement Income Security Act) prevents a state from requiring that a self-insured employer provide certain benefits to their employees. However, a single-payer plan would not mandate the composition of employer benefit plans - it would replace them with a new system that would essentially be “Medicare for all.” The state would require employers to pay a payroll tax into the health care trust fund, which is clearly legal.

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How will the Health Planning Board operate?

A health planning board would be a public body with representatives of patients and medical experts. The representatives would decide on what treatments, medications and services should be covered, based on community needs and medical science, and allocate capital for major new investments based on assessments of where need is greatest.

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Since we could finance a fairly good system, like the Norwegian, Danish or Swedish system, with the public money we are already spending (60% of health costs), why do we need to raise the additional 40% (from employers and individuals)?

There are three reasons why the U.S. health care system costs more than other systems throughout the world. One, we spend two to three times as much as they do on administration. Two, we have much more excess capacity of expensive technology than they do (more CT scanners, MRI scanners, and surgery suites). Three, we pay higher prices for services than they do.

There is no doubt that we do not need to spend more than we currently spend to cover comprehensive care for everyone. But the initial transition to a universal system would be very disruptive if we spent less. That is because we have a tremendous medical infrastructure, some of which would likely retain its excess capacity during the transition phase. Secondly, we would likely retain salaries for health professionals at their current levels. Thirdly, we would cover much more than most other countries do by including dental care, eye care, and prescriptions. And for these reasons we would need the extra 40% that we are already spending - but NOT more. We could cover all the uninsured and improve coverage for those who have skimpy coverage for the same amount we are currently spending!

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How much of the health care dollar is publicly financed?

Over sixty percent (60.5 percent) of health spending in the U.S. is funded by government. Official figures for 2005 peg government’s share of total health expenditure at 45.4 percent, but this excludes two items:

1. Tax subsidies for private insurance, which cost the federal treasury $188.6 billion in 2004. These predominantly benefit wealthy taxpayers.

2. Government purchases of private health insurance for public employees such as police officers and teachers. Government paid private insurers $120.2 billion for such coverage in 2005: 24.7 percent of the total spending by U.S. employers for private insurance.

So, government’s true share amounted to 9.7 percent of gross domestic product in 2005, 60.5 percent of total health spending, or $4,048 per capita (out of total expenditure of $6,697).

By contrast, government health spending in Canada and the U.K. was 6.9 percent and 7.2 percent of gross domestic product respectively (or $2,337 and $2,371 per capita). Government health spending per capita in the U.S. exceeds total (public plus private) per capita health spending in every country except Norway, Switzerland and Luxembourg.

(Source: Himmelstein and Woolhandler, “Competition in a publicly funded healthcare system” BMJ 2007; 335:1126-1129 [1 December] and Woolhandler and Himmelstein, Health Affairs, 2002, 21(4), 88, “Paying for National Health Insurance - And Not Getting It.”

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Why not MSAs/HSAs?

Medical savings accounts (MSAs) and similar options such as health savings accounts (HSAs) are individual accounts from which medical expenses are paid. Once the account is depleted and a deductible is met, medical expenses are covered by a catastrophic plan, usually a managed care plan.

Individuals with significant health care needs would rapidly deplete their accounts and then be exposed to large out-of-pocket expenses; hence they would tend to select plans with more comprehensive coverage. Since only healthy individuals would be attracted to the MSAs/HSAs, higher-cost individuals would be concentrated in the more comprehensive plans, driving up premiums and threatening affordability. By placing everyone in the same pool, the cost of high-risk individuals is diluted by the larger sector of relatively healthy individuals, keeping health insurance costs affordable for everyone.

Currently, HSAs offer substantial tax savings to people in high-income brackets, but little to families with average incomes, and thus serve as a covert tax cut for the wealthy.

Moreover, MSA/HSA plans discourage preventive care, which generally would be paid out-of-pocket, and do nothing to restrain spending for catastrophic care, which accounts for most health costs. Finally, HSAs/MSAs discriminate against women, whose care costs, on average, $1,000 more than men’s annually. Hence, on the MSA/HAS plan, the average woman pays $1,000 more out-of-pocket than her male counterpart.

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Why not use tax subsidies to help the uninsured buy health insurance?

The major flaw of tax subsidies is that they would be used to help purchase plans in our current fragmented system. The administrative inefficiencies and inequities that characterize our system would be left in place, and we would continue to waste valuable resources that should be going to patient care instead. Moreover, even with tax subsidies, moderate- and lower-income individuals would be unable to afford good coverage, leaving them with modest benefits and high cost-sharing that would often make health care unaffordable. Instead of perpetuating our current inequities, tax policies should be used to create equity in contributions to a system in which everyone is assured access to comprehensive beneficial services.

If the tax subsidies are granted to individuals, employers would be motivated to drop their coverage, and most individuals covered would have merely rotated from employer coverage to individual coverage. The net reduction in the numbers of uninsured would be small. If the tax subsidies are granted to employers, a major shift in funding passes from employers to taxpayers without significant improvements efficiency or fairness. We can use the tax system to create equity in the way we fund health care, but we should also expect equity and efficiency in allocation of our health care resources. Distributing health resources according to human needs is possible only if we eliminate the private health plans and establish a publicly administered system.

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What is PNHP’s response to libertarian proposals for health savings accounts and deregulated insurance plans?

In response to the libertarian view: 1) We are already spending more than enough to provide all necessary health care services to everyone, and 2) The majority of Americans believe that everyone should be able to obtain necessary health care without having to face financial hardship.

The goal then is not only to have everyone covered with insurance, but also to make sure that insurance is effective in preventing the consequences of medical debt. We have a rapidly expanding epidemic of underinsurance, and the proposals of libertarians would expose the majority of us to the potential of excessive medical debt were we to develop significant medical problems. Policies with affordable premiums work for those who remain healthy, but most of health care spending is for those with major acute and chronic problems. The deregulated insurance plans and HSAs proposed by libertarians cannot ever effectively address the problem of how we are going to pay for most of the health care in this nation.

The most efficient and effective system would be to establish a single risk pool covering everyone, and fund it equitably. The libertarians do have a problem with “equitable.” That would require a transfer from the healthy to those with greater health care needs. But the United States has an additional unique problem. Since we spend twice as much per capita as the average industrialized nation, each person’s share (national health expenditures divided by the U.S. population) is no longer affordable. For a family of four, that would be over $30,000 when median household income is about $50,000. So an equitably financed system in the United States would also require a transfer from wealthier individuals to the majority of us. Libertarians and egalitarians will never agree on the appropriate course. All other nations tend toward an egalitarian approach.

The World Health Report 2008, published by the World Health Organization, singles out the United States for its exceptionalism - a system with “singularly high additional private expenditure” that persistently underperforms “across domains of health outcomes, quality, access, efficiency and equity.” Everyone should read this report. Very brief excerpts and a link to the full report can be found at: http://www.pnhp.org/news/2008/october/the_world_health_rep.php

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Won’t competition be impeded by a universal health care system?

Advocates of the “free market” approach to health care claim that competition will streamline the costs of health care and make it more efficient. What is overlooked is that past competitive activities in health care under a free market system have been wasteful and expensive, and are the major cause of rising costs.

There are two main areas where competition exists in health care: among the providers and among the payers. When, for example, hospitals compete they often duplicate expensive equipment in order to corner more of the market for lucrative procedure-oriented care. This drives up overall medical costs to pay for the equipment and encourages overtreatment. They also waste money on advertising and marketing. The preferred scenario has hospitals coordinating services and cooperating to meet the needs of their communities.

Competition among insurers (the payers) is not effective in containing costs either. Rather, it results in competitive practices such as avoiding the sick, cherry-picking, denial of payment for expensive procedures, etc. An insurance firm that engages in these practices may reduce its own outlays, but at the expense of other payers and patients.

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Why not make people who are higher risk pay higher premiums?

Experience-rated insurance requires higher risk people to pay higher premiums. This approach says that people who have had cancer in the past, or who have chronic conditions like diabetes and hypertension, or who have had dangerous exposures to substances like asbestos, must pay more because they are at higher risk of using health services. Experience rating allows insurance companies to cherry-pick the healthiest people and either refuse to insure the sickest or, what amounts to the same thing, charge prohibitively high rates. This approach makes no sense. The whole point of insurance is to spread the risk so that everyone is covered. If you raise premiums - and thereby exclude from coverage - those people unfortunate enough to be sick, you defeat the point of both insurance and the health care system. Genetic conditions, childhood diseases, accidents, injuries and income distribution (or how much equality there is in a society) play a much bigger role in people’s health than “individual lifestyle” factors. And we know that even for motivated patients, alcohol and tobacco cessation are difficult, and medical weight loss nearly impossible. We need public health, primary care and education programs to try to prevent disease, but punishing patients once they are ill is inhumane and counterproductive.

Community-rated health insurance is the socially fair approach. It spreads the risks evenly among all the insured. It removes the punitive element. It does not discriminate against the very sick, nor against those of us who are at higher risk because of our age (say, over 50) or our gender (reproductive-age females have higher health expenses than men, for obvious reasons).

Health care should be organized as a public service, like a fire department. A health system organized as a business is discriminatory and accountable to no one. At some point in our lives all of us will predictably need health care. Hence health insurance is unlike any other form of insurance; we all are involved.

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Won’t this raise my taxes?

Currently, about 60% of our health care system is financed by public money: federal and state taxes, property taxes and tax subsidies. These funds pay for Medicare, Medicaid, the VA, coverage for public employees (including police and teachers), elected officials, military personnel, etc. There are also hefty tax subsidies to employers to help pay for their employees’ health insurance. About 20% of health care is financed by all of us individually through out-of-pocket payments, such as co-pays, deductibles, the uninsured paying directly for care, people paying privately for premiums, etc. Private employers only pay 21% of health care costs. In all, it is a very “regressive” way to finance health care, in that the poor pay a much higher percentage of their income for health care than higher income individuals do.

A universal public system would be financed in the following way: The public funds already funneled to Medicare and Medicaid would be retained. The difference, or the gap between current public funding and what we would need for a universal health care system, would be financed by a payroll tax on employers (about 7%) and an income tax on individuals (about 2%). The payroll tax would replace all other employer expenses for employees’ health care, which would be eliminated. The income tax would take the place of all current insurance premiums, co-pays, deductibles, and other out-of-pocket payments. For the vast majority of people, a 2% income tax is less than what they now pay for insurance premiums and out-of-pocket payments such as co-pays and deductibles, particularly if a family member has a serious illness. It is also a fair and sustainable contribution.

Currently, 47 million people have no insurance and hundreds of thousands of people with insurance are bankrupted when they have an accident or illness. Employers who currently offer no health insurance would pay more, but those who currently offer coverage would, on average, pay less. For most large employers, a payroll tax in the 7% range would mean they would pay slightly less than they currently do (about 8.5%). No employer, moreover, would gain a competitive advantage because he had scrimped on employee health benefits. And health insurance would disappear from the bargaining table between employers and employees.

Of course, the biggest change would be that everyone would have the same comprehensive health coverage, including all medical, hospital, eye care, dental care, long-term care, and mental health services. Currently, many people and businesses are paying huge premiums for insurance so full of gaps like co-payments, deductibles and uncovered services that it would be almost worthless if they were to have a serious illness.

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Isn’t a payroll tax unfair to small businesses?

The payroll tax means a cost increase for businesses that are not currently insuring their workers. However, it is much less than they would pay at present for adequate coverage for themselves and their workers. For most small (and large) businesses already providing coverage, the payroll tax will mean substantial savings

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Walter Reed Army Medical Center has been in the news lately for poor care and treatment of returning soldiers from Iraq. Won’t national health insurance have similar problems?

As we consider what we can learn from the Walter Reed Army Medical Center debacle with regard to government-run efforts, some clarifications should be made:

1. Walter Reed Army Medical Center is an Army hospital and is run by the Department of Defense. The VA hospitals are run by the Veterans Administration (Veterans Health Administration), a separate organization. The news media has clouded this fact and has led the public to presume that all government-run health efforts fail. The VA health system continues to receive the best quality scores of any segment of the U.S. health system, with the most satisfied patients. It beats the best HMOs in quality ratings, has a model information system, and focuses on primary care. It has led in addressing medical errors and in its application of AHRQ quality guidelines to both inpatients and outpatients. In 2004 it won the Baldridge Prize for quality and patient-safety improvements.

2. There is a lot we can learn from the Walter Reed disgrace. Its operation was outsourced to a Halliburton-connected company in 2002, over the objections of some Army medical personnel and leadership, with a subsequent drastic reduction in staff and loss of government employees with institutional experience. There was also some hanky-panky with the contracting process; when the government employees’ bid for the operations contract came in lower than the Halliburton company’s bid, the bids were “recalculated” to make the private company the lowest bidder.

(This section was contributed by Dr. Anne Carroll.)

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What about incremental reform of the health system?

As a matter of policy, PNHP expressly opposes many so-called gradual steps towards single-payer. Many well-meaning supporters often push these bills as “feasible steps” to move us towards single-payer, but the history of these kinds of health reform efforts - Hawaii in 1974, Massachusetts in 1988, Oregon in 1989, Tennessee in 1992, Minnesota in 1992, Maine in 2003, etc. - shows that despite their claims of pragmatism, incremental reforms have consistently failed for more than three decades. Incremental reforms cannot garner administrative savings and redirect them to care. Hence they always founder on the shoals of cost. In addition, these reforms distract attention from the economically realistic, if politically challenging, option of single-payer reform.

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What happens to investor-owned hospitals under national health insurance (NHI)?

“The NHI program would compensate owners of investor-owned hospitals, group/staff model HMOs, nursing homes and clinics for the loss of their clinical facilities, as well as any computers and administrative facilities needed to manage NHI. They would not be reimbursed for loss of business opportunities or for administrative capacity not used by NHI. Investor-owned providers would be converted to nonprofit status. The NHI would issue long-term bonds to amortize the one-time costs of compensating investors for the appraised value of their facilities. These conversion costs would be offset by reductions in payments for capital that are currently folded into Medicare and other reimbursements.” (Physicians’ Proposal, JAMA, August 13, 2003.)

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What proportion of health spending is for undocumented immigrants?

Very little. All foreign-born people, including immigrant workers who have legal status and who have lived in the U.S. for years, account for somewhat less than one-quarter of the uninsured, according to the Census Bureau. We do know that foreign-born people in the U.S. are, on average, healthier and utilize little health care - about half of the health care (per capita) of U.S.-born persons. Surprisingly this is true whether or not they have insurance. Immigrant children receive very little care, 74 percent less overall than other children. So, if the foreign born are less than one-quarter of the uninsured, only one-eighth of health spending on the uninsured is going to the foreign born, which translates into a tiny fraction of all U.S. health spending. In fact, most immigrants have health insurance coverage, and 30% of immigrants use no health care at all in the course of a year. Undocumented immigrants are politically unpopular and hence a convenient target, but they are not the cause of rising health care costs.

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The insurance industry says that PNHP’s figures on administrative costs are outdated. Is this true?

PNHP has published a series of peer-reviewed studies over the past 20 years showing a steady increase in health administrative costs. While some aspects of administrative cost estimation (e.g. physicians’ billing costs) require special studies, others, such as insurance overhead, can be easily tracked from publicly available data. These figures show no evidence of a fall in administrative costs since our most recent (2003) comprehensive estimate that administration consumes at least 31% of U.S. health care spending.

Recently, right-wing “think tanks” have released studies claiming that Medicare’s administrative costs are far higher than the official 3% estimate. These estimates add to Medicare’s costs a share of the salaries of the President and members of Congress, the cost of running the Internal Revenue Service, etc. But none of these added costs would go away if Medicare were abolished, or up if Medicare were expanded to cover everyone. Most economists agree that such expenses should not be included in calculating Medicare’s overhead.

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How much could the states save on administrative waste by adopting a statewide single-payer program?

Data on total health expenditures by state (excluding administrative spending) is available at: http://www.cms.hhs.gov/NationalHealthExpendData/05_NationalHealthAccountsStateHealthAccountsResidence.asp#TopOfPage

Estimates of state administrative costs (a few years old, but the best available) are in an article by Drs. David Himmelstein and Steffie Woolhandler from 2003.

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What will happen to malpractice costs under national health insurance?

They will fall dramatically, for several reasons. First, about half of all malpractice awards go to pay present and future medical costs (e.g. for infants born with serious disabilities). Single payer national health insurance will eliminate the need for these awards. Second, many claims arise from a lack of communication between doctor and patient (e.g. in the Emergency Department). Miscommunication/mistakes are heightened under the present system because physicians don’t have continuity with their patients (to know their prior medical history, establish therapeutic trust, etc) and patients aren’t allowed to choose and keep the doctors and other caregivers they know and trust (due to insurance arrangements). Single payer improves quality in many ways, but in particular by facilitating long-term, continuous relationships with caregivers. For details on how single payer can improve the quality of health care, see “A Better Quality Alternative: Single Payer National Health Insurance.” For these and other reasons, malpractice costs in three nations with single payer are much lower than in the United States, and we would expect them to fall dramatically here. For details, see “Medical Liability in Three Single-Payer Countries” paper by Clara Felice and Litsa Lambkros.

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Should PNHP support a public Medicare-like option in a market of private plans?

Response by Drs. David Himmelstein and Steffie Woolhandler:

The “public plan option” won’t work to fix the health care system for 2 reasons.

1 - It foregoes at least 84% of the administrative savings available through single payer. The public plan option would do nothing to streamline the administrative tasks (and costs) of hospitals, physicians offices, and nursing homes, which would still contend with multiple payers, and hence still need the complex cost tracking and billing apparatus that drives administrative costs. These unnecessary provider administrative costs account for the vast majority of bureaucratic waste. Hence, even 95% of Americans who are currently privately insured were to join the public plan (and it had overhead costs at current Medicare levels), the savings on insurance overhead would amount to only 16% of the roughly $400 billion annually achievable through single payer - not enough to make reform affordable.

2 - A quarter century of experience with public/private competition in the Medicare program demonstrates that the private plans will not allow a level playing field. Despite strict regulation, private insurers have successfully cherry picked healthier seniors, and have exploited regional health spending differences to their advantage. They have progressively undermined the public plan - which started as the single payer for seniors and has now become a funding mechanism for HMOs - and a place to dump the unprofitably ill. A public plan option does not lead toward single payer, but toward the segregation of patients; with profitable ones in private plans and unprofitable ones in the public plan.

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Would a “public plan option” at least be a step in the right direction?

Answers contributed by PNHP Board members Dr. Andy Coates and Dr. Don McCanne

Answer by Dr. Andy Coates

I am not convinced that it is fair to call the “public plan option” (aka Jacob Hacker’s proposal) “a move in the right direction.”

In the best case scenario this proposal would, I believe, accelerate the trend toward two-tiered care in our country. But we should recognize first that MoveOn and its friends are suggesting scenarios, not backing a specific proposal. The “public plan option,” as yet, amounts to no more than talking points, with some therefore ungrounded assertions along the lines of the quotes by Dr. Dean. (Single payer advocates in contrast have been winning support for legislation — H.R. 676 in the house and now a bill in the Senate, introduced by Senator Sanders.)

If these “public plan option” talking points are intended as a wedge for single payer against private insurance, we should see that they are also a wedge for private health insurance against single payer, the program of national health insurance that the large majority have been shown to want in poll after poll. Single payer has been dismissed by Dr. Dean and many other leading Democrats as “not politically feasible.” Indeed, the “public option” notion grew out of this very idea — the assumption that the insurance industry is too powerful, that we will always have private health insurance.

When Dean and others insist on the “choice” of insurer, they insist upon the “choice” of “keeping the insurance you have” — let’s keep the insurance business and its market, they assert. But the purpose of private health insurance and its market are the opposite of social responsibility — and individual responsibility too.

Choice of insurance companies only matters because it restricts choice in care. What matters for our health is choice among caregivers, choice in location of care. The very purpose of the insurance market is to restrict these choices and by doing so extract money from the health care system. “Adverse selection,” the name of the game of health insurance business success is a reason why we should abolish health insurance as a business. Keeping that market offers the industry plenty of what Jessica calls “protection.”

The insurance companies know all about how to keep the healthy and wealthy while showing the sick and the poor the “choice” of another plan. That is why the insurance industry lately has offered to move to community rating — if only the government will criminalize the uninsured and mandate the purchase of health insurance.

Getting back to one of the scenarios — the “choice” of buying Medicare, the “option” of paying health insurance premiums to a government entity (1) will not guarantee health care to all (as Dr. Dean asserts) and (2) will not be sustainable due to cost. Hundreds of billions of additional dollars annually will not be sustainable — on top of 2.5 trillion dollars, on top of spending that is twice what any nation spends per person. That is why Mr. Obama called $600 billion over ten years a “down payment.”

In another scenario, Senator Baucus, leader of the bipartisan “board of directors” who are working this out behind closed doors has suggested that the “public option” will be the chance to buy insurance through Federal Employee Health Benefit Program, something candidates Clinton and Obama discussed. These are (1) administered by the insurance industry and (2) way out of reach for the uninsured and underinsured, thus would at least require colossal government subsidy, way beyond the $600 billion “down payment.” Baucus also supports a “mandate” that criminalizes the uninsured.

The “public plan option” will not expand our choice of caregivers, will not be universal, cannot offer comprehensive care (and thus can not lessen disparities in care or improve quality) — and above all there will be no way to pay for it, especially as the economy continues to tank. We should conclude that it is not reform!

We should also recognize, with confidence in people to decide and act for themselves, that the single payer cause is growing into a mass movement for civil rights. We may not be likely to win single payer this spring, but as the only proposal for health reform that will save hundreds of billions of dollars annually, that is comprehensive and just and practical, our prospects will continue to brighten, no matter what inside-the-beltway compromise people like Dr. Dean ultimately recommend we make with the insurance industry.

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Answer by Dr. Don McCanne

The option to purchase a public plan within a market of private health insurance plans would merely provide one more player in our inefficient, dysfunctional, fragmented, multi-payer system of financing health care, that is if the public option even survives the political process. It would leave in place the deficiencies that have resulted in very high costs with the poorest health care value of all nations (i.e., overpriced mediocrity in health care).

Those who believe that the people of this nation would have the wisdom to drop their private plans and join the government program are ignoring history. When Congress authorized private plans to compete with our existing public program, Medicare, many enrollees did just the opposite. One-fifth have left the traditional Medicare program and joined the private plans.

So why should we care? Why shouldn’t they have the right to choose private plans if they want them? We know that those private plans are wasting money, both in their own costs and the administrative burden they place on the delivery system, but what all too many don’t realize is that we are all paying for that waste because of the inherent structural deficiencies in our financing system. Plus we are being deprived of the reforms needed in our health care delivery system that our own single payer monopsony would bring us.

Single payer activists, don’t give up. As President Obama said in his press conference this week, “persistence!?

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Universal healthcare is okay for a small country or organization like Switzerland, Canada, or the Veterans Administration, but it wouldn’t work when scaled up to meet the needs of a large country like the US

Medicare is a national program that works reasonably well. There isno reason whatsoever that would make it hard to scale up. Indeed, Medicare was initiated (and administered for tens of millions of enrollees) before computers became available - scaling it up 7 or 8 fold should not prove difficult.

In Canada, health care is administered at the provincial level. The Ontario Health Insurance Program, which includes the city of Toronto as well as rural areas, is a good example. Since much of the program we envision would be regionalized, with regions similar in size to Ontario, that program seems a sound indication that scale should not be problematic.

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Recent Attacks on Single Payer Health Reform: Ideology Masquerading as Scholarship

By David U. Himmelstein, M.D. and Steffie Woolhandler, M.D., M.P.H.

Some conservative opponents of single payer health reform have been claiming that new research proves that Canada’s single payer national health insurance program has performed poorly, and that projected savings on administration are illusory. In the commentaries below we analyze the two most prominent examples of this new research a paper by June and Dave O’Neill (“Health Status, Health Care and Inequality: Canada Vs. the U.S.”) and a report by Bejamin Zycher (“Comparing Public and Private Health Insurance: Would a Single Payer System Save Enough to Cover the Uninsured?”).

The O’Neill’s “Health Status, Health Care and Inequality: Canada vs. the U.S.“

A recent paper by June and Dave O’Neill contests previous research findings that health outcomes are better in Canada than in the U.S. The O’Neills also claim that income-based health disparities are larger in Canada than in the U.S., that access to care is better in the U.S. and that cancer screening and survival are worse in Canada.

The O’Neills collected no new data. Their analysis rests on idiosyncratic, highly selective and overtly biased reinterpretations of previously published data — mostly from the Joint Canada/U.S. Survey of Health (JCUSH), a population-based survey conducted jointly by the U.S. and Canadian government statistical agencies. While they extensively cite the few pieces of published data that supports their grim view of Canada’s health system, they ignore a large body of research and statistics that conflicts with their portrayal.

We will briefly discuss the main assertions in the O’Neill paper.

1-Canada’s lower mortality rates are not a result of better health care

The O’Neills assert that Canada’s longer life expectancy (2 years longer) and lower infant mortality rate (5.3 deaths/1000 live births vs. 6.8 in the U.S.) have nothing to do with health care. Rather, they claim that non-medical factors such as substance abuse, obesity, low education and “cultural factors” explain the U.S.’ poor performance.

They argue that high infant mortality in the U.S. simply reflects the high frequency of preterm births and low birth weight, and especially the very poor outcomes among African-Americans. American’s short life expectancy, they say, comes from high rates of obesity, as well as homicides and accidents.

But the U.S.’ high rate of prematurity and low birth weight is, largely, a result of poor care — inadequately treated infections and chronic illnesses among pregnant women, and the shockingly frequent failure to deliver adequate prenatal care. 16% of pregnant women in the U.S. receive no care at all in the first trimester of pregnancy, far higher than in Canada.

While the O’Neill’s dwell on the high obesity rates in the U.S. as an important non-medical cause of mortality differences, they ignore Canada’s significantly higher smoking rate — a graver threat to health than obesity. Moreover, they cite data from the OECD that exaggerates the obesity differences, ignoring the more reliable JCUSH data that they use for most of their other comparisons (presumably because the JCUSH found more modest differences in obesity rates).

They emphasize that accidents and homicides account for a large fraction of the U.S./Canada mortality difference among young adults, age 20-24. But deaths are rare in this age group, and accident/homicides account for virtually none of the difference in older age groups, where almost all of the deaths occur. In fact, differences in heart disease cause most of the Canadian advantage — a difference that almost certainly reflects, at least in part, better access to care in Canada.

The O’Neills also ignore the fact that the U.S. had a lower infant mortality rate than Canada’s until the passage of national health insurance (NHI) in Canada, after which Canada’s rate fell sharply. Similarly, they never mention that most of Canada’s advantage in life expectancy emerged shortly after NHI was implemented.

In many of their data tables on mortality and other health measures, the O’Neills’ separate out white from minority Americans, and indicate that Canadians’ health outcomes are similar to those of white Americans. Of course, excluding minorities in the U.S. means excluding one third of the entire population, and more than three quarters of the poor. In essence, they want to exclude the 100 million poorest and sickest Americans, and compare the remainder to a cross section of Canadians, including the sick and poor.

2-Other measures besides mortality rates are better indicators of the quality of health care in the two nations, and the U.S. comes out well on these.

The O’Neill’s simply assert that self-reported health status (the answer to the question “How would you rate your health? Excellent, good, fair or poor?”) is a better measure of the impact of the health care system than are mortality rates. Yet this measure has never been validated for cross national comparisons of the type they make, and it seems very likely to be greatly affected by cultural norms. And, as with death rate comparisons, only by eliminating minority Americans from the comparison can they conclude that the U.S. looks slightly better than Canada.

They then compare the two nations using a “health utility index” and the percent of people with pain that limits their activities. For both of these, Canadians do better than Americans, until minorities are subtracted from the population.

Finally, they compare the prevalence of chronic condition like diabetes, emphysema and arthritis in the two nations, and the proportion of people with each condition who are getting treatment. They conclude that while slightly more Americans are chronically ill, more of them are getting treatment. But millions of uninsured Americans with chronic illnesses like diabetes or high blood pressure are unaware of their diagnoses because they can’t afford the doctors visit or lab test needed to make the diagnosis. Surveys will not identify undiagnosed persons as having chronic disease. Hence, the proportion getting treatment is falsely inflated in the U.S. Moreover, even the differences they cite to favor the U.S. are not statistically significant. Hence, a more accurate depiction of the data would state that among people who know of their diagnoses, rates of care are similar in the two nations.

3-More Americans get cancer screening and the U.S. has more high tech health resources than Canada

The O’Neills cite higher screening rates in the U.S. for cervical cancer (PAP smears), breast cancer (mammography), colon cancer (colonoscopy or sigmoidoscopy) and prostate cancer (PSA testing). Only the small PAP smear difference is real.

For mammography, they include all women 40-69 in their calculation of screening rates. But neither the American College of Physicians nor the Canadian Task Force on Preventive Health Care recommend mammograms for all women 40-50. Mammograms for women in this age group leads to more breast surgery and other cancer treatments, but has not been shown to lower overall mortality. It is likely that most of the difference in breast cancer screening is due to higher screening rates among young women in the U.S., who may even be harmed by excessive mammograms.

There’s a similar problem with their analysis of colon cancer screening. They include people age 40-69. Yet standard guidelines do not recommend colon cancer screening in normal risk individuals before age 50. They’ve fudged the data to get a result they want.

Neither the U.S. Preventive Services Task Force nor its Canadian counterpart recommend routine PSA testing because its not at all clear that such testing does more good than harm — it turns up lots of false positives, including many small tumors that would never cause serious problems if left untreated. Routine screening may well lead to many unnecessary operations that leave men incontinent and impotent. Yet the O’Neill’s interpret Canada’s lower PSA screening rate as an indicator of poor quality care.

We may ultimately find that PSA screening or early mammography saves lives — or causes more harm than good. But at present, we just don’t know whether the lower use of these technologies in Canada is a good thing or a bad one.

Their analysis also trumpets the greater number of CT scanners and MRI machines in the U.S. as an indicator of better quality. Yet recent estimates suggest that in the coming years radiation from CT scans may cause as many of 2% of all cancer deaths in the U.S. — about 30,000 excess deaths annually. It is far from clear that the greater use of CT scanners in the U.S. (relative to Canada) causes more good than harm.

4-Waits for care compromise access in Canada, and these access problems are worse than those in the U.S.

The O’Neill analysis admits that fewer Canadians than Americans report an unmet health need (11.3% vs. 14.4%). In the U.S., cost is the big problem, while waits for care are more prominent in Canada. They try to obfuscate the Canadian advantage on access measures by presenting a complex sub-group analysis of pain suffered by those unable to get care. But when you cut through their obfuscation, even this measure favors Canada; about 12% more Americans who say they’re unable to get care report being in pain.

5-Cancer mortality rates are higher in Canada, indicating worse cancer care

The O’Neills claim that mortality rates for lung, breast, colon and prostate cancers are lower in the U.S. than in Canada. They calculate mortality rates by dividing cancer deaths by the number of cases of cancer.

When cancer death rates are calculated in a more standard fashion, i.e. the number of deaths per thousand people in the population, age adjusted cancer mortality is actually lower in Canada than in the U.S. for all of these cancers except colorectal cancer. But there are more cancers diagnosed in the U.S. Hence, the death rate among those who are diagnosed — the figure the O’Neills choose as the most important - is lower in the U.S.

This higher incidence of cancers diagnosed in the U.S. probably reflects more intensive screening programs, which diagnose more people with cancer. But, as stated above, its far from clear that diagnosing small prostate cancers based on PSA screening causes more good than harm. Most elderly men with prostate cancer do not die of that disease, but of heart disease or some other illness. (It is likely that some breast and lung cancers that are diagnosed through screening would also never come to light without screening.) In the U.S., these men with small, non-lethal cancers appear in the denominator of the O’Neill’s calculation of cancer mortality rates, but not the numerator. In Canada, they appear in neither the numerator nor denominator. Thus, their estimate of cancer mortality rates is biased against Canada because of the higher screening rate in the U.S.

6-Income-based health disparities are, if anything, steeper in Canada than in the U.S.

The O’Neills admit that health differences between those above and below the median income are sharper in the U.S. than in Canada. In fact, the differences between the top and bottom 10% are also bigger in the U.S., as are those between the top and bottom 25% etc.

But the O’Neills want to measure health inequities on a new scale. They observe that the rich in the U.S. are much richer than the rich in Canada, and the poor are much poorer. Rather than comparing high and low income persons, they decide to analyze how much worse health gets for each dollar decrease in income. Since the U.S. income gradient is much steeper, this analysis automatically makes the health per dollar gradient less steep. Notice that this method would find that a nation with almost no income inequality would automatically have very steep health inequalities.

Here’s an example. In Country A, the top 1% has an average income of $60,000 and a mortality rate of 100 per 1000. The bottom 1% has an average income of $30,000 and a mortality rate of 130 per 1000. Then, according to the O’Neills’ method for each $1000 increase in income, the mortality rate rises 1 per 1000.

In Country B, the top 1% has an average income of $603,000 and a mortality rate of 100 per 1000. The bottom 1% has an average income of $3,000 and a mortality rate of 300 per 1000. Then, according to the O’Neills’ method for each $1000 increase in income, the mortality rate rises only 1 per 3000.

So the O’Neills’ calculus would judge the income/health gradient less steep in Country B (where the poor have a death rate 300% higher than the wealthy) than in Country A (where the poor have a death rate 10% higher than the wealthy).

7-What’s left out?

The O’Neill’s paper cites dozens of references. But they fail to mention any of the numerous previous studies that directly address the questions they seek to answer. These include:

1-Previous analyses of the JCUSH data by the National Center for Health Statistics (http://www.cdc.gov/nchs/pressroom/04news/firstjointsurvey.htm) and by our group at Harvard (http://www.ajph.org/cgi/content/abstract/96/7/1300), which found a far different result.

2-The many published studies directly comparing the quality of medical care in the two nations for cancer patients, renal dialysis patients etc. 38 of these studies were included in a systematic review which concluded that, on average, mortality rates are 5% lower in Canada (http://www.openmedicine.ca/article/view/8/1).

3-The large body of literature showing that Canada’s health care system is far more efficient, with administrative overhead that is a small fraction of the U.S. level (http://content.nejm.org/cgi/content/short/349/8/768)

4-A recent analysis of deaths that could be prevented by good medical care ranked the U.S. worst among the 19 nations studied, well behind Canada which ranked 6th. Moreover, while Canada’s ranking improved between 1997 and 2003, the U.S. fell further behind. (http://content.healthaffairs.org/cgi/content/abstract/27/1/58)

There is much to criticize in Canada’s health care system. But the O’Neill’s analysis strays far from legitimate scientific discourse, mixing selective citation and creative accounting that is intellectually dishonest.

Bejamin Zycher’s “Comparing Public and Private Health Insurance: Would a Single Payer System Save Enough to Cover the Uninsured?”

Benjamin Zycher, an economist at the right wing Manhattan Institute, has recently issued a report disputing claims that a single payer health care reform would realize large administrative and overhead savings. We will briefly respond to the main arguments in Zycher’s paper.

1-Medicare’s administrative costs are far higher than the figure given in the National Health Accounts.

The National Health Accounts indicate that administrative costs account for only 3% of total Medicare spending (vs. 14% in private insurers). But Zycher wants to add to this a proportional share of all government spending. That is, he claims that 14% of the President’s salary, the cost of Congress, the FBI, the federal courts etc, should be attributed to Medicare, since Medicare accounts for 14% of federal spending. Based on this, he estimates “true” Medicare administrative costs at 6% of total outlays, and concludes that potential savings on insurance overhead is only 8% of premiums, not 11%.

Zycher’s argument assumes that expanding Medicare to cover all Americans would drive up the costs of all government agencies, Congress etc. — an absurd assumption. Would we really raise the president’s salary, or a senator’s pay as part of implementing a single payer system? In fact, there is no reason to posit increases in any such costs, and the Canadian experience suggests that Medicare’s overhead could actually be reduced to about 1% by simplifying hospital and physician payment.

Additional information on Medicare's administrative costs:

2011 Primer on Medicare Spending and Financing

Kaiser Family Foundation

Administrative Costs

The costs of administering the Medicare program have remained low over the years – less than 2 percent of program expenditures. As such, program administration is not a contributing factor to Medicare’s expenditure growth. Administrative costs include all expenses by government agencies in administering the program (HHS, Treasury, the Social Security Administration, and the Medicare Payment Advisory Commission). Also included are the cost of claims contractors and other costs incurred in the payment of benefits, collection of Medicare taxes, fraud and abuse control activities, various demonstration projects, and building costs associated with program administration.

http://www.kff.org/medicare/7731.cfm

2-The higher taxes needed to fund national health insurance would cause massive economic losses that more than offset any administrative savings.

Zycher argues that every dollar collected in taxes by the government actually costs the economy about $1.76 because of foregone private investment. He wants to add a large portion of this cost to Medicare’s overhead, arriving at an estimate that overhead consumes 52% of total Medicare spending.

First, his estimate of the economic consequences of taxation is questionable at best. His assumption that the taxes raised for NHI would come from investment, not from existing health care expenditures, is unfounded. Its simply crazy to posit that money flowing to health care through private insurers provides strikingly more stimulus to the economy than the exact same amount flowing through a government insurance plan.

3-Private insurers’ overhead is not really wasteful.

Zycher admits that Medicare and NHI achieve large savings on underwriting, advertising etc. But he argues that these activities are good things because they “align premiums with costs”, stop the healthy from cross-subsidizing the sick, and make everybody pay the true costs of their own care. He assumes that a market-based health insurance system — which minimizes risk pooling and cross-subsidies - must be most efficient. Therefore, the costs of administering such a market are, by definition, not waste but a necessary part of efficiency.

Of course, he does not and cannot adduce any evidence that a market-based health insurance system is actually efficient. In fact, the overwhelming evidence indicates that it is far less efficient than NHI.

4-What Zycher leaves out.

Zycher’s arguments completely ignore the massive administrative waste that private insurers inflict on hospitals, doctors, nursing homes etc. In fact, insurance overhead accounts for only one-quarter of total health care administrative costs in the U.S. The complexity of our current reimbursement schemes requires providers to fight with insurers for payment for every aspirin and bandaid. This requires a huge administrative staff, billing computers etc.

In contrast, a single payer system could greatly streamline providers’ paperwork. Paying hospitals on a lump sum budget basis — e.g. as a fire department is currently paid — could cut hospital administration costs in half. Similar savings could be realized by simplifying doctors’ billing.

In sum, Zycher’s analysis falsely inflates Medicare’s overhead costs, makes outlandish assumptions about the economic costs of taxes vs. premiums, attributes unsubstantiated social benefits to advertising and insurance underwriting, and ignores the massive administrative burden borne by providers.

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When Canada adopted single payer, did she allow labor unions to opt-out and “keep what they have.”

No. Neither the provinces nor the federal government ever allowed labor unions to opt-out of the plan. Confusion on this point seems to arise from two places. 1) The province of Alberta did not join the single payer system until 1968, and 2) from the beginning, for non-covered benefits only, unions and individuals could “keep what they had” and could bargain for supplementary health benefits with private insurance companies.

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What does PNHP have to say about the primary care workforce shortage?

Countries with strong health care systems have at least half of their physicians in generalist primare care practice 50 percent in Canada, 70 percent in the United Kingdom (Starfield, B, Is primary care essential? Lancet 344: 1129, 1994)

In 2008, less than 8 percent of U. S. seniors chose family medicine, a 50 percent decline since 1997; only 199 U. S, seniors matched into primary care internal medicine, 248 into IM/Peds, and 53 into primary Peds. The percentage of international medical graduates (IMG’s) in our 3 primary care specialties is now 73 percent for IM, 68 percent for Peds, and 55 percent for Fam. Med. (Pugno, P , et al Fam Med 40 (8): 563, 2008) I don’t believe that we have more than about 30 percent of our physicians in primary care. Only 20 percent of internal medicine graduates become general internists, and most pediatric graduates go into sub-specialties. (Bodenheimer, T. Primary care—Will it survive? N Engl J Med 355 (9):861, 2006).

Primary care has been declining in this country for many years, as a result of multiple factors, including more attractive lifestyles and reimbursement on the non-primary care fields;student perceptions of the demands, rewards, and prestige of generalist practice; and uncertainty of the health care environment. The American College of Physicians in 2007 declared that: “Our primary care infrastructure is at grave risk of collapse”.

Single-payer national health insurance will provide an opportunity to restructure the U.S. physician workforce, strenghten and rebuild primary care. We should have at least 50 percent of our physicians in primary care fields. Useful approaches include reimbursement reform, loan forgiveness programs for graduating medical students entering primary care residencies, increased funding for graduate medical education (GME) teaching programs in primary care, and reallocation of GME training slots by specialty.

Answer contributed by Dr. John Geyman, PNHP Past President

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What is a Voucher Plan? What’s Wrong With It?

A Voucher Plan is a version of health reform that seeks to provide a simplified means for individuals to purchase health insurance, while retaining the private insurance system intact. The principal advocates of this plan are Ezekiel Emanuel, a bioethicist now serving as one of President Obama’s principal advisors on health care reform, and Victor Fuchs, a retired economist from Stanford University. Under this plan, individuals would be given a health care certificate, an insurance “voucher,” which would entitle them to enroll in a private health plan of their choice. Employer-based insurance would be eliminated. The vouchers would, under the Emanuel-Fuchs plan, be paid for through a value-added tax (VAT), essentially a sales tax on all manufactured goods and services. This is a highly regressive way of financing such a plan, since low-income people spend a much larger percentage of their income on purchases of goods and services than do higher-income people. However, the main problem with such a plan is that it leaves the wasteful, inefficient, and inequitable private insurance system in place, with no change at all in its operation. It simply makes it easier for us to purchase their defective product.

Answer contributed by Len Rodberg, Ph.D.

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What about the claim (in videos circulating on the internet) that a patient in Canada would have died of a brain tumor if he hadn’t come to the U.S. for an MRI?

The video of Lindsay McCreith is by Stuart Browning who is infamous for not allowing objectivity to interfere with his anti-government messages. Also, two interests intervened during the management of McCreith’s care. One is a firm that arranges medical tourism to the United States, using queues as a business stimulus. The other is a law firm that specializes in cases that would promote privatization of the Canadian medicare system. Thus it began as a setup for the libertarian/conservative camp.

The claim that he would have died had he waited the four months for an MRI scan is an outrageous lie. A C-T scan was done immediately. The tumor was identified, and it was of a nature that did not require emergency management. An emergency MRI would have been done if it were indicated, but it wasn’t.

We do not have all of the details that would come forth during discovery, but we do have a copy of the lawsuit. When you read it, it is clear that the claim is based on ideology rather than government mismanagement. Queues are a problem, but they are being addressed, with considerable success.

If Canadians are to continue to improve queues it is very important that non-emergency patients should never be allowed to purchase a place at the front of the queue. If that were allowed, queues for individuals who could not afford to pay for private care would become intolerable, creating a two-tiered system with boutique care for the wealthy and mediocrity in a neglected system for the non-wealthy.

Here is the lawsuit. (Keep in mind that the lawsuits are filed with inflammatory language, whereas the actual facts then must be confirmed during the discovery process.)

http://www.law.utoronto.ca/healthlaw/docs/case_McCreith.pdf

This is an article on low grade astrocytoma, confirming that this was not an emergency.

http://emedicine.medscape.com/article/1156429-overview

All health care systems can be improved, but the McCreith case should not serve as a basis for Canada to trade in their egalitarian system for the U.S. model with its profound health care injustices that cause so much financial hardship, physical suffering and death.

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How much do private insurance companies spend on overhead and profit?

Private insurance overhead and profit, on average, fluctuates between 12% and 14% nationally. This figure is somewhat lower than the 16-20% at many of the big insurers because it includes self-insured plans of many big employers that have overhead of about 6-7%. On the other hand, overhead in the individual market is often substantially higher than 20%, and in some cases above 30%.

The estimate that total administrative costs consume 31% of U.S. health spending is from research by Drs. David Himmelstein and Steffie Woolhandler and published in the New England Journal of Medicine in 2003. The figure would undoubtedly be higher today. Insurance overhead accounts for a minority of the overhead. Much more occurs in physicians’ offices, hospitals, and nursing homes - driven by our current fragmented payment system. The fact that insurance overhead per se accounts for a minority of the bureaucratic waste in the system explains why implementing a public option plan would not achieve most of the potential bureaucratic savings that can be realized through single payer. Even with a public option, hospitals, physicians and nursing homes would still have to maintain virtually all of their internal billing and cost tracking apparatus in order to fight with private insurers.

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Doesn't the threat of filibuster prevent fundamental reform?

The filibuster prevents more than fundamental health care reform. It hobbles our democracy. For two excellent articles on why the filibuster should be eliminated and majority rule restored, see the editorial "Filibustering the Public," The Nation, December 14, 2009 and Thomas Geoghegan, "The Case for Busting the Filibuster," September 7, 2009.

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What about the proposal to lower the eligibility age for Medicare to 55?

Lowering the eligibility age for Medicare to 55 only works if it is mandatory. Otherwise it becomes the place where all the sickest patients get dumped. That might be okay for the sick people since Medicare is often better and more secure than private coverage, but it would drive total health care costs (and premiums) up, not down.

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Will the Obama health plan cover all young adults?

No. Although the Act uses various programs to expand coverage for young adults, it is a disappointment because it fails to accomplish two of the most important goals of reform. Many young adults will still be left without coverage, and the Act fails to adequately control the increases in health care costs.

A fragmented system of private plans and public programs, such as that in the Affordable Care Act, is the most expensive model of reform, and it falls short on universality and equity. The single payer model, on the other hand, is the least expensive model of comprehensive reform, and it automatically enrolls everyone, while containing costs through proven, government-administered single payer policies. It is equitably financed through the tax system based on the ability to pay, so it is affordable to everyone.

A Commonwealth Foundation Brief ("Rite of Passage: Young Adults and the Affordable Care Act," May, 2010) describes the reasons why many will still not be enrolled in one of the programs and remain uninsured, some suggest that these programs are incremental steps that can be modified to further expand coverage. But there are no modifications that will ever ensure that everyone is enrolled. Nor will the modifications be able to adequately control costs.

The financing infrastructure of the Affordable Care Act is fatally flawed since it cannot ever reach our goals. In contrast, if we replaced the financing system with a single payer national health program, such as an improved Medicare that automatically covered everyone, we could eliminate the profound administrative excesses of our current fragmented financing system, and use global budgets for hospitals, negotiated rates for health care professionals, and bulk purchasing of pharmaceuticals and supplies to slow the intolerable increases in health care costs. Those economic tools are effective in a truly universal system, but really don't work in a dysfunctional, fragmented system such as that of the Affordable Care act.

Answer contributed Don McCanne, M.D., PNHP Senior Health Policy Fellow

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The number of uninsured Americans now exceeds 50.7 million people according to the Census Bureau. Won't the Obama health plan cover them?

The Patient Protection and Affordable Care Act (PPACA) will reduce the numbers of uninsured starting in 2014 (with about half of the new coverage being Medicaid, and the other half private plans) but by 2019 it is estimated it will still leave 23 million of the 50.7 million Americans identified as being uninsured without coverage.

However, it is important to note that the CBO estimate of 23 million uninsured does not include a whole additional category of people who face barriers to accessing care: People who are underinsured, who will face financial hardship should medical needs arise. Underinsurance will actually increase under PPACA.

Here's why PPACA is an underinsurance program: Employers will see little relief and will expand their present trend of shifting more insurance and health care costs onto their employees. Individuals buying plans in the new insurance exchanges will select underinsurance products with low actuarial values (30 to 40 percent of costs must be paid by the patient) with subsidies that are inadequate to avoid financial hardship. Many will move into the Medicaid program which has more expansive coverage, but which reimburses providers at such a low rate that far too many will not be willing to accept patients under this program. With Medicaid chasing away providers, it too has become another form of underinsurance.

Thus the touted increase in insurance enrollment under PPACA will be more than offset by the explosion in underinsurance - affecting the majority of Americans.

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What about report cards on physicians? Won't they reduce costs and improve quality?

The best study of the impact of report cards on providers (a study of heart surgeons in New York) found they actually increased costs, worsened care, and inevitably gave physicians incentives to avoid the sickest patients. Several papers have documented the destructive effect of the NY Dept of Health’s heart surgery report cards. The best is by Dranove et al, available here.

Here’s a quote from the Dranove paper:

“[O]ur results show that report cards [on heart surgeons] led to increased expenditures for both healthy and sick patients, marginal health benefits for healthy patients, and major adverse health consequences for sicker patients. Thus, we conclude that report cards reduced our measure of welfare over the time period of our study” (p. 577). “[M]andatory reporting mechanisms inevitably give providers the incentive to decline to treat more difficult and complicated patients” (p. 581).

– David Dranove et al., “Is more information better? The effects of ‘report cards’ on health care providers,” Journal of Political Economy 2003;111:555-588

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Why are health care costs rising and how can single payer "bend the cost curve"?

High administrative costs and excessive - and even ridiculous - prices under the current system are themselves symptoms of the increasing commercialization of health care and the growing dominance of private firms in health care delivery and financing. Cutting administrative costs and mandating reasonable pricing would result in very large one-time savings and allow an affordable transition to comprehensive coverage of the un- and under-insured, but without other cost control mechanisms these savings would soon be eaten up by continued health care inflation.

Over the longer term, the keys to savings lie in improved health planning implemented through control of capital spending, as well as limitations on market incentives and limitations on for-profit involvement in health care delivery.

- Health planning to assure that investments in expensive new technology meet needs, but do not exceed them, is the only proven means to limit the excessive and dangerous interventions that drive up costs and lower quality. It is the salutary alternative to the current strategies of case-by-case review by HMOs, or the potentially disastrous incentives offered under capitation arrangements.

- Limits on for-profit ownership and excessive compensation of health care executives are needed to dull the incentives for institutional gain at the expense of system-wide performance. For-profit hospitals and dialysis facilities paid by Medicare have higher costs and lower quality than non-profits. Elminating them is key to "bending the cost curve."

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What is PNHP view of ACO's?

While the term ACO remains at best vaguely defined, the concept is hauntingly similar to the capitated managed care experiment that proved disastrous in the 1990s. In both instances, providers receive a set annual payment to cover the costs of all care, and get to keep whatever they don't spend on patients. The obvious winning strategy - from a business point of view - is to recruit relatively healthy patients, offering luxurious care for the healthy and minimally ill, and subtle queues that those with expensive illness would be better off elsewhere. Neither risk adjustment nor quality monitoring schemes are up to the task of blunting these incentives.

An ACO can game risk adjustments by ferreting out additional diagnoses that may be clinically unimportant but would up its capitation payment, and make its outcomes look better as well. The Dartmouth group has already shown that more expensive providers label their patients with more diagnoses in this way. Quality monitoring efforts measure only a tiny slice of what's important in medicine. Overarching measures of quality like death rates and family/community well being are either too rare to measure in a statistically reliable manner, too subtle to capture with current or foreseeable measurement strategies, or too biased by differences in the baseline health of enrollees. Evidence from the UK shows that providers will improve on the aspects of care that are measured, but neglect those that are not, and it's far from clear that monitoring of quality measures has actually improved quality or can prevent abuses.

In sum, the ACO strategy remains an untested theory for health reform. Considerable experience with similar reforms in the past suggests that this ACO strategy will lead to yet another health policy dead end.

Answer contributed by Drs. Steffie Woolhandler and David Himmelstein

..Physicians for a National Health Program

29 E Madison Suite 602, Chicago, IL 60602 ¤ Find us on a map

Phone (312) 782-6006
Fax: (312) 782-6007
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© PNHP 2011

The Must See Chart (This Is What Class War Looks Like)

2011-03-19T05:52:00.000-07:00

The Must See Chart (This Is What Class War Looks Like)

Dr. Atul Gawande Compares Obama's "Frustrating" Record on Healthcare Reform and LBJ's Leadership in Passing Medicare

2011-03-19T05:46:00.000-07:00

Dr. Atul Gawande Compares Obama's "Frustrating" Record on Healthcare Reform and LBJ's Leadership in Passing Medicare

Ralph Nader and Daniel Ellsberg: We Need to See Courage and Mobilization Here as Well as the Middle East

2011-03-19T05:38:00.000-07:00

Ralph Nader and Daniel Ellsberg: We Need to See Courage and Mobilization Here as Well as the Middle East

Is Christianity compatible with Anarchy?

2011-03-19T04:22:00.000-07:00

Is Christianity compatible with Anarchy?

I think the word anarchy has a shock value. It puts images of chaos and violence in people’s heads. Even I didn’t know really what it meant till recently when I was having a conversation and someone mentioned it. I had to suppress my own preconceived notions to hear what theirs were. Then I had to go home and read up a little about it. The “aha” came when I realized why they mentioned it to me. It was really an interesting political idea. I think since Wisconsin, I have had more thoughts about a solution to our plutocracy and those go straight to the notion of organizing the growing number of groups seeking to come together to change the broken system.

Some would say that Christianity or any other formal religion is incompatible with anarchy, but my own journey has brought me down a different road to bring me where I am on issues regarding the compatibility of Christianity and progressive politics including ideas about mutualism and socialistic libertarianism. On that same note, I have strong feelings about what is going wrong today but I don’t allow my ideology to push out my practical ideas about solutions. If I were ideologically driven, I would lose the ability to have conversations with the other side. This is so important, if not the game changer. I suggest that having the conversation is the first part of developing a clear view and respecting other ideas, even if they go against ones grain. I have had conversations with anarchists and there were several times we did not have the same base knowledge or had walked the same path to get where we were on issues. That is interesting because often I find that I think that with cons and bible beaters. So there is a danger I see now in using certain terms and discussing ideology in a way which is giving the term and then defining it. Somehow, I need to work on giving the definition and then the term or now term at all.

So now I want to clear up the compatibility question I felt was the problem. Somehow, “religion” or the imaginary man in the sky as some would put it seems to be incompatible with anarchy. For me, I have always had a battle between tradition, doctrine, boxes, rules, spirituality, skepticism, and faith. What always brings me back to my place of peace, is that I have theologians who give me the feeling I’m not alone and that there is something after this life. Indeed, if I ended up with Christianity, it was probably because of my mother, but the tradition of prayer and viewing spiritual center in a way that I do is simply what it is. Emergent Christians and progressive Christians speak about how to change the church from within, I do not have the strength to try that, but I support it by telling Christians who are still in church about them.
I wiki ‘d the emergent Christians for you…. The emerging church (sometimes referred to as the emergent movement or emergent conversation) is a Christian movement of the late 20th and early 21st century that crosses a number of theological boundaries: participants can be described as evangelical, Protestant, Catholic,^[1] post-evangelical, anabaptist, adventist,^[2] liberal, post-liberal, reformed, charismatic, neocharismatic, post-charismatic, conservative, and post-conservative. Proponents, however, believe the movement transcends such "modernist" labels of "conservative" and "liberal," calling the movement a "conversation" to emphasize its developing and decentralized nature, its vast range of standpoints, and its commitment to dialogue. Participants seek to live their faith in what they believe to be a "postmodern" society. What those involved in the conversation mostly agree on is their disillusionment with the organized and institutional church and their support for the deconstruction of modern Christian worship, modern evangelism, and the nature of modern Christian community.

Evolving in Monkey Town

2010-08-13T11:00:00.000-07:00

So Evolving in Monkey Town is like the hottest new book to come out among the emergent christians. So I had to read it, especially after hearing Rachel Evans interviewed on the Nick and Josh podcast. I really enjoyed this read because it was so honest. Rachel made me think about how much easier it was just to accept authority in church. It is just alot easier to accept a view that everyone else is nodding their heads and saying amen to. It just is. It is much harder to say, "I dont know for sure" but/and/or "I would love to hear the different views on the matter". I mean, for example, what does it mean when we have young men, out of work, struggling for meaning and direction. They either begin abusing themselves or others in their frustration. Sometimes the alcohol and drugs infiltrates and some even take their own lives. And some join the Army, not because they wanted to but because they need a job. Risking their lives in a war most dont understand and some of them killed. What has gone wrong in our society to creat this joblessness? this lack of solid education? this war mongering nature? This violent nature? What does our faith have to do with this? Rachel doesnt answer the question but I think she does a good job of asking the tough questions. What does the church have to do with the society? What is the role of the church in a society? What is the role of the pastor, reverend, preacher or priest? Should a pastor be a source of moral leadership? Should a pastor ask questions? How do we change?
All good questions and Im "Evolving in KKK Town".

Alvin Greene sounded dimwitted

2010-06-13T17:51:00.000-07:00

Did you hear his interview with Keith?! He couldn't answer the questions. Sounded like he was being prompted. Something is rotten in the state of South Carolina.

A New Kind of Christianity

2010-06-08T10:07:00.000-07:00

I really loved the book A New Kind of Christianity. It has helped me to put things into perspective.

McClaren asks 10 questions and then discusses them very methodically. These questions are:

1. What is the overarching story line of the Bible?

2. How should the Bible be understood?

3. Is God violent?

4. Who is Jesus and why is He important?

5. What is the Gospel?

6. What do we do about the Church?

7. Can we find a way to address human sexuality without fighting about it?

8. Can we find a better way of viewing the future?

9. How should followers of Jesus relate to people of other religions?

10. What do we do now? (How do we translate our quest into action?)

McLaren doesn't so much provide pat answers to these questions as give thoughtful responses which leave the door open for further exploration. His tone throughout is humble, circumspect and low-key. This is not a book for people who want a pedagogue to tell them what to believe. Rather it inspires you to bring your own theology into the light and take an honest look at what you believe, why you believe it and if, perhaps, you ought to rethink a thing or two (or ten).

I was loosing my faith till I read this book and now my faith is stronger than ever. I guess you could say I'm an emergent christian now.

The Greenies

2010-05-31T13:30:00.000-07:00

The Oberlin(OH) UU Fellowship (OUUF) has been recognized by the UUA as a Green Sanctuary congregation. Attached are a couple photos that show the Green Team (affectionately known as Greenies) reprising some of their activities. The first is posed inside our Sanctuary in front of our Banner. Props include a petition drive seeking prevention of cruelty to farm animals, Fair Trade coffee sold with our Fellowship's name and logo, canvas shopping bag, rubber gloves & boots for stream cleanup. Left to right: Gail Powell, Megan Schief, Margaret Medina, Elizabeth Aldrich, Dave Burwasser, and Barbara Fuchsman.

The second photo was taken at the home of our Fellowship President, Cindy Frantz, an active member of the Greenies, in front of a large composter and a rain barrel. The former is mostly concealed and the latter totally hidden by our enthusiastic Team. Left to right are: Gail Powell, Barbara Fuchsman, Megan Schief, Margaret Medina, Cindy Frantz, and Elizabeth Aldrich.

Peace Prize President Obama increases military spending higher than ever.

2010-05-18T05:51:00.001-07:00

http://www.tcpc.org/news/item.cfm?news_id=449

My heart is breaking...

Why Christianity must adapt --or perish by Alex Wilhelm

2010-05-15T16:27:00.000-07:00

There is a fundamental question facing Christian sects in America, an ideological distinction that cleaves the many churches into two different camps: is it better to fit the church and Christianity to the world, thus keeping the faith relevant, or is it better to mold the world to the faith? Put more bluntly, whose vision of the future of Christianity is correct: the conservative, literal Baptists or the modern, liberal Episcopalians? Which is best for the people? Which is best for the world? Are their dogmas really so distinct?

The non-religious of the world will be quick to point out that this is in fact something of a new question, whether the religion should fit the culture or the other way about. Historically, Christianity's church held much more control and influence in daily lives of people around the world. The question of adapting the religion to better fit a morality in flux (most people would say for the better) was moot. The Bible and the Church were both the guide and the morality.

Modern times have changed the equation. Freedom to practice religion as one wishes implies less central homogeneity among Christians. Without a central core, doctrine can wander. Once you have the freedom to leave to find a better-fitting sect, start your own, or just stop practicing all together, it becomes much more difficult to corral a society. Unless a single sect so dominates a certain area, no specific church or even Christendom can exert enough control to enforce its views. I would posit that voluntary assimilation is no control at all.

This, of course, is why Brian D. McLaren is on the right path in his most recent work A New Kind of Christianity. McLaren is advocating a different, perhaps upgraded form of Christianity that takes a more objective view of history and employs a better interpretation of the Bible. This allows him to take what he finds good and best in that book, rendering it more applicable and accessible to a modern, educated people.

At least he recognizes the challenge. As humanity progresses around the world, unlocking the science of the universe, time seems to move more quickly. The pace of progress accelerates, from the depressed call of "nothing new under the sun" to the doubling of human knowledge every decade or so (estimates vary, pick your number); we now expect change as an inherent, paradoxically stable truth.

How does this fit with the literalist, conservative Christian view? You can see that it is intrinsically opposed; a more liberal interpretation of Christian doctrine could make space for science that promises the great, the life-improving, and the new. A literal interpretation of the Bible offers regressionism and leaves little room for progress. This is exactly where McLaren finds the inherent problem with modern Christianity, and the exact thing that must change: the Bible is a ballast.

What of a new Bible, one that makes more sense examining the past and is pro-human when applied to the future, releasing past dogma for improvements and corrections? As you may have guessed, it is not necessary to replace the physical work and words of the Bible; it is sufficient to have it become a new book via a fresh reading.

Now, where does that leave us? The temperate Christians among us might find that to be a fair idea, already having been employing it in everything but name. Most Christians read Genesis and Revelations as allegory and tale, not as fact. The proportion of Christians who take Scripture to be literal truth declines as the education of a population rises, creating an increasingly irreconcilable tension among intellectuals and the religious. Testament to this is the difference in religiosity shown between scientists and the average citizen.

The relevancy and perceived truth of the Bible among Christians and non-Christians through time has always been changing. But the general trend has long been towards complete repudiation by the non-religious, and reinterpretation among the faithful. McLaren is calling for a much quicker change, a larger, conscious adaptation of the religion's text and therefore the religion itself. This manifests as a firm repudiation of the most odious passages (e.g., how to enslave, when to stone, and so forth are to be disregarded).

Why should these changes be made now? Is there such a dire need here in the United States? In short, yes. The Pew Forum has a rather revealing recent poll that outlines a quick collapse of American religion. Quick, that is, in a historical context. Given that we have long been a majority-Christian nation, the Pew numbers of aggregate religion are a fair look at how Christianity is surviving in the States. What can we see? Of people born from 1981 on, some 26 percent claim no religious affiliation. Among people born between 1965 and 1980, the percentage of non-believers is a lower 20 percent. Heading farther back, those born from 1946 to 1964 are only 13-percent non-religious.

A doubling, that is, between the boomers and the most recent generation. As you know, doubling is a geometric function. If the number of non-believers doubles again in 50 years, then by around 2050, the United States will be a majority non-religious country. Clearly, if Christianity seeks to not only stay relevant but viable, it must adapt. The proof is in the numbers; Christianity is suffering.

The Biblical passages subjugating women to the back of the bus need to be let go to reach the modern woman, who no more expects to be treated as a second class citizen than to be beaten. The passages condemning people born homosexual as abominations need to be released to make the church inclusive. The blatantly incorrect attempts at science and history in the book need to be shut out if Christianity is to attract the educated who could not reconcile the Bible and the real world.

If Christians want to find some sort of hope to reverse the trend in the game that they are losing, they would be wise to listen to not just McLaren but also the person sitting next to them who left the Church because it never spoke to them. That person is the reason Christianity is suffering a silent crisis.

The Illustrated Tea Party Dictionary

2010-04-08T06:07:00.000-07:00

Um, this is just bad. Bad. But man I enjoyed it. Big dummies.

http://gawker.com/5506871/the-illustrated-tea-party-dictionary

Green Party Values

2010-03-31T07:31:00.000-07:00

Ten Key Values of the Green Party

Originally ratified at the Green Party Convention in Denver, CO, June 2000.

TKV Flyer w/Spanish translation (PDF)

Democracy is Coming (to the USA) Brochure (PDF)

Platform

Links

1. GRASSROOTS DEMOCRACY
Every human being deserves a say in the decisions that affect their lives and not be subject to the will of another. Therefore, we will work to increase public participation at every level of government and to ensure that our public representatives are fully accountable to the people who elect them. We will also work to create new types of political organizations which expand the process of participatory democracy by directly including citizens in the decision-making process.

2. SOCIAL JUSTICE AND EQUAL OPPORTUNITY
All persons should have the rights and opportunity to benefit equally from the resources afforded us by society and the environment. We must consciously confront in ourselves, our organizations, and society at large, barriers such as racism and class oppression, sexism and homophobia, ageism and disability, which act to deny fair treatment and equal justice under the law.

3. ECOLOGICAL WISDOM
Human societies must operate with the understanding that we are part of nature, not separate from nature. We must maintain an ecological balance and live within the ecological and resource limits of our communities and our planet. We support a sustainable society which utilizes resources in such a way that future generations will benefit and not suffer from the practices of our generation. To this end we must practice agriculture which replenishes the soil; move to an energy efficient economy; and live in ways that respect the integrity of natural systems.

4. NON-VIOLENCE
It is essential that we develop effective alternatives to society’s current patterns of violence. We will work to demilitarize, and eliminate weapons of mass destruction, without being naive about the intentions of other governments. We recognize the need for self-defense and the defense of others who are in helpless situations. We promote non-violent methods to oppose practices and policies with which we disagree, and will guide our actions toward lasting personal, community and global peace.

5. DECENTRALIZATION
Centralization of wealth and power contributes to social and economic injustice, environmental destruction, and militarization. Therefore, we support a restructuring of social, political and economic institutions away from a system which is controlled by and mostly benefits the powerful few, to a democratic, less bureaucratic system. Decision-making should, as much as possible, remain at the individual and local level, while assuring that civil rights are protected for all citizens.

6. COMMUNITY-BASED ECONOMICS AND ECONOMIC JUSTICE
We recognize it is essential to create a vibrant and sustainable economic system, one that can create jobs and provide a decent standard of living for all people while maintaining a healthy ecological balance. A successful economic system will offer meaningful work with dignity, while paying a “living wage” which reflects the real value of a person’s work.

Local communities must look to economic development that assures protection of the environment and workers’ rights; broad citizen participation in planning; and enhancement of our “quality of life.” We support independently owned and operated companies which are socially responsible, as well as co-operatives and public enterprises that distribute resources and control to more people through democratic participation.

7. FEMINISM AND GENDER EQUITY
We have inherited a social system based on male domination of politics and economics. We call for the replacement of the cultural ethics of domination and control with more cooperative ways of interacting that respect differences of opinion and gender. Human values such as equity between the sexes, interpersonal responsibility, and honesty must be developed with moral conscience. We should remember that the process that determines our decisions and actions is just as important as achieving the outcome we want.

8. RESPECT FOR DIVERSITY
We believe it is important to value cultural, ethnic, racial, sexual, religious and spiritual diversity, and to promote the development of respectful relationships across these lines.

We believe that the many diverse elements of society should be reflected in our organizations and decision-making bodies, and we support the leadership of people who have been traditionally closed out of leadership roles. We acknowledge and encourage respect for other life forms than our own and the preservation of biodiversity.

9. PERSONAL AND GLOBAL RESPONSIBILITY
We encourage individuals to act to improve their personal well-being and, at the same time, to enhance ecological balance and social harmony. We seek to join with people and organizations around the world to foster peace, economic justice, and the health of the planet.

10. FUTURE FOCUS AND SUSTAINABILITY
Our actions and policies should be motivated by long-term goals. We seek to protect valuable natural resources, safely disposing of or “unmaking” all waste we create, while developing a sustainable economics that does not depend on continual expansion for survival. We must counterbalance the drive for short-term profits by assuring that economic development, new technologies, and fiscal policies are responsible to future generations who will inherit the results of our actions.

Furthermore to my blogger friend

2010-03-31T07:00:00.001-07:00

I have been a staunch democrat for 25 years. I have voted party line year after year and supported democrats unabashedly with my money and time. I lived in Florida during the Gore disaster. I saw what you saw. It crushed me and I am deeply saddened that Gore was not elected.
But now, I have switched to the Green Party. I realize now that the machine is broken, just as Nader said. This reform and change of direction has to be grassroots led and we can no longer tolerate corruption at any level in any form. The Supreme Courts decision to create corporate personhood two months ago is the reason why I made the decision to switch parties. That was the most unbelievable corporate state move imaginable.
Nader is right on so many levels and sadly he is passionate like myself. Like him, I could never make it in politics because I get on my soap box and forget myself. Nader is right that citizenship is an important job. We need to take the driver seat.
The last year has opened my eyes. I log into Opencongress.org regularly and the last year has been eye-opening and alarming. Thank God for Politifact.com as well. We all should be reading these for our information, not Fox news.

Ralph Nader vs. John Stossel. Impact Symposium

2010-03-31T06:27:00.000-07:00

I subscribe to three local bloggers...they are all students or progressive. Two of them went to the debate last night and both saw exactly what I saw. Nader was backing up his arguments with history, facts, strong legal experience. He spoke like someone who has been in the halls of congress and been at many round tables in government. Stossel sounded like an entertainer who was just trying to get a laugh. YUP. I expected more.
I'd write more but just read Nader's books and you will see that intelligent discussion. Dealing with the real world and not ideology is a huge step in any deeper meaningful reform of our systems.

Paid leave is a human right

2010-02-04T22:24:00.001-08:00

Paid leave is a human right

Posted January 25th, 2010 by Janet Walsh

Paid parental leave is a human right, one guaranteed by virtually every country. But not the United States!

When you gave birth or adopted your kids, did you take leave without pay? How did this affect breastfeeding, your health, your baby’s health, or your family’s finances? How did this affect the timing of your return to work? How else did the lack of paid parental leave affect you and your family?

Human Rights Watch, a nongovernmental human rights group, is hoping to interview parents about their experience with unpaid maternity and paternity leave, and the impact on their families. The interviews will be used for a report (using pseudonyms, not actual names of interviewees) and, depending on the findings, for making recommendations on US law and policy.

Please contact Human Rights Watch at walshj@hrw.org if you would like to share your story through a short interview. To learn more about Human Rights Watch, visit www.hrw.org.

Maternity/Paternity Leave

2010-02-04T22:21:00.001-08:00

M: Maternity/Paternity Leave

Paid family leave combats poverty, gives children a healthy start, and lowers the wage gap between women and men by providing structural support to balance work and family.

Selena's Story

Selena's baby boy, Connor, was born six weeks early. As Connor was rushed to the Neonatal Intensive Care unit, Selena found herself alone in a hospital bed realizing that she was going to go home well before her baby. "There was no way we could afford for me to take off more than we planned,” recalls Selena. So after Selena had the baby on Thursday, she was released from the hospital Friday, and was back at her desk on Monday morning. “It was the hardest two and a half weeks of my life,” she says recalling the ache of being away from her newborn son. More »

Know the Facts

Having a baby is a leading cause of "poverty spells" in the U.S. -- when income dips below what's needed for basic living expenses.
In the U.S., 49% of mothers cobble together paid leave following childbirth by using sick days, vacation days, disability leave, and maternity leave.
51% of new mothers lack any paid leave -- so some take unpaid leave, some quit, some even lose their jobs.
The U.S is one of only 4 countries that doesn't offer paid leave to new mothers -- the others are Papua New Guinea, Swaziland, and Lesotho.
Paid family leave has been shown to reduce infant mortality by as much as 20% (and the U.S. ranks a low 37th of all countries in infant mortality).

Emotions high, Senate opens partisan health debate

2009-11-30T19:02:00.000-08:00

Emotions high, Senate opens partisan health debate

By DAVID ESPO

Latest News

Emotions high, Senate opens partisan health debate

CBO: Health bill would reduce premiums on average

WASHINGTON (AP) -- Riven by partisanship, the Senate plunged into a widely anticipated debate Monday over sweeping health care legislation that President Barack Obama and congressional Democrats have vowed to approve and Republicans have sworn to block.

Debate is expected to last for weeks over the legislation, which includes a first-time requirement for most Americans to carry insurance and a mandate for insurers to cover any paying customer regardless of medical history or condition.

"We must avoid the temptation to drown in distractions and distortions," Senate Majority Leader Harry Reid said in the first moments of the first speech, a jab at Republicans that was reciprocated minutes later.

"Well, I don't know what's more preposterous: saying that this plan 'saves Medicare' or thinking that people will actually believe you," Sen. Mitch McConnell of Kentucky, said of Reid's oft-made statement.

At a cost of nearly $1 trillion, the legislation is designed to extend health care to millions of American who lack it, abolish insurance industry practices such as denying coverage based on pre-existing conditions and cut back on the rise of health care spending overall.

Despite its huge price tag, the Congressional Budget Office has estimated the 2,074-page bill would reduce federal deficits by $130 billion over the next decade. In all, CBO said 31 million uninsured individuals would receive insurance if the bill were enacted, many of them assisted by federal subsidies. As much as 94 percent of the eligible population would wind up covered. The legislation would be paid for through a combination of cuts in projected Medicare payments to hospitals and other providers, a payroll tax on the wealthy and taxes on drug makers, medical device manufacturers, owners of high-cost insurance and others.

It has taken months to advance the legislation to the floor, Democrats struggling with their own internal divisions as well as Republican opposition.

Democrats control 60 seats in the Senate, precisely the number needed to trump a promised Republican filibuster. While Reid spent most of the day jousting with Republicans, his ability to steer the bill to passage will depend on finding ways to finesse controversial provisions within the measure. None is more important than calls for the government to sell insurance in competition with private firms. Liberals favor the plan; moderate and conservative Democrats oppose it. As drafted the bill establishes a so-called government option, although each state can block it.

Even before Reid rose to speak, the two parties were squabbling over a new Congressional Budget Office study assessing the legislation's impact on the cost of insurance.

Sen. Max Baucus, D-Mont., said it showed that "whether you work for a small business, a large company or you work for yourself, the vast majority of Americans will see lower premiums than they would if we don't pass health reform."

Not so, said a statement from McConnell's office: "Most people will end up paying more or seeing no significant savings."

The 28-page report was less clear-cut than either side said.

It said that by 2016, premium prices for Americans working at large companies, about 134 million people, would be between zero and 3 percent lower on average than would otherwise be the case.

At small companies, estimated to provide coverage for 25 million by 2016, the average premium would be between 1 percent higher to 2 percent lower on average. That did not factor in the federal subsidies that would be available to the firms to spur them to provide coverage. Those receiving the assistance would have premiums as much as 11 percent lower on average.

CBO said for non-group coverage, premiums would rise by between 10 percent and 13 percent on average. But more than half that group is expected to receive federal subsidies that would result in premiums as much as 59 percent less costly on average. Individuals purchasing coverage without any federal assistance would presumably face higher costs, although CBO's letter did not indicate how much more.

The debate over premiums was only one of many expected as the Senate dug into a complicated bill that seemingly delved into every corner of the health care system.

But both parties seemed to have political considerations in mind as the day wore on.

The first proposed change to the legislation, offered by Sen. Barbara Mikulski, D-Md., would increase insurance benefits for women, mandating that policies include an annual health screening.

As the health care debate has unfolded in Congress, both parties have spent months vying for the support of women.

Not to be outdone, Republicans issued a statement saying that as written, an advisory committee that recently drew criticism for proposing a delay in routine mammogram screening would have even greater authority.

The two sides also sparred over issues important to seniors, whom polls show are particularly concerned about the impact of health care.

Reid sought Republicans' agreement that Social Security would be protected as debate moved ahead.

Sen. Mike Enzi, R-Wyo., objected, saying Reid had refused to extend the same protection to Medicare.

Not long afterward, Sen. John McCain proposed stripping out a total of $440 billion in Medicare cuts to home health providers, hospitals, hospices and other organizations, saying those reductions could not be sustained politically.

In a slashing attack on the White House and Democrats, the Arizona Republican accused the bill's supporters of resorting to "Bernie Madoff accounting, Enron accounting" to mask the true impact on the deficit.

The House approved its version of the health care bill last month. It would have to be reconciled with any Senate-passed measure before legislation could go to the White House for Obama's signature.

Public Option update

2009-10-30T10:22:00.001-07:00

CLEAR MAJORITY NOW BACKS PLAN
Americans still divided on overall packages

A new Washington Post-ABC News poll shows that support for a government-run health-care plan to compete with private insurers has rebounded from its summertime lows and wins clear majority support from the public.

Americans remain sharply divided about the overall packages moving closer to votes in Congress and President Obama's leadership on the issue, reflecting the partisan battle that has raged for months over the administration's top legislative priority. But sizable majorities back two key and controversial provisions: both the so-called public option and a new mandate that would require all Americans to carry health insurance.

Independents and senior citizens, two groups crucial to the debate, have warmed to the idea of a public option, and are particularly supportive if it would be administered by the states and limited to those without access to affordable private coverage.

But in a sign of the fragile coalition politics that influence the negotiations in Congress, Obama's approval ratings on health-care reform are slipping among his fellow Democrats even as they are solidifying among independents and seniors. Among Democrats, strong approval of his handling of the issue has dropped 15 percentage points since mid-September.

These numbers underscore the challenges ahead for the president and Democratic leaders in Congress as they attempt to maintain support among liberals and moderates in their own party while continuing to win over at least a few Republican lawmakers.

Overall, 45 percent of Americans favor the broad outlines of the proposals now moving in Congress, while 48 percent are opposed, about the same division that existed in August, at the height of angry town hall meetings over health-care reform. Seven in 10 Democrats back the plan, while almost nine in 10 Republicans oppose it. Independents divide 52 percent against, 42 percent in favor of the legislation.

There are also deep splits in the new poll over whether the proposed changes would go too far or not far enough in expanding coverage and controlling costs. Twice as many see the plan as leaning toward too much government involvement, but since last month there has been a nine-point increase in the number who say government should be more involved.

On the issue that has been perhaps the most pronounced flash point in the national debate, 57 percent of all Americans now favor a public insurance option, while 40 percent oppose it. Support has risen since mid-August, when a bare majority, 52 percent, said they favored it. (In a June Post-ABC poll, support was 62 percent.)

If a public plan were run by the states and available only to those who lack affordable private options, support for it jumps to 76 percent. Under those circumstances, even a majority of Republicans, 56 percent, would be in favor of it, about double their level of support without such a limitation.

Fifty-six percent of those polled back a provision mandating that all Americans buy insurance, either through their employers or on their own or through Medicare or Medicaid. That number rises to 71 percent if the government were to provide subsidies for many lower-income Americans to help them buy coverage. With those qualifiers, a majority of Republicans say they support the mandate.

The public option

Faced with a basic choice that soon may confront the administration and Democratic congressional leaders, a slim majority of Americans, 51 percent, would prefer a plan that included some form of government insurance for people who cannot get affordable private coverage even if it had no GOP support in Congress. Thirty-seven percent would rather have a bipartisan plan that did not feature a public option. Republicans and Democrats are on opposite sides of this question, while independents prefer a bill that includes a public option but does not have Republican support, by 52 percent to 35 percent.

But if there is clear majority support for the public option and the mandate, there is broad opposition to one of the major mechanisms proposed to pay for the bill. The Senate Finance Committee suggested taxing the most costly private insurance plans to help offset the costs of extending coverage to millions more people. Sixty-one percent oppose the idea, while 35 percent favor it.

Nearly seven in 10 say they think that any health-care measure would increase the federal budget deficit, a possible concern for Obama. But nearly half of those who see the legislation as growing the deficit also say the increase would be "worth it."

Concerns about the implications for Medicare continue to cloud the debate. More than twice as many Americans (43 percent to 18 percent) say they think the legislation would weaken Medicare. Despite the dip in opposition to a health-care overhaul among seniors, most, 51 percent, still think reform would hurt the popular program.

Overall, 57 percent approve of the way Obama is handling his job as president and 40 percent disapprove. While those numbers have moved only marginally over the past few months, here, too, are fresh signs of restiveness among the party faithful: "Strong approval" among liberal Democrats is down 16 percentage points over the past month.

On the economy, 50 percent approve of Obama's efforts, while 48 percent disapprove.

The president receives better marks from all Americans for his handling of international affairs and his performance as commander in chief (57 percent approval on each). Slim majorities also approve of how he is dealing the situation with Iran and his winning of the Nobel Peace Prize. A majority disapprove of his work on the federal budget deficit.

Partisan divide

Despite those mixed reviews on domestic priorities, Obama continues to hold a big political advantage over Republicans.

Poll respondents are evenly divided when asked whether they have confidence in Obama to make the right decisions for the country's future, but just 19 percent express confidence in the Republicans in Congress to do so. Even among Republicans, only 40 percent express confidence in the GOP congressional leadership to make good choices.

Only 20 percent of adults identify themselves as Republicans, little changed in recent months, but still the lowest single number in Post-ABC polls since 1983. Political independents continue to make up the largest group, at 42 percent of respondents; 33 percent call themselves Democrats.

The wide gap in partisan leanings and the lack of confidence in the GOP carries into early assessments of the November 2010 midterm elections: Fifty-one percent say they would back the Democratic candidate in their congressional district if the elections were held now, while 39 percent would vote for the Republican. Independents split 45 percent for the Democrat, 41 percent for the Republican.

The poll was conducted by conventional and cellular telephone from Oct. 15 to 19 among a random sample of 1,004 adults. The margin of sampling error for the full poll is plus or minus three percentage points.

Legislation - Health Care: U.S. Senator Bernie Sanders (Vermont)

2009-10-30T10:21:00.000-07:00

Legislation - Health Care: U.S. Senator Bernie Sanders (Vermont)

Mad as Hell Doctors rally in Nashville in front of HCA headquarters

2009-09-21T20:50:00.000-07:00

I wondered if I would feel guilty about protesting in front of HCA since I worked for HCA for about 9 years, but I didnt. It was actually pretty cathartic. I shouted SINGLE PAYER NOW and sang songs about the evils of our insurance industry and had a great time with people of like mind about health care in America. On that note, most of them were physicians, nurses and union leaders. I found that very telling as it concerns the entire debate. The providers are disgusted with the inhumanity. I loved the quote they said at the rally "Of all the forms of inequality injustice in healthcare is the most shocking & inhumane" by. Dr Martin Luther King Jr. It amazes me that more people are disgusted too.

I blame the media for not getting the truth out there. I blame the insurance industry for spending 20 billion this year on fighting health care reform. I blame big pharma for spending 20 billion on fighting healthcare reform. I don't blame the people as I feel unless you have a large view of healthcare the whole issue is very difficult to understand. It is probably difficult to see the relationship between health outcomes and fee for service. I really didn't get it until recently when I saw procedures abused and ordered without clinical indication. After the 100th CT of the brain on a person who had no clinical indication I realized, hey, wow, we are doing this to make money!!! It was a light turning on moment and I felt very disgusted. We were irradiating peoples brains for profit and increasing their risk for brain cancer!! Unbelieveable!

Anyway, I really don't have much more time to blog tonight but I just wanted to say this "do you really believe that Corporate CEOs have your best interest in mind when they decide how much your life and health is worth?"

Mad-As-Hell Doctors On Cross-Country Tour with a Mission Read more at: http://www.huffingtonpost.com/michele-swenson/imad-as-hell-doctorsi-on_b_286591.html

2009-09-21T08:24:00.001-07:00

They have been ostracized and marginalized in the great U.S. health care reform debate, but now a group of doctors, many from Physicians for a National Health Care Program, are hitting the road and taking action, and they visited Denver on September 14. They will arrive in Washington on September 30 in time for a rally in Lafayette Park, next to the White House.

Doctors and others demonstrate for single-payer

Retired physician Dr. Joe Eusterman calls single-payer health care the "fiscally conservative, socially responsible" health care reform. Private insurance is simply not sustainable. When he encountered Wendell Potter, former CIGNA executive, at a recent rally, Potter told him there should be no place for insurances profiteering from primary health care. Dr. Eusterman notes that the Swiss and most other industrial nations don't tolerate for-profit primary care. He cites a recent study by the California Nurses Association demonstrating that a family of four with an annual income of $56,000 would pay just $2,700 per year for health care under HR 676, the proposed House bill for single-payer coverage.

A number of Colorado doctors lent their support to the traveling physicians. Dr. Cory Carroll, a solo family practice provider from Ft. Collins, describes a U.S. "nonsystem" of health care that is "destroying primary care." One of his patients has insurance with a $3,000 deductible, and thus refuses to have a diagnostic colonoscopy because he cannot afford it. Because government insurance payments are more timely and simple to file for, Dr. Carroll notes that 60% of his practice consists of Medicare recipients. Due to laborious, costly administrative paperwork required by private insurances, he predicts he is six months from dropping all commercial insurances.

The U.S. has good practitioners, but we don't get early treatment. "You can't get preventive care in an emergency room," said family practitioner, Dr. Eugene Uphoff. Through his three months in Yugoslavia post-medical school, he viewed a place where medical school is free, and no med student can choose a specialty until they have dedicated two years providing primary care in high-needs, rural areas. He notes it is not uncommon for new doctors in the U.S. to carry medical school debts of $250,000 to $300,000, one reason so many shun primary care for a higher-paying specialty.

A Canadian physician he recently met asked Dr. Bob Seward point blank, "Why don't you Americans take care of your own people?" Dr. Seward spent 15 years at a VA Hospital, where the care was good, and he was never told he could not order a test for a patient. The switchover to electronic records was tough, he said, but reaped many rewards. Though 100,000 vets were displaced by Hurricane Katrina, all of their medical records remained accessible.

Dr. Margaret Flowers flew to Denver to join the doctors' tour through a couple of cities. Dr. Flowers is one of the "Baucus 13" -- doctors, nurses, lawyers and other single-payer advocates who were arrested and charged with "disruption of Congress" after standing up before Senator Max Baucus and the Senate Finance Committee to ask that a single-payer advocate be permitted to testify. The May hearings were intended ostensibly to listen to a representative cross-section of health care stakeholders, but inexplicably marginalized the single-payer model. On June 11 Flowers was finally granted the right to testify before the Senate HELP Committee.

Dr. Flowers left her pediatric practice in Maryland a couple of years ago to work for single-payer health care reform full time. Lack of political will is the only obstacle she sees to meaningful reform. She reminds everyone that the Weinder Amendment presents an opportunity for our representatives to vote for HR 676, a Medicare-for-All reform model after the House reconvenes in September.

The doctors plan visits to congressional leaders on October 1, and intend to request a meeting with President Obama in Washington. Their message to legislators, stated on their website, is to reboot the conversation, and use HR 676 as a starting point for a new health care conversation. Assemble a team of the "best minds among health care professionals" to present a single-payer proposal to Congress. With concerns about deficit spending, single-payer remains the only model that saves enough money to provide comprehensive health care access to all -- a point that has been glossed over in Washington.

The doctors ask that white ribbons be worn and tied wherever visible. If you are in Washington tie a ribbon to the White House fence and take a picture and share it with them, suggests Margaret Flowers. The ribbons demonstrate the dire need for action in memory of the 60 people a day who die without health care access in the U.S.

For more news and commentary from Colorado, check out HuffPost's just-launched Denver section.

Registered Nurses Association of Ontario (RNAO). Breastfeeding best practice guidelines for nurses: supplement. Toronto (ON)

2009-09-18T16:40:00.000-07:00

MAJOR RECOMMENDATIONS

Note from the National Guideline Clearinghouse (NGC): In March 2007, the Registered Nurses Association of Ontario amended the current practice recommendations for this topic. Through the review process, no recommendations were deleted. These have been noted below as "changed" or "unchanged" or "new."

The levels of evidence supporting the recommendations (Level I, II-1, II-2, II-3, III) are defined at the end of the "Major Recommendations" field.

Practice Recommendations

Recommendation 1 (Changed March 2007)

Nurses in all practice settings, endorse the Baby-Friendly™ Hospital Initiative (BFHI), which was jointly launched in 1992 by the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) and the Baby-Friendly Initiative in Community Health Services (Breastfeeding Committee for Canada). The BFHI directs health care facilities to meet the "Ten Steps to Successful Breastfeeding". (Level of Evidence II-3)

Recommendation 1.1 (Level of Evidence III) (Unchanged)

Nurses have a role in advocating for "breastfeeding friendly" environments by:

Advocating for supportive facilities and systems such as day-care facilities, "mother and baby" areas for breastfeeding, public breastfeeding areas, 24-hour help for families having difficulties in breastfeeding
Promoting community action in breastfeeding

Recommendation 2 (Unchanged)

Nurses and health care practice settings endorse the World Health Organization (WHO) recommendation for exclusive breastfeeding for the first six months, with introduction of complementary foods and continued breastfeeding up to two years and beyond thereafter. (Level of Evidence I)

Recommendation 3 (Changed March 2007)

Nurses should perform a comprehensive breastfeeding assessment of mother/baby/family, both prenatally and postnatally, to facilitate intervention and the development of a breastfeeding plan. (Level of Evidence II-3)

Recommendation 3.1 (Level of Evidence III) (Unchanged)

Key components of the prenatal assessment should include:

Personal and demographic variables that may influence breastfeeding rates
Intent to breastfeed
Access to support for breastfeeding, including significant others and peers
Attitude about breastfeeding among health care providers, significant others and peers
Physical factors, including breasts and nipples, that may affect a woman's ability to breastfeed

Recommendation 3.2 (Level of Evidence III except where noted) (Changed March 2007)

Key components of the postnatal assessment should include:

Intrapartum practices and interventions including medications
Level of maternal physical discomfort
Observation of positioning, latching, and sucking
Signs of milk transfer
Parental ability to identify infant feeding cues
Mother-infant interaction and maternal response to feeding cues
Maternal perception of infant satisfaction/satiety cues
Woman's ability to identify significant others who are available and supportive of the decision to breastfeed
Delivery experience
Infant physical assessment
Maternal breastfeeding self-efficacy (Level of Evidence I)

Recommendation 4 (Changed March 2007)

Nurses should provide informational support to couples during the childbearing age, as well as to expectant mothers/couples/families and assist them in making informed decisions regarding breastfeeding. Education should include, as a minimum, the following:

Benefits of breastfeeding (Level I)
Lifestyle issues (Level III)
Milk production (Level I)
Breastfeeding positions (Level I)
Latching/milk transfer (Level I)
Prevention and management of problems (Level III)
Medical interventions (Level III)
When to seek help (Level III)
Where to get additional information and resources (Level III)
Benefits of skin to skin contact (Level III)
Recognizing feeding cues (Level III)

Recommendation 4.1 (New March 2007)

Women's partners should be encouraged to attend breastfeeding education classes (Level of Evidence I)

Recommendation 5 (Changed March 2007)

Nurses should perform a comprehensive breastfeeding assessment of mother/baby prior to hospital discharge (Level of III)

Recommendation 5.1 (Unchanged)

If mother and baby are discharged within 48 hours of birth, there must be a face-to-face follow up assessment conducted within 48 hours of discharge by a qualified health care professional, such as a Public Health Nurse or Community Nurse specializing in maternal/newborn care. (Level of Evidence III)

Recommendation 5.2 (Changed March 2007)

Discharge of low-risk mothers and infants after 48 hours may be followed by a telephone call within 48 hours of discharge, rather than a home visit. (Level of Evidence I)

Recommendation 6 (Changed March 2007)

Nurses should provide information, emotional and physical support to breastfeeding mothers with an attitude that conveys support for breastfeeding. (Level of Evidence II-3)

Recommendation 7 (Changed March 2007)

Nurses should support local peer support breastfeeding programs, ensuring that women are provided with peer support resources. (Level of Evidence I)

Recommendation 8 (New March 2007)

Nurses should initiate skin to skin contact between mother and infant immediately after birth as part of ongoing, routine care. (Level of Evidence II-2)

Education Recommendations

Recommendation 9 (Changed March 2007)

Organizations must ensure that nurses providing breastfeeding support receive education appropriate to their role in breastfeeding in order to develop the knowledge, skill and attitudes to implement breastfeeding policy and to support breastfeeding mothers. (Level of Evidence III)

Organization and Policy Recommendations

Recommendation 10 (Changed March 2007)

Practice settings/organizations should work towards Baby Friendly Initiative designation as part of a comprehensive plan towards improving breastfeeding outcomes. (Level of Evidence I)

Recommendation 11 (Changed March 2007)

Practice settings should evaluate the effectiveness of their breastfeeding support on rates of initiation, duration and exclusivity of breastfeeding.(Level of Evidence III)

Recommendation 12 (Changed March 2007)

Organizations should establish and support peer support programs. (Level of Evidence I)

Recommendation 13 (Unchanged)

Nursing best practice guidelines can be successfully implemented only when there are adequate planning, resources, organizational, and administrative support, and appropriate facilitation.

Organizations may develop a plan for implementation that includes:

An assessment of organizational readiness and barriers to education
Involvement of all members (whether in a direct or indirect supportive function) who will contribute to the implementation process
Dedication of a qualified individual to provide the support needed for the education and implementation process
Ongoing opportunities for discussion and education to reinforce the importance of best practices
Opportunities for reflection on personal and organizational experience in implementing guidelines

(Level of Evidence III)

Refer to the "Description of the Implementation Strategy" field for more information.

Definitions:

Level I: Evidence obtained from at least one properly designed randomized controlled trial, plus consensus of panel

Level II-1: Evidence obtained from well-designed controlled trials without randomization, plus consensus of panel

Level II-2: Evidence obtained from well-designed cohort or case-control analytic studies, preferably for more than one centre or research group, plus consensus of panel

Level II-3: Evidence from multiple time series with or without the intervention. Dramatic results in uncontrolled experiments (such as results of the introduction of penicillin treatment in the 1940s) could also be regarded as this type of evidence, plus consensus of panel

Level III: Opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees, plus consensus of panel

CLINICAL ALGORITHM(S)

An algorithm is provided in the original guideline document for an immediate postpartum decision tree.

Mad As Hell Doctors press case for single-payer health care at Minnesota Capitol

2009-09-17T14:19:00.000-07:00

By Casey Selix | Thursday, Sept. 17, 2009

Could Minnesota be the next Saskatchewan in the single-payer health care movement?

The possibility was raised Wednesday during the two-hour Mad As Hell Doctors rally in the state Capitol rotunda.

In 1947, sparsely populated Saskatchewan became the first Canadian province to offer a universal hospitalization insurance program in North America. In 1962, it created the first universal Medicare program in North America, blazing the trail for the rest of Canada to eventually approve a national health service.

"This is about movement-building," said U.S. Rep. Dennis Kucinich, D-Ohio, who spoke to the rally via telephone. "The day will arrive when health care is a civil right, and if there's one place in the nation that can make this happen, it's Minnesota."

Not if state Rep. Tom Emmers, R-Delano, has any say in the matter. On Monday, the gubernatorial candidate and two other lawmakers said they would introduce a state constitutional amendment to "protect the freedom of personal choice in health care.''

Effort to protect single-payer option for states
Kucinich is sponsor of an amendment to federal health care-reform legislation that would protect states' rights if they want to pursue their own single-payer plans. State Sen. John Marty, DFL-Roseville, a candidate for governor, and Rep. David Bly, DFL-Northfield, are co-authors of the Minnesota Health Plan, a single-payer health care program that would cover necessary services for Minnesotans from cradle to grave. The legislation has 71 co-sponsors.

The Mad As Hell Doctors left Oregon Sept. 8 on a 26-city road trip en route to Washington, D.C., where they hope to meet with President Barack Obama to lobby for a single-payer, or Medicare for All, plan. Obama hasn't said yes yet, but the White House has started blocking emails of the group's form letters. About 5,000 emails urging Obama to meet with the doctors had been sent at last check, said Dr. Paul Hochfeld, of Corvallis, Ore., who urged rally attendees to send emails from their own addresses.

Hochfeld, producer of the "Health, Money and Fear" documentaryfeatured on MinnPost in July, said the White House called to find out when the form letter would be removed from the site because they were being inundated.

"We replied we would be delighted to do that as soon as President Obama agrees to meet with the Mad As Hell Doctors and have a discussion about single-payer," Hochfeld told the crowd.

That brought a round of applause and cheers from 100 or so folks in the rotunda.

The rally came four days after Obama visited Minnesota to push his health-care reform package, which includes a public option or insurance exchange but not a government-run single-payer plan.

Visits to Mankato and the Capitol
The Mad As Hell Doctors stopped at a Mankato church on Wednesday before arriving in St. Paul and parking their Winnebago in front of the Capitol, within the sight line of Republican Gov. Tim Pawlenty's office. Pawlenty, considered a 2012 presidential contender, has been critical of Obama's and Democrats' health-care reform proposals.

In an interview before the rally, Hochfeld acknowledged that single-payer is a long shot in this Congress. The group would like to see a presidential commission look at health care "objectively — with the insurance companies and stakeholders out of the room."

"When you look at the facts, the only reason single payer is not being considered is because of our political process," he said. "I'm not mad about health care — I'm mad about our political process."

If nothing else, he told MinnPost, the national debate will be an opportunity to make lemonade out of lemons. "If we don't get single-payer out of this Congress, and I don't think we're going to get single-payer out of this Congress, we'll be making lemonade. … We'll use health care as the poster child for why we need campaign finance reform and why we need to not give corporations any more rights over people."

'37th in health outcomes'
The doctors believe that a single-payer system is the best route to universal health care and that it would allow their profession to focus more on patients instead of the varying claim requirements of 1,300 health insurance companies in the nation.

One by one, doctors explained to the crowd why they're mad as hell about the state of our health-care system. Here are a few:

"I'm mad as hell when we're ranked by the World Health Organization as 37th in health outcomes and our nation spends twice as much on health care," said Dr. Marc Sapir of Alameda, Calif.

MinnPost photo by Casey SelixMinnesota Health Plan advocate Bernice Vetsch asks Tom Kelly, right, of the Minnesota Nurses Association to sign a petition Wednesday in the Capitol rotunda before the Mad As Hell Doctors rally begins.

Retired internist Robert Seward of Oregon, who once worked for the VA Hospital in St. Cloud, Minn.: "I'm mad because Americans are going bankrupt from health-care bills."

Dr. Joe Eusterman of Portland, who went to the University of Minnesota's medical school: "I'm mad as hell because of the lies and fear-mongering being used by the status-quo folks."

Not just doctors are mad. Mad As Hell Nurses from Minnesota spoke, too.

'Discharge instructions'
Emergency room nurse Eileen Weber gave some "discharge instructions": Support the Kucinich amendment. Attend the town hall of Republican Rep. John Kline on Friday night in Lakeville. Support "the champions" of single-payer legislation in Minnesota, including Marty, Bly and other lawmakers attending the rally.

Rally attendees also got to express their anger in a cheer led by Mad As Hell Doctors' creative director Adam Klugman. The group's name, he explained, comes from the 1976 movie "Network," when a fired TV anchor becomes so anguished that he yells out the window: "I'm mad as hell and I'm not going to take it anymore."

Klugman got the crowd to raise their voices in the echo chamber-like rotunda: "I'm mad as hell and I'm not going to take it anymore!"

Single-payer advocate and Rep. Keith Ellison, D-Minneapolis, also spoke to the group by telephone. "Sixty-three percent of doctors support the public option. … I want to let you know we are rock-solid — we won't vote for anything that doesn't include a public option."

As for state Republican lawmakers' plan to protect personal choices in health care?

"They're thinking health insurance equals health care, and they're two different things," Marty told MinnPost. "Under health insurance, a lot of people don't get health care" because of the expenses and restrictions.

As for Minnesota becoming the next Saskatchewan? "We hope Minnesota can play a lead role in that," Marty said.

Wednesday's rally was sponsored by the Minnesota chapter of Physicians for a National Health Plan, which has more than 400 members in Minnesota.

Next stop for the Mad As Hell Doctors: Madison, Wis.

Casey Selix, a news editor and staff writer for MinnPost.com, can be reached at cselix[at]minnpost.com.

Obamaâs Health Care Speech

2009-09-13T02:21:00.001-07:00

Obamaâs Health Care Speech

Shared via AddThis

Physicans supporting single payer.

2009-09-13T02:10:00.000-07:00

Health care La Grande man joins ‘Mad as Hell Doctors’ on caravan to D.C.

Written by Tristen Knight, The Observer September 11, 2009 03:43 pm

A group of Oregon doctors got an enthusiastic send-off Tuesday at Pioneer Courthouse Square in Portland as they began a national tour from Oregon to Washington, D.C., to urge Congress and the Obama administration to consider all options before settling on a plan to fix the health care system.

They call themselves the “Mad as Hell Doctors.” They are traveling across the nation to promote a single-payer health care plan.

“We believe that we should have an affordable, universal heath insurance system that covers everybody in the United States by putting everyone in the same risk pool,” said Bill Whitaker, a retired social worker from La Grande who is traveling with the doctors to help promote the cause. “There is nearly 47 million people who have no health insurance at all.”

Paul Hochfeld, an emergency room physician from Corvallis, said our nation’s health care system uses too many unnecessary drugs, specialists and tests that’s bloating the system financially.

“The people that are making decisions on our health care system are making the decision on what makes the most profits,” Hochfeld told KATU news.

Federal spending for health care totaled more than $600 billion in 2005 and keeps doubling every year, according to the U.S. Office of Management and Budget. The cost is expected to reach as high as $4.3 trillion by 2017.

“It costs nearly twice as much per person to deliver health care in the U.S. as it does in any other industrialized nation,” said Whitaker.

Not only are Americans spending more on health care, but out of the other 23 industrialized countries, the U.S. has the highest infant mortality rate, similar to Poland and Hungary, according to the Commonwealth Fund Scorecard in 2006. The U.S. also ranked among the bottom in health life expectancy at age 60, meaning Americans spend more years living in poor health than living happy, healthy lives.

“We’ve relied on a private system of health insurance tied to employment, whereas other countries simply say health insurance is a right to every person in their country,” said Whitaker.

With a custom-painted RV called the “Care-A-Van”, the group is traveling to Washington, D.C., stopping in major cities to conduct rallies, attend meetings, hold discussion panels and meet with local and national press to raise awareness.

To keep the buzz going during the trip, the group has made Facebook, YouTube and Twitter pages that it plans on updating daily. They also will upload videos on their website showing the days’ events.

They also hope to meet with President Barack Obama and rally in Washington, D.C., on Oct. 1.

“On Sept. 30, we will be in Gettysburg, Pa., and there we expect a large number of people with their own vehicles for the final trip to the White House,” said Whitaker.

The Mad as Hell Doctors have already been in contact with public officials in Washington and have secured meetings with some members of Congress. They also have a request to see the president, but their first request was denied, according to the organization’s website.

While there has been some resistance from the White House so far, the Mad as Hell Doctors are confident that as the road trip continues, their support will grow.

“We’ve already had a lot of support and the trip is just starting,” said Whitaker.

While many people support universal heath care, some are concerned about where the money would come from and how much control the government would have. But the Mad as Hell Doctors think the new system wouldn’t change as much as people think.

“A single-payer system would not change the delivery of health care at all — doctors would still be private individuals and working for private practices,” said Whitaker. “The only difference would be instead of filling out forms for the 200 or so insurance companies, they would receive their payment directly from one payer.”

Cheryl Simpson of La Grande, a social activist and a retired executive director of Idaho’s End of Life Coalition, a statewide advocacy group that promotes quality care at the end of life, agrees with Whitaker that there needs to be change.

“I’m mad as hell because a diagnoses of a life-threatening condition, such as cancer, is also a diagnoses of lost health insurance,” said Simpson. “If at any point in time they lose their employment or another situation arises, they will never get health insurance again, and that’s just not fair.”

For more information, visit www.madashelldoctors.com.

Please see my firend's blog Cup of Joe Powell, The Medical Industrial Complex

2009-09-08T04:05:00.000-07:00

http://cupofjoepowell.blogspot.com/2009/09/medical-industrial-complex.html

A brilliant post and I think it is worthy of praise.

As I thought: The notion of exposing young children to infections in a bid to protect them from later allergies is wrong, latest research suggests.

2009-09-08T03:47:00.000-07:00

http://news.bbc.co.uk/2/hi/health/8241774.stm

The decades-old "hygiene hypothesis" holds that early exposure to microbes somehow challenges the immune system and strengthens it against allergies.

Studies have shown children exposed to bugs by older siblings or attending nursery cut their future allergy risk.

But new work published by the American Thoracic Society casts doubt on this.

No benefit

The study by Dutch investigators at the Erasmus University found although children in day care got more colds and other infections, they were just as likely as other children to go on to develop asthma or another allergy by the age of eight.

There is some truth in the hygiene hypothesis

A spokeswoman from Allergy UK

The children who went to nursery and who had older had more than quadruple the risk of frequent chest infections and double the risk of wheezing in early life, with no obvious pay off in terms of later protection from allergy.

The infections may, therefore, do more harm than good, contrary to common belief, the authors told the American Journal of Respiratory and Critical Care Medicine.

Lead author of the study on 4,000 children, Dr Johan de Jongste, said: "Early day care should not be promoted for reasons of preventing asthma and allergy.

"Early day care merely seems to shift the burden of respiratory morbidity to an earlier age where it is more troublesome than at a later age."

Other experts have questioned if we need exposure to dirt and germs to build a balanced and healthy immune system.

Too clean?

Experience shows children who grow up on farms are less likely to develop allergies like hay fever and asthma.

And there is the belief that too much cleanliness is not a good thing, and our excessive use of disinfectant products is partly to blame for the recent allergy boom.

But Professor Sally Bloomfield from the International Scientific Forum on Home Hygiene disagrees. She said: "There is no evidence at all for this. However much we clean our homes we are still constantly exposed to microbes."

A spokeswoman from Allergy UK said: "There is some truth in the hygiene hypothesis. Certainly, little Johnny playing in the mud and growing up on a farm may be more healthy than other children. And we are probably mollycoddling our children a little too much.

"But allergies run in families. In susceptible individuals, there is something in their environment that triggers the allergy. For asthma, that could be a dusty home."

Dr Elaine Vickers of Asthma UK said: "The hygiene hypothesis is a hot topic of debate in the research community.

"Whatever the truth, the best advice we can currently give to parents is not to smoke around their children and make sure they have a balanced diet and get plenty of exercise."

France Fights Universal Care's High Cost

2009-09-06T15:01:00.001-07:00

By DAVID GAUTHIER-VILLARS

When Laure Cuccarolo went into early labor on a recent Sunday night in a village in southern France, her only choice was to ask the local fire brigade to whisk her to a hospital 30 miles away. A closer one had been shuttered by cost cuts in France's universal health system.

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Doctors, trade unions and others have called national protests against French health-care cutbacks this year. One petition signed by prominent physicians said they feared the intent of the reform was to turn health care into a 'lucrative business' rather than a public service.

Ms. Cuccarolo's little girl was born in a firetruck.

France claims it long ago achieved much of what today's U.S. health-care overhaul is seeking: It covers everyone, and provides what supporters say is high-quality care. But soaring costs are pushing the system into crisis. The result: As Congress fights over whether America should be more like France, the French government is trying to borrow U.S. tactics.

In recent months, France imposed American-style "co-pays" on patients to try to throttle back prescription-drug costs and forced state hospitals to crack down on expenses. "A hospital doesn't need to be money-losing to provide good-quality treatment," President Nicolas Sarkozy thundered in a recent speech to doctors.

And service cuts -- such as the closure of a maternity ward near Ms. Cuccarolo's home -- are prompting complaints from patients, doctors and nurses that care is being rationed. That concern echos worries among some Americans that the U.S. changes could lead to rationing.

The French system's fragile solvency shows how tough it is to provide universal coverage while controlling costs, the professed twin goals of President Barack Obama's proposed overhaul.

French taxpayers fund a state health insurer, Assurance Maladie, proportionally to their income, and patients get treatment even if they can't pay for it. France spends 11% of national output on health services, compared with 17% in the U.S., and routinely outranks the U.S. in infant mortality and some other health measures.

The problem is that Assurance Maladie has been in the red since 1989. This year the annual shortfall is expected to reach €9.4 billion ($13.5 billion), and €15 billion in 2010, or roughly 10% of its budget.

France's woes provide grist to critics of Mr. Obama and the Democrats' vision of a new public health plan to compete with private health insurers. Republicans argue that tens of millions of Americans would leave their employer-provided coverage for the cheaper, public option, bankrupting the federal government.

Despite the structural differences between the U.S. and French systems, both face similar root problems: rising drug costs, aging populations and growing unemployment, albeit for slightly different reasons. In the U.S., being unemployed means you might lose your coverage; in France, it means less tax money flowing into Assurance Maladie's coffers.

France faces a major obstacle to its reforms: French people consider access to health care a societal right, and any effort to cut coverage can lead to a big fight.

For instance, in France, people with long-term diseases get 100% coverage (similar to, say, Medicare for patients with end-stage kidney diseases). The government proposed trimming coverage not directly related to a patient's primary illness -- a sore throat for someone with diabetes, for example. The proposal created such public outcry that French Health Minister Roselyne Bachelot later said the 100% coverage rule was "set in stone."

Health Expenditures

Total expenditure on health in 2007, as a percentage of GDP.

Australia	8.7%†
Austria	10.1%
Belgium	10.2%*
Canada	10.1%
Czech Republic	6.8%
Denmark	9.8%
Finland	8.2%
France	11.0%
Germany	10.4%
Greece	9.6%
Hungary	7.4%
Iceland	9.3%
Ireland	7.6%
Italy	8.7%
Japan	8.1%†
Korea	6.8%
Luxembourg	7.3%†*
Mexico	5.9%
Netherlands	9.8%*
New Zealand	9.2%
Norway	8.9%
Poland	6.4%
Portugal	9.9%†
Slovak Republic	7.7%
Spain	8.5%
Sweden	9.1%
Switzerland	10.8%*
Turkey	5.7%‡
United Kingdom	8.4%
United States	16.0%

* Estimated

† For 2006

‡ For 2005

Source: OECD Health Data 2009

"French people are so attached to their health-insurance system that they almost never support changes," says Frédéric Van Roekeghem, Assurance Maladie's director.

Both patients and doctors say they feel the effects of Mr. Sarkozy's cuts. They certainly had an impact on Ms. Cuccarolo of the firetruck birth.

She lives near the medieval town of Figeac, in southern France. The maternity ward of the public hospital there was closed in June as part of a nationwide effort to close smaller, less efficient units. In 2008, fewer than 270 babies were born at the Figeac maternity ward, below the annual minimum required of 300, says Fabien Chanabas, deputy director of the local public hospital.

"We were providing good-quality obstetric services," he says. "But at a very high cost." Since the maternity closed, he says, the hospital narrowed its deficit and began reallocating resources toward geriatric services, which are in high demand.

In the Figeac region, however, people feel short-changed. "Until the 1960s, many women delivered their babies at home," says Michel Delpech, mayor of the village where Ms. Cuccarolo lives. "The opening of the Figeac maternity was big progress. Its closure is perceived as a regression."

For Ms. Cuccarolo, it meant she would have to drive to Cahors, about 30 miles away. "That's fine when you can plan in advance," she says. "But my little girl came a month earlier than expected."

France launched its first national health-care system in 1945. World War II had left the country in ruins, and private insurers were weak. The idea: Create a single health insurer and make it compulsory for all companies and workers to pay premiums to it based on a percentage of salaries. Patients can choose their own doctors, and -- unlike the U.S., where private health insurers can have a say -- doctors can prescribe any therapy or drug without approval of the national health insurance.

Private insurers, both for-profit and not-for-profit, continued to exist, providing optional benefits such as prescription sunglasses, orthodontics care or individual hospital rooms.

At a time when the U.S. is considering ways of providing coverage for its entire population, France's blending of public and private medical structures offers important lessons, says Victor Rodwin, professor of health policy and management at New York University's Wagner School. The French managed to design a universal system incorporating physician choice and a mix of public and private service providers, without it being "a monolithic system of Soviet variety," he says.

It took decades before the pieces fell into place. Only in 1999 did legislation mandate that anyone with a regular residence permit is entitled to health benefits with no strings attached. Also that year, France clarified rules for illegal residents: Those who can justify more than three months of presence on French territory, and don't have financial resources, can receive full coverage.

That made the system universal.

In the U.S., health-overhaul bills don't attempt to cover illegal immigrants. Doing so would increase costs and is considered politically difficult.

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A protest in April in Caen, France.

Today, Assurance Maladie covers about 88% of France's population of 65 million. The remaining 12%, mainly farmers and shop owners, get coverage through other mandatory insurance plans, some of which are heavily government-subsidized. About 90% of the population subscribes to supplemental private health-care plans.

Proponents of the private-based U.S. health system argue that competition between insurers helps provide patients with the best possible service. In France, however, Assurance Maladie says its dominant position is its best asset to manage risks and keep doctors in check.

"Here, we spread health risks on a very large base," says Mr. Van Roekeghem of Assurance Maladie.

Journal Community

DISCUSS

“Even with all its disadvantages, the French national health-care plan is glaringly better and more cost effective than ours.”

— David Wayne Osedach

The quasi-monopoly of Assurance Maladie makes it the country's largest buyer of medical services. That gives it clout to keep the fees charged by doctors low. About 90% of general practitioners in France have an agreement with Assurance Maladie specifying that they can't charge more than €22 (about $32) for a consultation. For house calls they can add €3.50 to the bill.

By comparison, under Medicare, doctors are paid $91.97 for a first visit and $124.97 for a moderately complex consultation, according to the American College of Physicians.

In France, "If you are in medical care for the money, you'd better change jobs," says Marc Lanfranchi, a general practitioner from Nancy, an eastern town. On the other hand, medical school is paid for by the government, and malpractice insurance is much cheaper.

In 2000, the World Health Organization ranked France first in a one-time study of the health-care services of 191 countries. The U.S. placed 37th.

Financial pain has long dogged the French plan. As in the U.S., demand for care is growing faster than the economy as people take better care of themselves and new treatments become available.

Tilting the Balance

Since France began building up its universal health-care system, in 1945, successive governments have been faced with the challenge of balancing the national health insurance budget without going back on the original promise of taking good care of the entire population. For the past three decades, small reductions in health care coverage and incremental increases in health-care taxes have been the main recipe.

1976 -- Coverage of ambulance costs is reduced.

1977 -- Coverage of some medications is reduced. Some hospital beds are closed.

1982 -- Patients must pay a "moderating fee" of 20 francs (3 euros) out of pocket when they are hospitalized.

1985 -- Coverage of some paramedical procedures is reduced.

1986 -- Increase in health-care payroll taxes.

1987 -- Letters sent to the national health insurance must be stamped.

1988 -- Creation of a special tax on medication advertising to help fund health care.

1990 -- Introduction of the CSG, a new tax levied on all types of income to help fund health care.

1991 -- Increase in health-care taxes levied on payroll.

1993 -- Increase in CSG rate. Coverage of doctor consultation is reduced.

1996 -- Increase in health-care taxes. A new health-care tax is levied on private health-care plans.

1999 -- New tax levied on drug makers when their revenue exceeds a pre-defined level.

2000 -- Doctors are required to explain to the national health insurance why they granted a worker sick leave.

2003 -- The "moderating fee," which was increased over time, is raised to 15 euros.

2004 -- Patients must register with a "preferred" general practitioner who will reroute them toward specialists when necessary, or face lower reimbursement for care.

2005 -- The national health insurance deducts 1 euro off doctor consultation fees before it starts calculating how much it must reimburse patients.

2008 -- The national health insurance deducts 50 cents off every pack of medicine before it starts calculating how much it must reimburse patients.

Source: WSJ research.

Since the 1970s, almost all successive French health ministers have tried to reduce expenses, but mostly managed to push through only minor cost cuts. For instance, in 1987, patients were required to put a stamp on letters they mailed to the national health insurer. Previously, postage was government-subsidized.

In 2004, France introduced a system under which patients must select a "preferred" general practitioner who then sends them onward to specialists when necessary. Under that policy -- similar to one used by many private U.S. health-care plans -- France's national health insurance reimburses only 30% of the bill, instead of the standard 70%, if patients consult a doctor other than the one they chose.

At the start, patients balked, saying it infringed on their right to consult the doctors of their choice. But the system is now credited for helping improve the coordination between primary and specialty care, which remains one of the main weakness in the U.S. health-care system.

In recent years, Assurance Maladie has focused on reducing high medicine bills. Just like U.S. insurers and pharmacy-benefit managers, France's national health insurer is promoting the use of cheaper generic drugs, penalizing patients when they don't use them by basing reimbursements on generic-drug prices.

The most important aspect of Mr. Sarkozy's latest health-care legislation, passed this summer, focuses on reducing costs at state hospitals. About two-thirds of France's hospitals are state-run, and they are seen as ripe for efficiency savings. Among other things, Mr. Sarkozy has asked them to hire more business managers and behave more like private companies, for instance, by balancing their budgets.

The proposals didn't go down well.

In April, some of France's most famous doctors signed a petition saying they feared Mr. Sarkozy would turn health care into a "lucrative business" rather than a public service.

In the U.S., hospitals are paid for each individual procedure. This system, called fee-for-service, is suspected of contributing to runaway costs because it doesn't give hospitals an incentive to limit the number of tests or procedures.

Ironically, France is actually in the midst of shifting to a fee-for-service system for its state-run hospitals. The hope is that it will be easier for the government to track if the money is being spent efficiently, compared with the old system of simply giving hospitals an annual lump-sum payment.

France's private hospitals are more cost-efficient. But state hospitals say it is unfair to compare the two, because state hospitals often handle complex cases that private hospitals can't.

"When a private hospital has trouble with a newborn baby, we are here to help, night and day," says Pascal Le Roux, a pediatrician at the state hospital in Le Havre, an industrial city in northern France. "Having people standing by costs money."

In theory, Assurance Maladie should be able to contain hospital costs the same way it does with doctors: by harnessing its position as the dominant payer in the health-care system. In practice, it doesn't work that way.

The state hospital of Le Havre, called Groupement Hospitalier du Havre, or GHH, has nearly 2,000 beds and is one of the most financially strapped in France. A 2002 report by France's health-inspection authority found that the hospital had a track record of falsifying accounts in order to obtain more state funds.

Philippe Paris was hired about two years ago to help fix the hospital's spiraling costs. He is cutting 173 jobs out of the staff of 3,543.

And he is trying to enforce working hours. "People don't work enough," he said. "If consultations are scheduled to begin at 8 a.m., that means 8 a.m. and not 11 a.m."

Yet even the smallest budget moves are proving controversial. Local residents are up in arms over a cost-cutting measure that makes patients pay €1.10 an hour to park at the hospital. "It's a scandal," says retired local Communist politician Gérard Eude. "It goes against the very idea of universal health care."

Kangaroo Care & The Amazing Power of Skin to Skin

2009-09-05T23:10:00.000-07:00

Mother’s Last Skin-to-Skin Goodbye Saves her 20 oz Baby

August 20, 2009 by Amy Philo

Source:
Lisa Arneill, Editor
Follow On Twitter: growingyourbaby

http://www.growingyourbaby.com/2007/12/07/parents-last-good-bye-saved-their-babys-life/

Parents ‘Last Good Bye’ Saved Their Baby’s Life
December 7, 2007
Sometimes a preemie doesn’t need to be hooked up to 10 different machines to be given the chance to survive.
When Carolyn Isbister put her 20oz baby on her chest for a cuddle, she thought that it would be the only chance she would ever have to hold her.
Doctors had told the parents that baby Rachel only had only minutes to live because her heart was beating once every ten seconds and she was not breathing.
Isbister remembers:
I didn’t want her to die being cold. So I lifted her out of her blanket and put her against my skin to warm her up. Her feet were so cold.
It was the only cuddle I was going to have with her, so I wanted to remember the moment.” Then something remarkable happened. The warmth of her mother’s skin kick started Rachael’s heart into beating properly, which allowed her to take little breaths of her own.
We couldn’t believe it – and neither could the doctors. She let out a tiny cry.
The doctors came in and said there was still no hope – but I wasn’t letting go of her. We had her blessed by the hospital chaplain, and waited for her to slip away. But she still hung on.
And then amazingly the pink color began to return to her cheeks. She literally was turning from gray to pink before our eyes, and she began to warm up too.
The sad part is that when the baby was born, doctors took one look at her and said ‘no’.
They didn’t even try to help her with her breathing as they said it would just prolong her dying. Everyone just gave up on her,” her mom remembered.
At 24 weeks a womb infection had led to her premature labor and birth and Isbister (who also has two children Samuel, 10, and Kirsten, 8 ) said, “We were terrified we were going to lose her. I had suffered three miscarriages before, so we didn’t think there was much hope.” When Rachael was born she was grey and lifeless.
Ian Laing, a consultant neonatologist at the hospital, said: “All the signs were that the little one was not going to make it and we took the decision to let mum have a cuddle as it was all we could do.
Two hours later the wee thing was crying. This is indeed a miracle baby and I have seen nothing like it in my 27 years of practice. I have not the slightest doubt that mother’s love saved her daughter.”
Rachael was moved onto a ventilator where she continued to make steady progress and was tube and syringe fed her mother’s pumped breastmilk.
Isbister said, “The doctors said that she had proved she was a fighter and that she now deserved some intensive care as there was some hope. She had done it all on her own – without any medical intervention or drugs. She had clung on to life – and it was all because of that cuddle. It had warmed up her body and regulated her heart and breathing enough for her to start fighting.
At 5 weeks she was taken off the ventilator and began breastfeeding on her own. At four months Rachel went home with her parents, weighing 8lbs – the same as any other healthy newborn. Because Rachel had suffered from a lack of oxygen doctors said there was a high risk of damage to her brain. But a scan showed no evidence of any problems and today Rachel is on par with her peers.
Rachel’s mom tells us, “She is doing so well. When we brought her home, the doctors told us that she was a remarkable little girl. And most of all, she just loves her cuddles. She will sleep for hours, just curled into my chest. It was that first cuddle which saved her life – and I’m just so glad I trusted my instinct and picked her up when I did. Otherwise she wouldn’t be here today.”

When a parent holds their baby on their chest, skin-to-skin, it is referred to as Kangaroo Mother Care.
The benefits for all babies of KMC are that they stabilize faster with skin-to-skin care than in an incubator (very few stabilize in an incubator well during the first six hours of life). KMC babies also have stable oxygen rates and breathing thanks to the steady regulation of Mother’s respiration. The heart rate is stable (mother’s heartbeat regulates baby’s heartbeat). The temperature is most stable on the mother – in skin-to-skin care mothers chest automatically warms to warm a cold baby, and mothers core temperature drops if her baby has a temperature.
Sleeping within an arm’s reach of baby (as long as a parent does not smoke) also regulates all of his physiological needs in the same way ~ they are kept steady thanks to Mom’s warm, even-paced body. We lose far fewer babies to prematurity, irregularity of breathing or heartbeat after birth, and SIDS all with the natural help of skin-to-skin holding, or Kangaroo Care.
Read More About skin-to-skin benefits for ALL babies (full term and premature) here: kangaroomothercare.com

For more stories by growyourbaby please visit their website. Story originally posted in 2007 and has been viewed more than 15,000 times on their site. Spread the word about this amazing story so that more babies can be saved!

Here’s a relevant article on their site about the research of Tim Oberlander on the effects of antidepressants on the unborn baby:http://www.growingyourbaby.com/2006/08/26/taking-antidepressants-while-pregnant-may-effect-baby/

Obama should heed Kennedy, press ahead with health reform - The Boston Globe

2009-09-05T20:40:00.001-07:00

Obama should heed Kennedy, press ahead with health reform - The Boston Globe

Posted using ShareThis

http://watergatesummer.blogspot.com/2009/09/what-to-twitter-and-share-on-fb-about.html

2009-09-04T08:02:00.000-07:00

http://watergatesummer.blogspot.com/2009/09/what-to-twitter-and-share-on-fb-about.html

Sadly We all Must Fight on, as 50 Million have NO Healthcare,22,000 Die per year with no Care (179,000 since 2001). So we must fight for all of us. Even those with Insurance are not safe from this Healthcare Crisis, or from Medical Debt. 62% of ALL bankruptcies are due to Medical Debt. 35 Million are on Food Stamps- remember that Many People are now choosing between Food and Meds. Now the Rumors are rampant- that Rahm has dumped the Public Option, and that Obama is "negogiating" with Olympia Snowe as she wants to set up a "Trigger" Plan. My Question is with so many Sick and Dying- WHY do we need at Trigger Plan. When is Enough Enough ?

There are Many Rallies and Town Meetings this week- Get out there...film and photo ...50 Million need us to be the Lion...
and Roar.
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MUST READ AND SHARE:::
CelluloidBlonde blogs the Stats in a Concise One Page , that is Staggering:
Sample:::500,000 People with Cancer are Currently Fighting the Disease with NO Insurance.The Sixth leading Cause of Death for NonElderly Adults is People dying without Healthcare.LINK:::http://celluloidblonde.wordpress.com/2009/08/25/condition-critical/
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The Truth about How Bad Is HealthCare Coverage is Unraveling in California.
(1) 1:5 Health Claims in California have been getting rejected. 22% of All Claims, Legal Authorities will now investigate, But More than 47 Million Dollars worth of Claims have been rejected. This Story is about theInvestigation of Denied Care and Claims. LINK: http://www.latimes.com/business/la-fi-insure4-2009sep04,0,4503502.story
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(2) This is an amazing Huffington Post article about how the Human Rights Aspect of this HCR debate has been missing, It is worth sharing and talking about. LINK:http://www.huffingtonpost.com/sameer-dossani/human-rights-missing-from_b_273006.html
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(3) This is a Twitter Link to Which Senators to Contact about the Public Option and where they stand. LINK: http://twitwall.com/view/?what=000E050B00
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(4) This is BlondeTwit's Post " Divided&Conquered", worth reading and sharing.
LINK: http://www.blondetwit.com/
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(5) This post is about a NY Physician that is trying to help, but is being shut down by the Government and Insurance Companies as he tries to provide Care to the Uninsured at a discount, giving them care they could afford. ( teabaggers were tweeting this with great glee ??!! )
LINK:http://www.crownheights.info/index.php?itemid=16213

Im taking the fish with me!!!

2009-09-04T07:46:00.000-07:00

http://www.youtube.com/watch?v=Hqip823vNmw&feature=player_embedded

Women need a single payer system.

2009-09-04T07:38:00.001-07:00

Health care is a fundamental human right, and ensuring access to quality, affordable and comprehensive health care within the United States is a moral imperative confronting our legislators today. Since 1993, the National Organization for Women has been a leader in the campaign for single-payer health care in the U.S. It is, as President Obama noted last week, the only way to ensure coverage for everyone.

Single-payer health care is particularly important for women. Women bear the brunt of this nation's broken health care system, and it's coming at us from multiple directions. Women are disproportionately under-insured in the U.S. because we tend to be clustered in part-time, non-union and other jobs that do not provide health care. When we do seek coverage on the open market, we are often charged more than men, even while many of us are deniedmaternity care. And because statistics show that women remain paid between 78 and 58 cents on the dollar compared to men, even those of us who are fortunate enough to receive employer-sponsored insurance are less likely to be able to pay premiums.

Moreover, the burden of caring for the sick has increasingly shifted from health care professionals to family caregivers. As insurance companies force hospitals to turn out patients shortly after major surgery, patients are sent home to be cared for by unpaid family members, predominantly women.

The best way to correct these problems is to enact single-payer health care, covering all women regardless of their employment status, immigration status or ability to pay. And while covering everyone, single-payer health care would also be significantly more cost-effective than the system we have now, because removing the profit-seeking insurance companies from the equation eliminates a huge portion of health care costs.

Despite what some of our elected officials might think, any public plan must cover all reproductive health services. Women have a right to full access to the complete range of reproductive health care services. This includes HIV/STD testing, maternity care, pre- and post-natal care, contraception and abortion.

The greed and dominance of the private health insurance industry is both a symptom of and a major contributor to the massive inequality that is entrenched in our society. Single-payer health care promotes health and economic justice for all.

Former Jasper County Republican Chairman on Single Payer -Jack Bernard

2009-08-31T05:56:00.001-07:00

By Jack Bernard
Ledger-Enquirer
August 23, 2009

I am a Republican, former chairman of the Republican Party in Jasper County, Ga., and chair of that county commission. Under our two-party system, it is easy to see why we Republicans oppose Democratic Party reform proposals. We are the opposition party and do not want them to get the political credit for solving a nasty problem.

Since the Democrats are in the driver’s seat, it is up to them to lead and bring their stragglers in line. However, the Democrats are fighting internally, failing to articulate a straightforward vision of the future or even one bill (Obamacare, if you will).

Republican pundits are sitting back and chuckling, as they always do when reform is mentioned, and repeating the same self-serving platitudes.

What amazes me is that no one is calling these individuals to account. In my view, it is unpatriotic to continue to lie to the American public about the situation facing us. Over the last 10 years, wages have gone up by about one-fourth. Health insurance premiums have gone up well over 100 percent. We cannot continue along this path to fiscal destruction. Inaction is not an option.

It is also against American values to mislead the public into believing that everyone can get good care even if they do not have insurance. The mark of a great nation is not how well it treats its privileged, but rather how well it treats its downtrodden. On this measure, we fail miserably; strange for a nation that prides itself on being the most religious democracy in the world.

Very few health or insurance professionals advocate for a single-payer system, the best way to control costs and ensure access. I hear all sorts of reasons: rationing (really, like HMOs do not do that now), paperwork (apparently insurance company bureaucracy does not count), socialism (come on — practitioners will still be independent and we all know it) and so forth. It is rare that we hear the underlying cause openly stated: greed. It will cut my income.

The members of Physicians for a National Health Plan are an exception to this rule. If you take a look at their Web site, www.pnhp.org, the rationale for a single-payer system is clearly articulated.

Universal Medicare will both control costs and achieve universal access to high quality care. Congressmen would get the same insurance as you and I. You better believe your coverage would be just as good as or better than what you are getting now.

The problem is not technical; it is political. It is high time we put the country ahead of ourselves and establish a single-payer system.

(Jack Bernard is CEO of Monticello (Ga.) Health Care Solutions and a former chairman of the Jasper County Commission and the Jasper County Republican Party.)

http://www.ledger-enquirer.com/sunday_voices/story/814348.html

Worker gets damages after breastfeeding firing

2009-08-29T22:31:00.001-07:00

Marina Chavez gave birth to her fourth child a month prematurely in April 2007 and returned to work at a Los Angeles-area taqueria 30 days later, needing the $7.55-an-hour cashier job to feed her family.

On her third night back, her boyfriend brought their newborn son to work and Chavez breastfed the child in their car during her lunch break.
The next night, she got a call from the company's general manager, Jaime Acosta, who, according to a state civil rights commission, told her he didn't want her back at work until she was done breastfeeding. When Chavez said she couldn't wait that long, Acosta replied that he didn't like her attitude and she was fired, the commission said.
Her dismissal has led to a precedent-setting ruling by the state Fair Employment and Housing Commission in San Francisco. The decision, made public last week, said punishing a female employee for breastfeeding during a work break amounts to sex discrimination.
"Breastfeeding, on her own break time, is an activity intrinsic to Chavez's sex, female, and also protected under California law," the commission said.
The commission also said her former employer, Acosta Tacos, had discriminated against Chavez by not holding her previous job open for her during her pregnancy leave, forcing her to work at different locations each night as openings occurred. The commission ordered the company to pay her $21,645 for lost wages and $20,000 for emotional distress, and to pay a $5,000 fine to the state for a willful civil rights violation.
"It is unconscionable that a working mother should be penalized for needing to feed her newborn baby," said Phyllis Cheng, director of the Department of Fair Employment and Housing, which represented Chavez before the commission.
That isn't what happened, Acosta said Friday. He said he fired Chavez for incompetence and insubordination, an assertion he also made to the commission, which didn't believe him.
"I did not fire her because she was breastfeeding," he said in an interview. "I just made a comment to her - 'Is it safe to be out here in the parking lot?' " If the law requires employers to allow breastfeeding, he said, "I have no problem with that."
Acosta said the small company, which owns three taquerias in Inglewood and Hawthorne, would appeal the ruling, but might have to file for bankruptcy because of the damage award.
A 2002 California law requires employers to provide a reasonable amount of break time for an employee who wants to breastfeed an infant child, unless a break would seriously disrupt the employer's operations. California also allows a mother to breastfeed her child "in any location, public or private."
No state court or agency had previously considered, however, whether denying the right to breastfeed amounts to sex discrimination. Awarding damages to an employee in such a case is rare if not unprecedented in the United States, said Loretta McCallister, spokeswoman for La Leche League, a support organization for breastfeeding women.
"That's teaching employers that there's nothing wrong with it," she said.

E-mail Bob Egelko at begelko@sfchronicle.com.

This article appeared on page C - 1 of the San Francisco Chronicle

Proud United Methodist

2009-08-24T08:22:00.000-07:00

I am more than glowing as I read the article you can find at this link:
http://gbgm-umc.org/global_news/full_article.cfm?articleid=5503

Why Women Need Single Payer By Gary Lapon

2009-08-24T05:42:00.000-07:00

Everybody In, Nobody Out

Why Women Need Single Payer

By GARY LAPON

"Women At Risk: Why Many Women Are Forgoing Needed Health Care," an issue brief released this month by the Commonwealth Fund, reveals the gender inequality of the U.S. health care system and illustrates the gross inability of the current private health insurance system to meet the needs of working class women and men.

Although the study doesn't call for it, it provides further evidence for the compelling case for "everybody in, nobody out" single payer health reform as necessary both to provide universal access to health care and as a blow against sexism.

Report authors Sheila D. Rustgi, Michelle M. Doty, and Sara R. Collings begin by placing their findings in the context of an economic crisis where millions of workers are losing their jobs (and with it their employer-provided health insurance) while "health care costs are rising at a rate of more than 6 percent per year...increasingly, health insurance and access to care are falling further out of reach for many working families."

Women are disproportionately affected because on average they "require more health care services [than men] during their reproductive years" and "have higher out-of-pocket medical costs." Considering that women are paid about 76 cents for every dollar a man makes, they face the triple burden of requiring more care, paying more each time they access care,and relying on less income to cover these costs.

Disturbingly, "in 2007, more than three of five adult women under age 65 reported a problem paying medical bills, a cost-related problem getting health care, or both." And this data, from before the onset of the current economic crisis, is likely much worse today.

While U.S. Census Bureau data shows that some 47 million (nearly 16 percent) of U.S. residents are uninsured, the inclusion of the underinsured--those who have insurance but "incur out-of-pocket health care costs" such as co-pays and premiums "that are high relative to their income"--reveals that health care woes are spread across a much broader section of the population.

According to the "Women at Risk" report, 75 percent of adults with yearly household income under $20,000 and 60 percent of those with household income between $20,000 and $39,999 "had gaps in their insurance coverage or were underinsured...in 2007, 45 percent of women and 39 percent of men were underinsured or uninsured for a time in the past year."

* * *

THE FINANCIAL burden of health care costs for the underinsured can be crushing, especially for those living paycheck to paycheck, and it's growing at a rapid rate. In 2007, 55 percent of women with household income under $20,000 spent at least 10 percent of their income on health care, up from 29 percent of those women in 2001, an increase of nearly 90 percent in just six years. The underinsured have coverage, but financial barriers mean they must at times go without needed care or choose between paying for care and other necessities such as food, rent, or debt payments.

According to the "Women at Risk" study, 67 percent of low-income women and 65 percent of moderate-income women responded "yes" when asked if, during 2007, because of cost they'd "not filled a prescription; skipped a medical test, treatment, or follow-up visit recommended by a doctor; not visited a doctor or clinic when they had a medical problem; or did not get needed specialist care." Working-class men fare better, but still face a crisis situation: for men in the same income brackets the percentages forgoing needed care are 57 percent and 52 percent, respectively.

Frequently, the un- and underinsured skip preventive care, such as cancer-screening: according to the Commonwealth report, "only 67 percent of underinsured women over the age of 50 received a mammogram in the past two years, compared with 85 percent of adequately insured women." Going without preventive care has tragic consequences: patients with treatable but dangerous diseases such as cancer and diabetes may go years without a diagnosis, only finding out about their condition when it's too late to prevent serious complications or even premature death.

According to Urban Institute findings based on Institute of Medicine methodology, 137,000 people died in the U.S. from 2000 to 2006 from a lack of health insurance. To put this in perspective, that is over 28 times the number of U.S. soldiers who've died in the wars in Iraq and Afghanistan, and 23,702 more than the number of U.S. residents murdered during those same six years.

The United States spends more on health care than any other country in the world, yet is the only advanced industrialized nation that does not provide universal access to care and thousands of poor and working class residents die each year as a result.

They die because health insurance giants maximize profits, which increased 170 percent from 2003-2007 to $12.6 billion for the industry leaders, by providing less care and passing more costs on to those who are insured, providing insufficient coverage to those who are underinsured, and refusing to cover those who cannot afford to pay enough in premiums for the insurance companies to make a profit.

Until the profit motive is removed and the insurance companies excluded by the introduction of a single-payer reform or system of socialized medicine, millions will continue to suffer from forgoing needed health care.

Proposed reforms that maintain a role for private insurance, such as the "health insurance mandate" reform (the Massachusetts model), under which everyone is required to purchase health insurance, even if they contain enough subsidies to insure everyone (and even in Massachusetts over 2 percent aren't covered) will amount to a massive public subsidy to the health insurance industry and fall short of providing universal health care.

As illustrated above, millions of the underinsured, those who have insurance but pay a prohibitively high percentage of their income in premiums and out-of-pocket costs, do not have access to the care they need. Having access to insurance is not the same as having access to care, and it is not enough to fill in the gaping cracks in the system.

Those who are oppressed and marginalized, such as low-income women, are more likely to fall through these cracks, or be "swept into them" (as described in Michael Moore's Sicko).

* * *

REPRODUCTION IS one of the main reasons women as a whole require a greater amount of health care than men. Women must pay for birth control, abortion services, prenatal, maternity, and post-partum care (before during, and immediately after the time of birth), and other services associated with choosing whether or not to have children or ensuring the health of mother and child.

According to a 2007 Thomson report for the March of Dimes entitled "The Healthcare Costs of Having a Baby," for the insured, the average vaginal birth in 2004 cost $7,737 (inclusive of prenatal and other care) while the average Cesarean section cost $10,958, the overwhelming majority paid for by the insurance company.

However, for the uninsured and underinsured, disproportionately low-income women, these costs are prohibitive and can have a devastating impact on the health of the woman and child. According to Dr. Jennifer L. Howse, president of the March of Dimes, "it is well documented that a lack of prenatal care is associated with poor birth outcomes, including prematurity and low birth-weight, and high out-of-pocket expenditures may discourage women from obtaining the care they need."

Control over reproduction is essential to winning equality for women. Working-class women who cannot afford birth control or an abortion when they so desire, do not have full control over their bodies and therefore cannot enjoy equality with men.

Similarly, this control is denied women who would like to have children but are discouraged or go without proper care because they lack adequate health insurance and cannot afford the costs associated with the care necessary to minimize health risks to mother and child.

For working-class women especially and for the working class as a whole, health-care costs associated with reproduction are one of the ways the capitalist class passes the cost burden of raising the next generation of workers onto the working class. The capitalist class wants workers to have more babies for the former to exploit for profits when the latter grow up, but would much rather the working class pay the costs and perform the unpaid labor to raise them.

The enactment of a system of universal health care, one that includes full funding for abortion (and a repeal of the Hyde Amendment restricting federal funding for abortion), would be a major victory for the women's rights movement, the labor movement (health care benefits are often used as a lever for employers to gain concessions from labor) and for the working class as a whole.

Today, according to a recent CBS/New York Times poll, 59 percent of Americans support government-provided national health insurance as opposed to 32 percent who think it should be left to the private sector. And numerous polls have shown that significant majorities of doctors support a single-payer system that eliminates the role of private health insurance.

Earlier this month, when nurses, doctors, and other "single-payer" advocates disrupted a Senate finance committee meeting on health care reform to ask why supporters of single-payer were not included and why committee chair Senator Max Baucus (D-Montana) refused to consider it, they were removed by police and arrested.

A government that would provide a seat at the table for health insurance executives who preside over a system that kills dozens every day by denying care, while arresting those who actually provide health care and speak for a majority of the population, is not going to pass single-payer unless pressured by a movement from below.

As Frederick Douglass wrote, "Without struggle, there is no progress." Supporters of women's and worker's rights should join the movement for single-payer health care, health care for all. Everybody in, nobody out!

Gary Lapon is an activist and healthcare worker in Western Massachusetts. This article originally appeared in the Socialist Worker.

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