Med Students Lobby for New Yorkers’ Health

Doctors must advocate for their patients’ health � with supervisors who approve procedures, for instance, or insurance companies that pay for services.

On Tuesday, dozens of doctors-to-be tried different advocacy skills � lobbying state lawmakers to advance proposals they believe will improve New Yorkers’ health.

“If we are not going to fight for our patients, who will?” Albany Medical College student Xin Guan asked a few dozen young adults in white coats who had stopped in the basement of the Legislative Office Building for coffee, bagels and a press briefing between their morning and afternoon visits to lawmakers.

It was the first Medical Student Advocacy Day, organized by Guan, originally from California, and two other second-year students from Albany Med, Ajay Major of Indiana and Phyllis Ying of Seattle.

Some 60 to 70 students from around the state joined them. A glance at the coats suggested most were from Albany Med, but some had traveled from several downstate schools, including Albert Einstein College of Medicine, SUNY Downstate Medical Center and Mt. Sinai Medical Center.

Guan, Major and Ying had prepped them with some activist training before the event. Lobbying representatives was a new activity for about half the students, they said.

While the group shared a concern for health issues, they spoke with legislators about proposals that interested them as individuals. Small groups organized around a few popular issues, including bills to provide universal health coverage for all New Yorkers, allow marijuana for medical use, and prohibit doctors from participating in the torture and improper treatment of prisoners.

Anti-hunger advocate Mark Dunlea gave the students a pep talk before they headed back out to meet their afternoon slate of legislators. Dunlea’s group, Hunger Action Network of New York State, works with a coalition of organizations that provide aid to low-income people who struggle with the costs of health care.

He told the students that their future profession would carry some weight with legislators. And he reminded them that legislators are public servants.

“Remember, these guys work for you,” he said.

Is Obamacare a Step Toward Single-Payer?

NO, NO and no: That’s been the Republican Party position on health care reform since the Obama administration’s first months in office. No matter how many pro-industry concessions were made in drafting what came to be called the Affordable Care Act (ACA), Republicans never wavered in their all-out opposition.

But increasingly since its disastrous rollout last fall, the ACA has had critics from the left, too–people who oppose a “reform” that falls far short of universal coverage while threatening harsh financial penalties on those who can afford them least unless they purchase the defective products of the private insurance industry.

Groups that criticized the ACA all along, such as Physicians for a National Health Program and National Nurses United, continue to stand for a “single-payer” program–where the government cuts out the insurers and guarantees health care for all under a system similar to the current Medicare program for the elderly, but much better funded and available to the whole population.

Then there are those among liberals and the left who disagree with both sides. They continue to defend the ACA–on the grounds that it is a step toward universal health care.

An editorial in the Nation magazine last month, for example, acknowledged that the ACA came about because Barack Obama and Democratic leaders in Congress “believed [single-payer] was politically unachievable, so they cobbled together a hybrid of public regulation and private insurance that has come back to haunt them.”

Nevertheless, wrote the Nation’s editors, the left should defend this “hybrid”: “Progressives must step in not only as ardent advocates for better implementation of the ACA–a relatively easy task–but also for structural repairs to the law that will make it a better bridge to the truly universal, truly humane and truly functional health care system that America needs…Indeed, winning [the fight for the ACA's effective implementation] will make future reforms all the more possible.”

The Nation is wrong. The ACA isn’t a bridge to universal health care. It is a cul-de-sac, structured above all else to maintain the central role of the health care industry in general, and private insurance companies in particular.

Achieving universal health coverage and access to care will require dismantling the core of the ACA and replacing it with something else entirely. Making a defense of the ACA in the way the Nation does–as a step in the direction of a single-payer system–cedes ground to the right and is counterproductive to the goal of winning health care as a human right.

Continue reading…

Single-Payer Is Not Dead

The prospects for single-payer health care — adored by many liberals, despised by private health insurers and looking better all the time to others — did not die in the Affordable Care Act. It was thrown a lifeline through a little-known provision tucked in the famously long legislation. Single-payer groups in several states are now lining up to make use of Section 1332.

Vermont is way ahead of the pack, but Hawaii, Oregon, New York, Washington, California, Colorado and Maryland have strong single-payer movements.

First, some definitions. Single-payer is a system where the government pays all medical bills. Canada has a single-payer system. By the way, Canada’s system is not socialized medicine but socialized insurance (like Medicare). In Canada, the doctors work for themselves.

Under Section 1332, states may apply for “innovation waivers” starting in 2017. They would let states try paths to health care reform different from those mapped out by the Affordable Care Act — as long as they meet certain of its goals. States must cover as many people and offer coverage as comprehensive and affordable. And they can’t increase the federal deficit. Qualifying states would receive the same federal funding that would have been available under Obamacare.

My conservative friends complain that the innovation waiver requirements would rule out everything but single-payer. No doubt they are diligently working on a more privatized alternative that would cover less, cost more and raise the federal deficit.

“Vermont is the only state where they’re thinking very concretely about using (the waiver) as part of their plan,” Judy Solomon, health care expert at the Center on Budget and Policy Priorities, told me.

Hawaii got close. Its Legislature passed a single-payer bill in 2009, which was vetoed by then-Gov. Linda Lingle, a Republican. Lawmakers overrode the veto, but Lingle refused to implement the law.

The quest remains rocky, Dr. Stephen Kemble, a single-payer advocate and past president of the Hawaii Medical Association, told me. “If Vermont can get things going, that would make things easier for others.”

In Washington state, “our focus is to work on grass-roots support,” says Dr. David McLanahan, Washington coordinator for Physicians for a National Health Program. “We’re laying the groundwork” for legislation and a request for an innovation waiver.

Problems in the Obamacare rollout have energized fans of single-payer. Computer glitches aside, the troubles stem chiefly from the law’s complexity. Single-payer is all about simplicity.

Under the Vermont plan, employers and individuals would no longer have to buy private health coverage.

They would instead pay a tax. The state-run system would also cover more things, like dental. And oh, yes, Vermonters could choose their hospitals and doctors.

William Hsiao, an economist at the Harvard School of Public Health, has projected that Vermont’s annual health care spending could fall 25 percent. The savings would more than pay for the new benefits.

How? Fewer dollars would go to advertising, executive windfalls and payouts to investors. Doctors dealing with one insurer would save on office staff. Fraud and abuse would shrink as a comprehensive database makes crooks easier to spot.

It’s too bad that some liberals have turned single-payer into a religion and are whacking the Vermont plan for not being pure enough. Vermont is permitting continued private coverage for very practical reasons.

Bear in mind that the most acclaimed health care systems — in Germany, in France and our Medicare — combine single-payer for basics with private coverage for the extras.

Vermont intends to use its state health insurance exchange as the structure on which to build its single-payer system. By 2017, the road to an innovation waiver should be clear.

Go forth, Green Mountain State. Show us what you can do.

Vermont House Committee Considers Road to Single Payer

From the Brattleboro Reformer –

The health care committee of the Vermont House is lining up some of the tasks that will have to be finished before the state rolls out the first-in-the-nation single payer health care system, now scheduled for 2017.

Meeting Friday at the Statehouse, the committee heard from legislative staffers who outlined details that will have to be worked out, such as how to ensure the state gets the maximum amount of federal dollars and who would be covered.

There are details such as what would happen if a person living in Vermont works in another state where their employer offers health insurance or if someone from another state worked in Vermont and their employer didn’t offer insurance.

On Tuesday, Gov. Peter Shumlin recommitted the state to the single payer goal.

The Obamacare We Deserve

Today marks the beginning of health care coverage under the Affordable Care Act�s new insurance exchanges, for which two million Americans have signed up. Now that the individual mandate is officially here, let me begin with an admission: Obamacare is awful.

That is the dirty little secret many liberals have avoided saying out loud for fear of aiding the president�s enemies, at a time when the ideal of universal health care needed all the support it could get. Unfortunately, this meant that instead of blaming companies like Novartis, which charges leukemia patients $90,000 annually for the drug Gleevec, or health insurance chief executives like Stephen Hemsley of UnitedHealth Group, who made nearly $102 million in 2009, for the sky-high price of American health care, the president�s Democratic supporters bought into the myth that it was all those people going to get free colonoscopies and chemotherapy for the fun of it.

I believe Obamacare�s rocky start � clueless planning, a lousy website, insurance companies raising rates, and the president�s telling people they could keep their coverage when, in fact, not all could � is a result of one fatal flaw: The Affordable Care Act is a pro-insurance-industry plan implemented by a president who knew in his heart that a single-payer, Medicare-for-all model was the true way to go. When right-wing critics �expose� the fact that President Obama endorsed a single-payer system before 2004, they�re actually telling the truth.

What we now call Obamacare was conceived at the Heritage Foundation, a conservative think tank, and birthed in Massachusetts by Mitt Romney, then the governor. The president took Romneycare, a program designed to keep the private insurance industry intact, and just improved some of its provisions. In effect, the president was simply trying to put lipstick on the dog in the carrier on top of Mitt Romney�s car. And we knew it.

By 2017, we will be funneling over $100 billion annually to private insurance companies. You can be sure they�ll use some of that to try to privatize Medicare.

For many people, the �affordable� part of the Affordable Care Act risks being a cruel joke. The cheapest plan available to a 60-year-old couple making $65,000 a year in Hartford, Conn., will cost $11,800 in annual premiums. And their deductible will be $12,600. If both become seriously ill, they might have to pay almost $25,000 in a single year. (Pre-Obamacare, they could have bought insurance that was cheaper but much worse, potentially with unlimited out-of-pocket costs.)

And yet � I would be remiss if I didn�t say this � Obamacare is a godsend. My friend Donna Smith, who was forced to move into her daughter�s spare room at age 52 because health problems bankrupted her and her husband, Larry, now has cancer again. As she undergoes treatment, at least she won�t be in terror of losing coverage and becoming uninsurable. Under Obamacare, her premium has been cut in half, to $456 per month.

Let�s not take a victory lap yet, but build on what there is to get what we deserve: universal quality health care.

Those who live in red states need the benefit of Medicaid expansion. It may have seemed like smart politics in the short term for Republican governors to grab the opportunity offered by the Supreme Court rulings that made Medicaid expansion optional for states, but it was long-term stupid: If those 20 states hold out, they will eventually lose an estimated total of $20 billion in federal funds per year � money that would be going to hospitals and treatment.

In blue states, let�s lobby for a public option on the insurance exchange � a health plan run by the state government, rather than a private insurer. In Massachusetts, State Senator James B. Eldridge is trying to pass a law that would set one up. Some counties in California are also trying it. Montana came up with another creative solution. Gov. Brian Schweitzer, a Democrat who just completed two terms, set up several health clinics to treat state workers, with no co-pays and no deductibles. The doctors there are salaried employees of the state of Montana; their only goal is their patients� health. (If this sounds too much like big government to you, you might like to know that Google, Cisco and Pepsi do exactly the same.)

All eyes are on Vermont�s plan for a single-payer system, starting in 2017. If it flies, it will change everything, with many states sure to follow suit by setting up their own versions. That�s why corporate money will soon flood into Vermont to crush it. The legislators who�ll go to the mat for this will need all the support they can get: If you live east of the Mississippi, look up the bus schedule to Montpelier.

So let�s get started. Obamacare can�t be fixed by its namesake. It�s up to us to make it happen.

Michael Moore is a documentary filmmaker whose 2007 film �Sicko� examined the American health care industry.