Single-Payer System Would Be a Boon to the Economy, Public Citizen Report Says

New System Would Boost Economy, Reduce Costs and Eliminate Unfair Burdens on Companies That Provide Health Insurance Benefits

WASHINGTON, D.C. � A publicly funded, universal health care system would aid businesses by engendering a more dynamic economy, taming costs and freeing businesses that provide health insurance of the costs of administering benefits and subsidizing the nation�s health care, a Public Citizen report released last week concludes.

�Small businesses have rated the cost of health insurance as their top concern for a quarter century, and large businesses struggle with health care obligations that their international competitors do not have to worry about,� said Taylor Lincoln, research director of Public Citizen�s Congress Watch division and author of the report. �If it weren�t for entrenched partisan alliances, business leaders would have demanded that Congress relieve them of health care burdens long ago.�

Publicly funded universal health care systems � such as the Canadian �single-payer� system, in which the government pays for all covered services � exist in nearly every developed country in the world. In the United States, universal care systems could be implemented either at the federal or state levels. The Affordable Care Act of 2010 includes language permitting states to apply for waivers that would enable them to institute universal care systems beginning in 2017. Vermont has passed legislation declaring an intention to do just that.

Public Citizen�s report, �Severing the Tie That Binds,� outlines three ways a universal health care system would benefit businesses.

First, it would end �job lock� and other economic distortions stemming from our health care financing system that hinder the freedom of individuals to pursue new ventures. Despite common perceptions that the United States is an entrepreneurial bastion, we have among the lowest rates of self-employment and small businesses among industrialized countries, researchers at the Center for Economic and Policy Research reported in 2009.

The researchers hypothesized that the dismal numbers in the United States were due to the high costs that individuals and small businesses here must pay for health care, which those in countries with universal access to health care do not face. By facilitating more entrepreneurship, a universal health care system here would likely boost economic growth, leaving businesses with a larger pool of potential customers.

Second, a universal care system would significantly dampen future increases to health care costs � and perhaps reduce costs � even as it greatly increased access to care. Numerous studies have concluded that the United States spends much more on administrative functions, such as billing and interactions with insurance companies, than other wealthy countries. Meanwhile, pharmaceuticals and procedures in the United States cost much more here than elsewhere.

A universal care system would reduce administrative costs by expanding economies of scale, streamlining processes and cutting insurance companies� marketing costs and profits from our national health care bill. At the same time, costs for drugs and procedures would be kept in check by increased transparency, as well as increased governmental bargaining power and rate-setting authority.

Third, although a publicly funded, universal care system would likely rely on significant revenue from businesses (such as through a payroll tax), there is reason to believe that total health care-related costs for businesses now providing benefits would decline, in part because a new system would spread costs more fairly.

Businesses that provide health care benefits would no longer have to essentially subsidize those that do not by covering the unreimbursed cost for care provided to the uninsured. Businesses also would be spared the costs of administering health care benefit programs. Meanwhile, funding formulas for universal care may reduce the overall share of national health care costs borne by the business sector by garnering revenue from a broader array of sources.

Elements of the solutions laid out in Public Citizen�s report already exist at the state level or are under consideration. For 35 years, Maryland has set across-the-board rates for hospital care, including care funded by Medicare and Medicaid. This program has saved tens of billions of dollars. In 2014, the scope of Maryland�s program was broadened by establishing overall caps on hospital budgets to counter the economic incentive to provide a greater volume of care. Establishing rate-setting authority and capping overall hospital budgets are hallmarks of the cost-savings mechanisms in universal care systems.

Vermont in 2011 passed legislation that called for it to create a �universal and unified health system� that would take advantage of provisions in the Patient Protection and Affordable Care Act that permit states to apply for waivers to craft their own health care systems beginning in 2017.

�The states might be flying below the radar, but they have a chance to implement solutions that should have widespread appeal,� said Lisa Gilbert, director of the Congress Watch division of Public Citizen. �If businesses leaders allow common sense to guide them, we think they will join the campaign for universal care.�

Unions, medical providers support universal health care in N.Y.

From the Times Union –

Twelve years after he first introduced a bill to promote universal health coverage in New York, Assembly Health Committee Chairman Richard Gottfried thinks Obamacare may give his cause the push it needs in 2014.

Federal officials have made successive fixes to address snags in the health law, formally the Affordable Care Act, which is intended to increase Americans’ access to health care.

“I think we are ready to refocus on real reform and real change and not just patchwork change,” Gottfried said Tuesday at the Capitol.

He stood flanked by state Sen. Bill Perkins, sponsor of a companion bill in the Senate, with a backdrop of representatives from labor unions, medical groups and the Working Families Party, who gave their support for the proposal, which is called New York Health.

While Gottfried could not say how much universal health care would cost state taxpayers, he estimated it could cut 20 percent off the more than $100 billion spent by government, private employers and individuals on services covered by the bill.

“The one thing that is certain is that money that we now spend … is dramatically more than what we would pay through New York Health,” Gottfried said.

An anti-insurance-industry refrain ran through the statements supporting the bill. Proponents of a so-called single-payer health system � under which the government is the sole purchaser of medical services � have decried the insurance industry’s influence in shaping Obamacare. The health exchanges that are at the heart of the law are government-run websites which allow individual consumers to shop for private insurance.

Dr. Frank Proscia, president of Doctors Council SEIU, a physicians union, denounced an insurance system that forces health providers to navigate a “maze of complex and counterintuitive policies” to provide care. “In a true single-payer system, all hospitals, doctors and providers would bill one entity … and the profiteers would be gone,” Proscia said.

Health care benefits have been negotiated by unions at the bargaining table, but labor representatives said they are happy to give up that contract fight to have universal coverage.

Bob Master, director of legalization/political action and mobilization for the Communications Workers of America, said employers have had the upper hand in negotiating health benefits, progressively reducing them or increasing employees’ contribution in recent years.

“All we have done in health care negotiations in the last 15 years is go backwards,” Master said.

Single Payer Rises Again

As the ACA takes effect, an alternative gains ground at the state level.

When Sergio Espana first began talking to people, just over a year ago, about the need for fundamental changes in the U.S. healthcare system, confusion often ensued. Some people didn�t understand why, if the Affordable Care Act (ACA) had passed, people still wanted to reform the system; others thought organizers were trying to sign them up for �Obamacare.�

Healthcare is a Human Right Maryland, the group to which Espana belongs, is in pursuit of something else: a truly universal healthcare system that would cover everyone and eliminate insurance companies once and for all. Espana and many others in the growing movement see opportunity in the renewed discussion around healthcare reform as the ACA�s insurance exchanges go into effect.

They believe that the ACA�s continued reliance on (and subsidies of) private insurance simply aren�t good enough. People are still falling through the cracks, employers are trying to dodge the requirement that they provide insurance for their workers, and many states refused federal subsidies to expand their Medicaid programs. What these activists want is a program that would replace existing insurance programs, cover everyone regardless of their employment status, and be funded by the government, with tax dollars. Such a plan had strong support when the national healthcare overhaul was being crafted in 2009�including initial backing by President Obama�but the president and Congress decided it wasn�t politically possible and passed the ACA as a compromise.

Now, the rocky launch of the healthcare exchanges that form the cornerstone of the Affordable Care Act has helped revive interest in single-payer, says Ida Hellander, director of policy and programs for the advocacy group Physicians for a National Health Program. New York State Assemblymember Richard Gottfried, the author of a 20-year-old single-payer bill that is receiving renewed support, points out that single-payer would avoid many of the issues of the ACA�s launch. �When you don�t have means testing and you don�t have to make guesses about who�s going to cover your doctor or your ailment, it�s very simple.�

While Republicans on the national stage have been grandstanding about �repealing and replacing� the ACA, grassroots activists are on the ground in many states organizing their neighbors around the idea of real universal healthcare. A national program remains the end goal, but Nijmie Dzurinko of Put People First! Pennsylvania believes that state efforts could have a domino effect. �Our job is to change what�s politically possible,� says Drew Christopher Joy of the Southern Maine Workers� Center, which is leading the effort in that state.

According to Hellander, about 25 states already have solid organizing toward single-payer, often accompanied by pending legislation. Some of these efforts predate the ACA: The California Nurses Association led the charge for single-payer in the mid-2000s, twice getting a bill through the California legislature only to have it vetoed by Gov. Arnold Schwarzenegger. Hellander says that the ACA has slowed down some efforts at state reform, as officials turned to setting up exchanges, but the law spurred others in Minnesota, Washington, Hawaii and Oregon. In New York, Gottfried notes that his bill has support from physicians groups, the nurses union and a majority of the lower house of the legislature. And in Massachusetts, considered the laboratory for the ACA, single-payer is now on the table thanks to gubernatorial candidate Don Berwick, the former administrator of the Centers for Medicare and Medicaid Services under Obama.

The biggest legislative victory to date has come in Vermont. Act 48, signed into law by Gov. Peter Shumlin in May of 2011, would begin to create a �universal and unified� healthcare system for the state. The bill, pioneered by the Vermont Workers� Center (VWC), is at the cutting edge of national healthcare policy. Its passage resulted from years of on-the-ground organizing around the principle that healthcare is a human right�that it must be universal, equitable, participatory, transparent and accountable.

However, Act 48 marks just the beginning of a lengthy process toward healthcare for all residents of the state, regardless of employment or citizenship. The next steps are to figure out how �Green Mountain Care� will fit into federal requirements set by the ACA and to pass a mechanism by which the program will be financed.

The VWC favors a more progressive income tax on individuals and employers, along with a wealth tax. Mary Gerisch, president of the VWC, says, �Even though new taxes or progressive taxation sounds very scary, in reality it�s going to be cheaper for everybody, just like it is in every other country, for them to pay it in taxation rather than to pay out of pocket at the doctor.�

This growing movement has attracted growing opposition, says Gerisch, who notes that a number of TV ads and websites have popped up to oppose Green Mountain Care. And Vermonters for Health Care Freedom, a new 501(c)4 organization founded by longtime Republican political operative Darcie Johnston, has paid for several ads and robocalling campaigns against the plan.

Small business owners, in particular, are susceptible to the fear that new taxes will put them out of business, Gerisch says. She mentions one example of a small business owner who was worried about a 10 percent tax (even though no tax has been decided upon), only to find out that he was already paying 13 percent of his profits to buy insurance for his employees, which would be unnecessary under a state plan.

Healthcare is a Human Right believes the organizing model pioneered in Vermont represents the best chance for passing universal healthcare, and the group is forging ahead with that model in its Maine, Maryland, and Pennsylvania chapters. Among the key elements are base-building and education. To combat corporate scare tactics, activists focus on arming citizens with good information.

In Maryland, according to Espana, more than 90 percent of the 1,200-plus people the organization has surveyed over the last year believe that healthcare is a right, and more than 86 percent support a publicly funded system. �Maryland has been coming off more and more as a progressive state. We�ve been able to get some version of a DREAM Act through, we got marriage equality last year�those are great victories but, economically, they�re not that transformational,� he says.

Joy sees an opportunity to build a strong community-labor alliance around universal care in Maine, where the state AFL-CIO has gotten on board with the Healthcare is a Human Right campaign, and the Maine State Nurses Association held a free health clinic to provide services and connect people to the campaign.

Dzurinko and Put People First! Pennsylvania have been organizing statewide�not only in Philadelphia and Pittsburgh, but in rural counties where the conventional wisdom has been that progressives can�t win. Dzurinko says that people in those counties frequently suggest, unprompted, that the U.S. should have a national healthcare system �like in Canada.�

�We often limit ourselves tremendously by not talking to people that we fear or that we have been told won�t agree,� Dzurinko says. �We can�t talk about universality unless we really are talking about everyone, and that means organizing in all communities.� Joy agrees: �If you�re not taking the time to really organize from the ground up, we�ll end up with the ACA again.�

For Espana, organizing around single-payer presents an opportunity to begin a broader discussion about economic justice and human rights. �All of these politics of austerity are just lies,� he says. �Through a fight for healthcare reform you can demonstrate that not only is it morally righteous for us to have a universal healthcare system, but it�s actually cheaper.�

True Single-Payer Healthcare System Being Considered in New York Assembly

From Truthout –

New York State Assemblyman Richard Gottfried, who represents the Chelsea and Hell’s Kitchen sections of Manhattan (D-75th District), has introduced a bill to implement a true single-payer healthcare system in New York State. Although the legislation made it out of the healthcare committee of the Assembly last year, it then was basically stonewalled from going much further.

Gottfried, chair of the health committee, told BuzzFlash at Truthout, the bill was re-introduced at the beginning of this session on January 8th of 2014.

What makes Gottfried’s bill distinct is that it would — if implemented in its ideal configuration — be a true single-payer healthcare system for all New Yorkers (except Veterans, who receive care through a government-administered system of providers employed by the Veterans Administration.)

This differs from what is called the Vermont “single-payer” system, which is a laudable one coming down the pike. But the Vermont healthcare insurance program would more accurately be called a comprehensive coverage system than a true single-payer.

Gottfried’s bill (2078A) would create the New York Health Trust Fund and all New Yorkers — in theory — (except veterans) would eventually receive care through the fund. They would carry a “New York Health” card for all their medical needs. Although still far from being enacted, what would make Gottfried’s bill a near seamless single-payer, if passed and implemented in its ideal form, is that the federal government would (and that is something, alas, unlikely to see for the time being given current DC private insurance control of politicians) pay Medicare and other federal programs directly into the state health insurance program. (Medicaid is already paid to states to administer the program within each state — but Gottfried’s bill would make Medicaid party of the pool of money funding “New York Health.”) There are still some gaps and exceptions that would be closed at a later time were the bill ever to be passed and the feds were to provide waivers, but it puts the first stage of a state single-payer on the map of consideration even if it is a political long shot.

Continue reading…

Maine Advocates Push for Single-Payer Care System

From the AP –

A government-run health care system in Maine would provide universal coverage to residents, cut down on administrative costs and free businesses from the complexities of providing insurance for their employees, supporters of a single-payer model said Thursday.

Advocates of a single-payer system have long been trying to implement the model in Maine with little success, but said they are hopeful that the steps Vermont officials have recently made to spearhead the effort there can help make it a reality in Maine.

“Our current health care system is complicated, is inefficient, unfair and pretty much broken,” said Julie Pease, president of Maine AllCare, the group behind the measure, which she said will “return our system to one where … our medical profession treats our patients based on their health care needs not on their ability to pay or what kind of insurance they have.”

The bill, sponsored by Democratic Rep. Charlie Priest of Brunswick, aims to create a single-payer health care system in Maine by 2017, as officials are trying to do in Vermont. Beginning in 2017, Vermont will offer a set package of coverage benefits to every resident under the program.

But the idea in Maine faces fierce opposition from insurance companies and questions remain about how the state could afford such an endeavor.

Dan Bernier, a lobbyist for the Maine Insurance Agents Association, said that government should focus its limited resources on the poor, elderly and disabled instead of those who can afford coverage.

“It is not the role of government to provide someone like myself, a lawyer and lobbyist, free health insurance,” he told the Insurance and Financial Services Committee on Thursday.

Supporters argue it would ultimately save the state as much as $1 billion down the line by eliminating unnecessary paperwork and administrative costs. The program would be paid for through taxes like people already do for Medicare and Medicaid, they said.

But the state first has to make a commitment to universal health care before every single detail can be worked out, said Joe Lendvai, a Brooklin resident who advocates on behalf of the bill with Maine AllCare.

“Unless we conceptually agree that we need to cover everyone, that every Maine resident deserves access to health care without any barriers, we are not going to succeed,” he said.

But any proposal to raise taxes would likely be rejected by Republican Gov. Paul LePage, who has vowed not to do so while he’s in office and vetoed the state budget last year because it included tax increases.

Democratic Sen. Geoff Gratwick of Bangor acknowledged that it will be tough to pass the measure in this political and economic environment, when budgets are especially tight. But he said that Maine lawmakers have long-understood the serious problems with the current health care system and want a change.

“This is going to happen whether or not we get it now, two years from now, 10 years from now,” he said. “It’s inevitable because our current system is broken,” he said.