The Most Important Job Posting in a Long While

If you seek a job with meaning and a chance to do some world-class good, here's one:

HEALTH CARE for ALL - OREGON
Job Announcement: ORGANIZER

Are you ready to make history?

Health Care for All-Oregon is a new coalition of 45 organizations (and counting) mobilizing to win a unified, equitable, publicly funded, comprehensive health care system for everyone in Oregon and the United States. We have active chapters around the state, thousands of contacts, and a solid leadership structure, all of which has been built by volunteers. Now we are ready to hire our first paid organizer to help us solidify our organization and build our momentum.

Duties include but are not limited to:

1. Create leadership development program to identify, train, and support leaders in HCAO chapters and member organizations

2. Organize new HCAO chapters in priority areas

3. Assist existing chapters and member organizations in developing greater capacity through assessment, planning, leadership development, training, and ongoing support.

4. Assist board and executive committee in developing and implementing strategic plan, regional and statewide meetings

5. Coordinate maintenance of supporter database

6. Collaborate with Communications committee to produce effective communications to supporters and the media

7. Collaborate with Fundraising committee to raise funds through individual donors (major and minor), monthly sustainers, organizational contributions, events, grants, etc.

8. Perform other related duties as assigned by HCAO Executive Committee.

Requirements
· Minimum five years experience in grassroots organizing, including all aspects such as fundraising, coalition-building, leadership development, strategic planning, communications;

· Ability to work independently and under supervision, prioritizing numerous and varied tasks;

· Ability to inform and inspire others through public speaking, meetings, and one-on-one relationships;

· Experience developing new programs and projects;

· Valid driver’s license and dependable vehicle (mileage to be reimbursed);

· Willingness to work long hours, including evenings and weekends, and travel statewide.

Additional desired attributes

· Background in health care policy and advocacy;

· Experience working with diverse constituencies, such as rural communities, communities of color, low-income communities, small businesses, etc.

Compensation:
Salary of $40K+, depending on experience; health insurance; paid vacation.

To apply, by June 18, 2012
Send cover letter, resume, and three references as Word attachments to singlepayoregon at gmail dot com, with the subject “Organizer application."

For background on Health Care for All-Oregon, see the (soon to be replaced) Oregon Single Payer Campaign website: http://oregonsinglepayer.org/.

WORD

Matt Wuerker deserves a Pulitzer for this one alone. It's astonishing how many Rube Goldberg complications we'll endure to avoid giving people simple access to health care.

About that "finest health care system in the world" stuff?

Image by Public Citizen via Flickr

Man Dies From Toothache, Couldn't Afford Meds

A Cincinnati man without insurance died from a tooth infection because he couldn't afford his medication. (Getty Images)

A 24-year-old Cincinnati father died from a tooth infection this week because he couldn't afford his medication, offering a sobering reminder of the importance of oral health and the number of people without access to dental or health care. . . .  Kyle Willis' wisdom tooth started hurting two weeks ago. When dentists told him it needed to be pulled, he decided to forgo the procedure, because he was unemployed and had no health insurance.

When his face started swelling and his head began to ache, Willis went to the emergency room, where he received prescriptions for antibiotics and pain medications. Willis couldn't afford both, so he chose the pain medications.

The tooth infection spread, causing his brain to swell. He died Tuesday.

WORD to the wise

Image by Public Citizen via FlickrFrom The New York Times
August 27, 2011
Sunday Dialogue: Curing the Health System



A letter on Wednesday urging a single-payer health plan, rather than individual mandates, set off an outpouring of reaction.

 The Letter:

To the Editor:  In "Will Health Care Reform Survive the Courts?" (State of Play, Sunday Review, Aug. 21), Philip M. Boffey states that "reforms would work far less well without an individual mandate" that requires citizens to buy health insurance or pay a penalty.

 I disagree. Health care reform could provide better care at less cost by replacing individual mandates with a single-payer national health care plan financed by taxes. Congress's power to mandate purchase of private products sold at a profit is disputable, but Congress's power to tax is not. 

Other industrialized countries have national health plans providing care to more citizens at less cost with better outcomes than our system. And they don't use mandates that allow insurers to charge different prices for different people.

These health care systems have three common properties: public subsidies ensure that everyone has access to care regardless of health, wealth or employment; primary care is encouraged; and publicly accountable, transparent, not-for-profit agencies transfer funds from patient to provider.

There is no need to experiment with mandates. Convert our current health care system into a national health plan.

SAMUEL METZ

Portland, Ore., Aug. 21, 2011
 The writer, an anesthesiologist, is a founding member of Mad as Hell Doctors, which advocates a single-payer system.

 Readers React

Dr. Metz is spot on with his advocacy of a single-payer plan instead of the individual mandate.

Sadly, despite the success of Medicare — a single-payer system that politicians tamper with at their peril — the "just say no" climate in Washington, fostered by Republicans who place ideology over country, took that option off the table and left us with an alternative that not only raises legal questions but also fails to address the real threat: the escalating costs of health care.

That said, the health care plan that the politicians have given us, which extends protection to millions of uninsured, is better than no plan at all.

After decades of talking about reform, we finally have a plan in place. With luck, a day will come when the political will for a single-payer system exists.

Until then, let's do our best to make the plan we have work.  JAY N. FELDMAN
Port Washington, N.Y., Aug. 24, 2011

 Dr. Metz is right that a single-payer system would be better than an individual mandate. But he does not mention that Medicare, although it is a single-payer, tax-supported system, still cannot control costs and will soon be bankrupt. A national health plan that controls costs needs to reform the way doctors are paid and are organized in practice.

 This is how doctors, if they are really "mad as hell," could help. They should join salaried multispecialty, not-for-profit group practices that can accept capitated prepayment for comprehensive care instead of fee for service, and can provide good, cost-effective care that supports primary-care doctors working in close collaboration with specialists.

 ARNOLD S. RELMAN
Cambridge, Mass., Aug. 24, 2011
The writer, a physician, is professor emeritus of medicine and of social medicine at Harvard Medical School and a former editor in chief of The New England Journal of Medicine.
-------


 We need Dr. Metz to keep the flame of national health insurance alive until this country is ready to embrace it as the most cost-effective way to provide coverage. But as Winston Churchill said, "You can always count on Americans to do the right thing — after they've tried everything else."

The battle to pass the Affordable Care Act and the challenge to sustain it should make clear that national health insurance will not be given serious consideration by politicians for some time.

Our approach to health reform has desirable features, like elimination of pre-existing condition exclusions. An individual mandate is required to make health reform work.

 Dr. Metz simply prefers another way to require all Americans to have coverage. More power to him. In the meantime, let's try the next best thing.

 BRUCE KELLEY
Minneapolis, Aug. 24, 2011
 -------------------

I am a young professional who is just starting out on my career path.

 I have already been juggled among health care systems because of different schools and different jobs, and the experience was not fun. Recently, I was lucky enough to find employment that offers health insurance, but if I should lose my job, I would lose my health insurance. This doesn't make me feel secure. The individual mandate doesn't make me feel secure either. Health insurance does not equal health care.

 I don't want to start paying into health insurance that I may lose because of powers beyond my control. With a single-payer system, you simply get enrolled into a public health insurance system. Through my taxes, I would be making an investment in my health future that would be there whether I lost my job or not. Now that would make me feel secure.

 MOLLY TAVELLA
Rancho Cucamonga, Calif., Aug. 24, 2011

 The writer is the education and outreach coordinator for Physicians for a National Health Program California.
-----------------------

 Of course Dr. Metz is correct that a single-payer system — comparable to that used in a number of other countries — would be both beneficial and less expensive than the privately skewed, hodgepodge system we have now. Unfortunately, the lack of political maturity in this country means that arguing that other societies have better ideas than we do is counterproductive, since the myth of American exceptionalism is more important than actually providing better health care while saving money in the process.

ALAN POSNER
East Lansing, Mich., Aug. 24, 2011
--------------------------------

 Dr. Metz presents a compelling argument in support of a single-payer plan. He cites the experience of other countries to show that such a system provides better health outcomes at lower cost. Our own experience shows that Medicare requires only about 3 percent for administrative costs, as opposed to 29 percent for private health insurance.

 Alas, these arguments are fated to fall on deaf ears. Between 2006 and 2009, the health sector spent $1.7 billion lobbying Congress and federal agencies. No wonder our government can't hear the rest of us!

 SHERMAN C. STEIN
Philadelphia, Aug. 24, 2011

The writer is a clinical professor of neurosurgery at the Hospital of the University of Pennsylvania.
----------------------------------

 Let me add some data to support Dr. Metz's proposal. The evidence is overwhelming. The cost of health care per person in other industrialized countries is on average less than half of that in the United States. If we spent as much per person as the other countries do, we would save $1.3 trillion every year.
One characteristic of those countries' health care is that there is a single entity that runs the system. This ensures uniform and minimal overhead and compliance costs, and provides guidance and regulation for the medical effectiveness of the various procedures.

 We can learn much from other countries. The question is whether we are mature enough to do so.

  LEONARD S. CHARLAP
Princeton, N.J., Aug. 24, 2011
 --------------------------------
 The Writer Responds

 I thank these readers for their thoughtful comments.


Dr. Stein notes that private insurance overhead is many times higher than Medicare's. Most economists agree. Including the cost to providers to collect from insurance companies nearly doubles the difference.

This administrative excess is more than sufficient to finance comprehensive health care for every American. Nearly 25 state and national studies of single-payer plans corroborate this.

Although single payer enables universal care without additional cost, Dr. Relman notes that it will not slow cost increases. He proposes a salaried physician model to replace fee for service. There is much evidence in support.

 The salaried physicians in the Department of Veterans Affairs medical system care for America's sickest patients at the lowest cost with the best outcomes and highest patient satisfaction of any system in the country. Clearly, when financial pressures are removed, physicians provide superb care.

 Mr. Marlow is only partly correct. In countries with national health plans, patients see their physicians more frequently than we do and spend more days per year in the hospital. Despite this increased access to care, these nations spend half as much as we do, and their populations are healthier. Presumably, unlimited access to inexpensive primary care reduces consumption of more expensive, more complex intensive care.

Ms. Tavella makes two important points. First, an insurance policy is no guarantee of health care. Most personal bankruptcies in America are precipitated by medical crises in families with health insurance when the crisis began.

Second, when the young, healthy and employed make health care payments in excess of what they consume, this is not a loss. It is an investment in future care when they are old, sick and retired.

  Messrs. Feldman, Kelley, Posner and Charlap mourn our inability to achieve single-payer health care despite its obvious financial advantages. But our obstacle is not political, but moral. Many Americans believe that it is immoral to pay for other people's care, even if doing so reduces their own costs. Others believe that it is immoral to pay taxes for health care, even if doing so protects their family from illness and financial catastrophe. We cannot argue morality, but we can present the health and financial consequences of allowing these morals to drive health care policy.

American single-payer systems include the Department of Veterans Affairs system; the Indian Health Service; Tri-Care, the military health plan; Taft-Hartley multiemployer plans; and Medicaid and Medicare. Any of these systems could be improved and expanded to cover all Americans.

Single-payer health care is America's health care solution to America's health problem.

SAMUEL METZ
Portland, Ore., Aug. 25, 2011

WORD: Chris Hedges

As Orwell noted, the hallmark of totalitarian power is the ability to call black white and have throngs of apparachiks dutifully nod and say "Yes, black is white."

So with "health care reform," a massive attempt to cement the corporate takeover of health care into place forever, especially with its absurd individual mandate, an order from the mob bosses to buy their "protection" or pay a penalty to their enforcer, the thug they hire to do their collections.

In true Orwellian fashion, Palintards and the Faux News crowd endlessly shriek about the "government takeover of health care" -- the point being to call black white and keep people from noticing that "Obamacare" is nothing more than a more expensive, more profitable, more totalitarian version of what we have now: health care rationing by wealth, with a collapsing public health system cheek-by-jowl with ultra-high-tech care for the apparachiks who please the mob bosses.

We have much to be thankful for this November, but much to be dismayed about. People like Chris Hedges are among the former. Some excerpts from his latest blast:

Power and the Tiny Acts of Rebellion
Monday 22 November 2010
by: Chris Hedges | Truthdig | Op-Ed

. . . Dr. Margaret Flowers, a pediatrician from Maryland who volunteers for Physicians for a National Health Program, knows what it is like to challenge the corporate leviathan. She was blacklisted by the corporate media. She was locked out of the debate on health care reform by the Democratic Party and liberal organizations such as MoveOn. She was abandoned by those in Congress who had once backed calls for a rational health care policy. And when she and seven other activists demanded that the argument for universal health care be considered at the hearings held by Senate Finance Committee Chairman Max Baucus, they were forcibly removed from the hearing room.

"The reform process exposed how broken our system is," Flowers said when we spoke a few days ago. "The health reform debate was never an actual debate. Those in power were very reluctant to have single-payer advocates testify or come to the table. They would not seriously consider our proposal because it was based on evidence of what works. And they did not want this evidence placed before the public. They needed the reform to be based on what they thought was politically feasible and acceptable to the industries that fund their campaigns." . . .

“You can't effect change from the inside,” she has concluded. “We have a huge imbalance of power. Until we have a shift in power we won't get effective change in any area, whether financial, climate, you name it. With the wealth inequalities, with the road we are headed down, we face serious problems. Those who work and advocate for social and economic justice have to now join together. We have to be independent of political parties and the major funders. The revolution will not be funded. This is very true.”

“Those who are working for effective change are not going to get foundation dollars,” she stated. “Once a foundation or a wealthy individual agrees to give money they control how that money is used. You have to report to them how you spend that money. They control what you can and cannot do. Robert Wood Johnson [the foundation], for example, funds many public health departments. They fund groups that advocate for health care reform, but those groups are not allowed to pursue or talk about single-payer. Robert Wood Johnson only supports work that is done to create what they call public/private partnership. And we know this is totally ineffective. We tried this before. It is allowing private insurers to exist but developing programs to fill the gaps. Robert Wood Johnson actually works against a single-payer health care system. The Health Care for America Now coalition was another example. It only supported what the Democrats supported.

There are a lot of activist groups controlled by the Democratic Party, including Families USA and MoveOn. MoveOn is a very good example. If you look at polls of Democrats on single-payer, about 80 percent support it. But at MoveOn meetings, which is made up mostly of Democrats, when people raised the idea of working for single-payer they were told by MoveOn leaders that the organization was not doing that. And this took place while the Democrats were busy selling out women's rights, immigrant rights to health care and abandoning the public option. Yet all these groups continued to work for the bill. They argued, in the end, that the health care bill had to be supported because it was not really about health care. It was about the viability of President Obama and the Democratic Party. This is why, in the end, we had to pass it.”

“The Democrats and the Republicans give the illusion that there are differences between them,” said Dr. Flowers. “This keeps the public divided. It weakens opposition. We fight over whether a Democrat will get elected or a Republican will get elected. We vote for the lesser evil, but meanwhile the policies the two parties enact are not significantly different. There were no Democrats willing to hold the line on single-payer. Not one. I don't see this changing until we radically shift the balance of power by creating a larger and broader social movement.”

The corporate control of every aspect of American life is mirrored in the corporate control of health care. And there are no barriers to prevent corporate domination of every sector of our lives.

“We are at a crisis,” Flowers said. “Health care providers, particularly those in primary care, are finding it very difficult to sustain an independent practice. We are seeing greater and greater corporatization of our health care. Practices are being taken over by these large corporations. You have absolutely no voice when it comes to dealing with the insurance company. They tell you what your reimbursements will be. They make it incredibly difficult and complex to get reimbursed. The rules are arbitrary and change frequently.”

“This new legislation [passed earlier this year] does not change any of that,” she said. “It does not make it easier for doctors. It adds more administrative complexity. We are going to continue to have a shortage of doctors. As the new law rolls out they are giving waivers as the provisions kick in because corporations like McDonald's say they can't comply. Insurance companies such as WellPoint, UnitedHealth Group, Aetna, Cigna and Humana that were mandated to sell new policies to children with pre-existing conditions announced they were not going to do it. They said they were going to stop selling new policies to children. So they got waivers from the Obama administration allowing them to charge higher premiums. Health care costs are going to rise faster.

The Center for Medicare and Medicaid Services estimated that after the legislation passed, our health care costs would rise more steeply than if we had done nothing. The Census Bureau reports that the number of uninsured in the U.S. jumped 10 percent to 51 million people in 2009. About 5.8 million were able to go on public programs, but a third of our population under the age of 65 was uninsured for some portion of 2009. The National Health Insurance Survey estimates that we now have 58 or 59 million uninsured. And the trend is toward underinsurance. These faulty insurance products leave people financially vulnerable if they have a serious accident or illness. They also have financial barriers to care. Co-pays and deductibles cause people to delay or avoid getting the care they need. And all these trends will worsen.” . . .

WORD: The price of private health insurance

These are what patient records look like in a system where health takes a back seat to insurance company profits. Image by fsse8info via Flickr

How much would you pay to keep your private health insurance instead of a single-payer system? A thousand dollars? Ten thousand dollars?

How about $350 billion? . . .

Driving this high cost is overhead - plain old ponderous paperwork generated by our private insurance system - to the tune of $350 billion a year. Make no mistake: This money does not pay for health care. It pays for administrators, accountants, billing clerks and benefits managers to transfer our money to health care providers. . . .

It all adds up - to $350 billion.

Clearly filtering our dollars through private insurance companies squanders a lot of money (one dollar out of every three to be exact) before it gets to real-world health care. These losses would evaporate if the U.S. adopted a single-payer system. Mind you, single-payer systems still have administrative costs, just $350 billion less than we have now.

Let's see how $350 billion in paperwork compares to other costs.

It is more than we spend on immigrant health care ($40 billion), defensive medicine ($60 billion), and health insurance fraud ($72 billion) -- combined. It is more than we spend on medications ($261 billion), obesity-related diseases ($144 billion), tobacco-related diseases ($168 billion) or alcohol-related diseases ($96 billion). It's more than we spent on the Afghanistan war ($179 billion). It's more than the annual interest on our national debt ($224 billion).

And it's more than the extra funding needed for comprehensive health care for all Americans ($225 billion).

Curiously, one of America's own single-payer systems, the Veterans Administration, takes care of the sickest patients with the best results at the lowest cost with the highest patient satisfaction in the nation. Can life without private health insurance paperwork be all that bad? . . .

A most telling graphic

WORD: Insurance parasites and the razz-ma-tazz of distraction

Awesome op-ed by a doc in the Big O. Excerpt:

Tobacco only affected the 40% of the population that smoked when the cigarette-cancer association began in the 1950s and the 20% of us who still do. The health insurance industry, on the other hand, affects every one of us. Its monopoly of health care financing extracts $500 annually from every citizen for its own administrative costs (not entirely devoted to lobbying and profit -- let's give the industry some credit), causes 45,000 annual deaths from inadequate access to health care (that's as many as die in automobile accidents), and precipitates most bankruptcies in the U.S. The money spent by our health insurance industry on administration could extend essential health care to every American. But we don't discuss that, do we?

Our health insurance industry succeeds as well in this century as the tobacco industry did in the last. Witness the congressional "reforms" -- all variants on a theme: Make every citizen buy our insurance. And if our price is too high, make our government buy it for them. All hail this great victory for free enterprise. But what about our health?

American spending on health care outstrips every other nation on earth, yet we lead in not one significant measure of public health. Can it be that our doctors, nurses and hospitals are that bad? Or is that we pay for them through private insurance? Our health insurance industry would have us believe our problem stems from spending too little on their profitable insurance, not spending too much.

The most brutal evidence of the insurance industry's success is the intensity with which all of us debate perennial unsolvable social challenges -- the role of government in private lives, how America's free enterprise system makes us special, whether tax dollars should fund abortion, whether people who work should provide free services to those who don't, how illegal immigrants sap our country's strength, the evil of socialist programs in foreign countries, the insidious threat of death panels, and the inherent inefficiency of any government to run anything. In short, the health insurance industry successfully diverts our attention from the root problem--that our method of financing health care through for-profit private insurance is driving our families and government into financial ruin.

So here we are, fighting not with the insurance industry but with each other: healthy against sick, insured against uninsured, libertarians against liberals, employed against jobless. Fear runs amok. Medicare recipients fear reduced benefits. Employers fear compulsory medical entitlements. Unions fear for their negotiated benefits. And everyone fears skyrocketing policy costs and decreasing access to physicians. We are paralyzed with terror.

Meanwhile, health insurance executives dab their collective brows, having successfully diverted us from realizing that their industry created and sustains our dilemma.

Can we escape this maelstrom?

Yes. With the health insurance industry spending $1.4 million daily on distractions, it takes grit to stay on target. But we must. We must demand our elected officials address the only three questions that matter: "What have you done to provide essential health care to all regardless of ability to pay, employment status or medical condition? What have you done to reduce costs? What have you done to improve our health? Everything else is irrelevant.

Can we stop the health insurance industry from killing Americans in this century faster than we stopped the tobacco industry in the last? Let's hope we don't have to wait another 50 years to find out.

Speaking of a broken system dominated by the health insurance leeches, an on-point documentary on the subject (intro video clip above):

Thursday, November 12, 2009
Salem Progressive Film Series: Health, Money and Fear
Doors open 6:15 p.m., film begins at 7:00 p.m.
Grand Theater, 191 High Street NE Adults $3, Students $2
America spends more than twice as much money on health care per person as other countries, yet gets much less in return. An ER physician looks at reasons for this and offers several prescriptions to cure the problem. For more information: http://www.salemprogressivefilms.net or 503-588-8713 or 503-779-5288.

If you haven't seen SICKO yet . . . don't miss it!

Cover of Sicko (Special Edition)

With the insurance company parasites -- the blood-engorged leeches who suck the lifeblood out of sick and injured people in order to lavish wealth on a tiny few -- fighting like cornered rats to deny the public any semblance of real reform, it's important that people are reminded of the horror stories that our dysfunctional health care financing "system" inflicts on everyday Americans. And it's important to everyone know that there is another way.

Many, many people left the theaters in tears and enraged after seeing SICKO -- and that's just the intensity we have to regain if we're to get anywhere with reform. So don't miss it!

You're Invited!
Join us for Marion County Dem's First MOVIE NITE [sic] SOCIAL!
No Charge; Donations Accepted
Wednesday, October 14, 7 PM
It's all happening at Marion Dems Headquarters,
250 Liberty SE, Salem.

This month's features:
Michael Moore's "SICKO"
PLUS... SNEAK PREVIEW OF a 'must see' health care documentary!

And plan to attend the "We're Counting on You!" rally earlier that same day if you can (RSVP at the link):

'We're counting on you!' Rally

Front steps of the Capitol (across from the Capitol Mall), 900 Court Street (Map)
Salem, OR 97303, Wednesday, October 14th, 12:00 PM

Let's keep the momentum going!

Message from your host, Tricia M.: Come join other MoveOn members for our "
WE’RE COUNTING ON YOU--PUBLIC OPTION NOW" – RALLY in SALEM on Wednesday, OCTOBER 14 at NOON.

Most of Oregon’s national representatives support a public health insurance option. The Salem-Keizer MoveOn Council wants to recognize that and encourage other Or...(more)egonians who also support a public option in upcoming national health care legislation to speak out and support them.

Noon to 1 PM, on Wednesday, October 14th, we are holding a rally at the Capitol in Salem, 900 Court Street, on the steps across from the Capitol Mall.

See you there!

He's right: Strong Public Option or nothing

Image by Getty Images via Daylife

Jack Lohman of Wisconsin

60 Votes????

Now they have them, and the Dems are in a more awkward position than ever. They don't want the power. They can pass meaningful healthcare reform if they want, but that's exactly what their funders don't want. So passing it makes them the enemy and not the R's.

We are in a difficult position. IF reform passes we want it to have a strong public option. But all indications are that it will have a mandate, a gigantic transfer of wealth from the lower- and middle-income people to the insurance industry.

Without the Public Option we should strive for nothing at all. Let's restart and protect the 15% that are uninsured and unemployed, and then move to a single payer system.

Remember that even when we get single payer, the battle is not over. The insurance companies are continuing to undermine the Canadian and UK systems, and they'll chip away at single payer even when installed here.

That's the way our corrupt political system works.

If the Dems were smart, they'd realize that they'd no longer need campaign cash if they just voted for the best interests of the country. Good health care and campaign reform would lock them in for decades.

We Can't Afford to Wait Vigil

Boy, if only we had a Democrat in teh White House and a Democratic majority in both houses of Congress . . . Image by seiuhealthcare775nw via Flickr

VIGIL for Public Option NOW
Riverfront Park, Salem, OR 97303
Wednesday, 2 Sep 2009, 7:30 PM
To sign up for this event.

Moyers on Health Care Reform

LBJ defeats Reagan, the GOP and the AMA, creates Medicare -- 100% Socialized Medicine for old people. Why do insurance companies love their profits and hate America? Image via Wikipedia

A procurement and systems analyst perspective on single-payer

One of the key reasons US manufacturing declines is that it has to compete with manufacturing in countries who don't tie health insurance to employment, relieving their employers of a huge cost burden. Image via Wikipedia

A friend whose father was a highly successful systems analyst and procurement expert for top socialist organizations (IBM and the Pentagon) took a look at health care from a systems perspective and came up with single-payer as the answer.

Top Ten Reasons Why We Absolutely Need Single Payer Healthcare

1. It will be much easier to get everyone covered without people being shuttled around seeking coverage and falling through the cracks, or suffering delayed approval and care when they become expensively sick. The dollar savings from eliminating this wasted time and effort will be significant in and of itself.

2. It will allow doctors to concentrate on patients, not their billing and collection problems as currently driven by multiple insurance providers with different requirements and paperwork.

3. It will make it possible, through compensation adjustments, to rebalance the number of medical practitioners by area of specialization to better meet the needs of the patient base. It also facilitates payment based on quality (outcomes), not just quantity of care.

4. It will facilitate, through payment incentives, improvement in the availability of health care services in currently underserved areas.

5. Because of the enhanced auditing capability inherent in a single payer system, it allows the day to day billing and collection process to be run on a presumption of integrity and honesty, thereby greatly simplifying procedures and paperwork for all involved.

6. It will create an environment where the pharmaceutical companies and medical equipment suppliers will be forced to deal with a very competent customer, instead of a group of disorganized ones.

7. It will create a situation where common accounting standards, utilizing direct costing principles and practices, can be implemented at hospitals, thereby linking costs and billing with services provided.

8. Once the payment process is centralized, it will facilitate meaningful analysis to identify cost drivers in all areas so effort can be concentrated on fixing them.

9. It will converts the twenty to twenty-five cents of every premium dollar currently expended by private insurers on excessive salaries, administration, advertising and profit into payment for healthcare services. This goes a long way toward paying for the fifty million people to be covered.

10. All of the above subjects are or should be part of a real health care reform effort, in fact, they are vital components. However, none of them have been or realistically can be accomplished (have a snowballs chance in hell) utilizing a process with private insurers as its backbone.

Questions to Ask About Health Care

Coat of arms of Canada, a country very much like the US, only it spends a LOT less on health care per person, covers EVERYONE, has a longer life expectancy, better infant mortality rates, and much higher satisfaction with health care. Obviously, we have nothing to learn from them. Image via Wikipedia

Questions Should You Find Yourself at a microphone at a 'Town Meeting':

1. If Canada's single-payer system is so god-awful, why have repeated Conservative governments at the provincial and national level in Canada never touched it? Canada is a democracy. If Canadians don't like their health care system, why haven't they gotten rid of it in 35 years? Since the system there is run by the separate provinces, many of which are very politically conservative, why has not one province ever tried to get rid of single-payer?

2. Why is rationing by income, as we do it here, better than rationing by need, as they do it in Canada?

3. Wouldn't single-payer mean that companies could no longer threaten working people with the loss of their health insurance? Why is this a bad idea?

4. The bigger the insurance pool, the better. So doesn't having a national pool, as with single-payer, make the most sense?

5. Why should we be allowing politicians who are taking money from the medical industry to write the new health care legislation?

6. How can the Congress be developing a health system reform scheme and not even invite experts from Canada down to explain their successful system?

7. If Medicare--a single-payer system here in America--is so popular with the elderly, how come it's no good for the rest of us?

8. Isn't it true that Medicare currently finances the most costly patient group--the elderly and infirm--so that extending it to the rest of the population--most of whom are young and healthy--would be much cheaper, per person?

9. The AMA, the Pharmaceutical Industry, and the Insurance Industry all bitterly opposed Medicare in 1964-5 when it was being debated in Congress and passed into law, with the right, led by Ronald Reagan, calling it creeping socialism. It became a life-saver for the elderly and didn't turn the US into a soviet republic. Why should we give a tinker's damn what those same three industry groups and the Republican right think of expanding single-payer now?

10. The executives of Canadian subsidiaries of US companies all support Canada's single-payer system, and even lobby collectively to have it expanded and better funded. Why does Congress listen to the executives of the parent companies here at home, and not invite those Canadian execs down to explain why they like single-payer?

The Issue that Surrounds Everything

One of the things we're going to need in the future is a lot more entrepreneurial activity. The old economy, based on gigantic and ever-increasing flows of energy and materials (and wastes) is grinding to a halt, and won't be coming back. In the future, there will be a lot fewer massive institutions employing hundreds of thousands of people in big bureaucratic kingdoms, with benefits. People will have to make a lot more of their own livelihood, and they will have to do so much more locally.

One of the big barriers to the kind of innovation and entrepreneurial behavior we need is our weird system of health insurance that's tied to employment rather than citizenship. By tying access to health insurance to working for someone else -- and typically, that means a very big someone else -- we discourage people from creating precisely the kind of ventures that we will need the most of in the future: small, local services that are aimed at meeting each others' basic needs.

People in the health insurance industry are, no doubt, occasionally wonderful people -- just like some of the people who sell guns and drugs in the black market are sometimes wonderful people. But their industry is a parasite, consuming 30% of our sky-high health care costs and producing exactly no health benefit. In fact, our insurance system is one of the root causes of our insanely poor overall rankings on national health indices: we are far and away #1 in spending but about 35th in health results. A good deal of that is due to the fact that we treat health care like a non-essential, and we allow other people do without access to it (so long as we ourselves have access). Thus, people don't follow good health maintenance and illness-prevention strategies and the giant money-sucking leeches in the health insurance biz don't want to pay for prevention because there's no guarantee that the eventual savings will accrue to them instead of their competitor.

Truly an insane system, but one that is so fantastically profitable for a few that it will not die easily, despite the huge amount of suffering and needless waste that it inflicts on us.

Socialist Health Plan? In Norway, Obama's Plan Not Even Close

If Michael Steele and the Republicans really believe that President Obama is proposing a socialist health plan, they need to get out more.

I've just returned from a research trip to Norway, where their universal health system really is socialist. It's also much less expensive than the current U.S. system, so maybe the Republicans would like it if they checked it out. The non-socialists in Norway support it because it works so well, especially compared with "the bad old days" of private medicine, when even the doctors' association advocated for socialized medicine as the only affordable way to make quality care available to all Norwegians.

One reason Norwegians like their system is that it's pro- economic innovation because it's not tied to the employer. Norwegians are free to change jobs for more challenging opportunities, or try their wings as entrepreneurs, because they don't have to worry about insurance - it's with them wherever they go. Economist Jonathan Gruber of MIT is one of many economists who believe that U.S. employer-tied health insurance is a drag on progress. But Obama's plan accepts the status quo even though it might not be affordable.

Norwegians like their system because it cuts red tape. The patient-doctor relationship isn't complicated by multiple insurances; if you need care, you get it as a matter of right. No bills to pay, no plans to juggle, no worry about your dependents, and no worry about your becoming a burden to your children.

Because Norwegians are practical, they enjoy saving money for quality health care. On a per capita basis, Norwegians spend $4,763 per year, and cover everyone, while U.S.'ers spend $7,290. By various standards of health quality, like life expectancy or rate of preventable deaths, Norway does better than the U.S. One key measure is physicians per capita: the U.S. has 2.43 physicians compared with Norway's 4 doctors per 1,000 population, even though Norway spends a third less of its Gross Domestic Product on health care than the U.S. does. (These numbers are from Bruce Bartlett, Forbes magazine columnist who was a former U.S. Treasury Department economist.)

While in Norway I did hear complaints - Norwegians famously believe everything can work better than it does - but I didn't interview anyone, from left wing to right wing, who would change the basic system. Maybe it's time for U.S. politicians to learn from what other countries are doing right.

Amen: why universal health care is critical to a viable food system

(Anyone who wants private health insurance should support private fire companies and police.) Image by Steve Rhodes via Flickr

Sharon Astyk nails it again: the giant parasite that is the health insurance industry is not just bankrupting us. It also prevents people from leaving make-work Mcjobs and learning to grow food, because we've tied access to health care to Mcjobs.

UPDATE: a Progressive Review reader submitted this there:

THOUGHTS ON SINGLE PAYER HEALTH INSURANCE

Richard Scheerer - Early in my work history, the manager of our personnel department came to me with a moral, ethical, and legal dilemma he was facing. Once a month, the president of the company directed this manager to provide him with a copy of the group medical claim report prepared by our plan administrator. From this report, the president could determine which employees or dependents had medical expenses and the severity of the condition involved. If the conditions had the potential of reoccurring costs, the president would indicate his dissatisfaction to the employee's superior leading to the employee being terminated or better yet, being forced to resign without unemployment benefits. Even valued employees or company officers did not escape; they would be slowly stripped of responsibilities and would never again qualify for a raise or promotion. What makes this situation so reprehensible and eye opening is that this was an insurance company that sold personal health insurance policies.

This is no longer an isolated situation as employers today continue to eliminate employees for medical reasons to reduce health care costs. The "downsizing" craze of a few years ago was a way to get rid of older long term employees and the higher expenses associated with them - salaries, longer vacations, higher health care costs, higher pension contributions, etc.

I have spent most of my career as an officer of various insurance companies and finished my career as a reinsurance intermediary. My insurance colleagues may look disdainfully upon this writing, but I strongly believe that private health insurance can not, and will not, result in the greater good for our society. I have watched the health insurance industry completely change. At one time, probably 30% of all life insurance companies and a number of casualty companies sold medical insurance. Today we are down to a handful that sell individual medical plans; probably no more that five to ten in any one state including a few national marketers.

The employer group insurance choices are not much better. Although there are a limited number of insurance companies offering group health insurance plans, there are a number of insurance companies and non-insurance administrators that provide claim services for employer self-insurance plans. Self-insured plans have become the trend in recent years as another way to control costs. Even these plans need reinsurance for excess and catastrophic losses, but here again we are down to only a few reinsurers willing to offer such coverage. Have one or two large claims and lose a reinsurer, and your plan is in real trouble.

The real problem with our system of reliance on private insurance, whether individual, group or for that matter employer self-insurance plans, is that no plan wants to pay claims. The primary goal of any private company operating under our capitalistic system is to generate as much profit as possible; as a result, the structure of our private health insurance system operates against good public health policy. Care is not the goal; profit is. The welfare our society is not considered. Greatest profit occurs by charging high premium and eliminating or restricting claims. Underwriting, pre-existing condition clauses and terminations are used to eliminate potential claims by assuring only the healthiest receive coverage. With high deductibles, coinsurance percentages, pre-certification, coverage restricted to certain providers, most plans are designed to reduce claims costs to the insurer and transfer these costs directly to the insured. Additionally, it is becoming common for plans to limit one's choice of providers and to limit treatment by requiring the provider have prior approval.

We spend 15% of our gross national product, basically twice that of most other developed countries, to insure 80-85% of our population. Are we getting twice the benefit? The answer appears to be no, as we have higher infant mortality, lower life expectancy, 50 million uninsured, and many more underinsured - the latter being the number one cause of bankruptcy. Since our system is not universal and public based, we are probably in the worst position of all developed countries to handle a epidemic or pandemic. Our employers are at a competitive disadvantage due to health care costs.

There are two insurance programs that are directly related to health care that also need discussion. First, almost all medical plans, group or individual, eliminate coverage for occupational accident and sickness. Employers are generally required to carry or furnish occupational sickness and accident coverage under mandatory worker's compensation laws. The cost of mandated workers compensation alone exceeded the wages in many third world companies; a reason in itself for outsourcing.

The second insurance program not being discussed is medical payment coverage under automobile insurance policies. This should not be confused with liability coverage. Medical coverage is immediate and does not require the assessment of liability. This is duplication of costs, but not a duplication of benefits. Injuries can be collected on only one policy.

There is only one true reform that addresses all - universal single payer health. Anything other than universal single payer will simply be a costly government band-aid to continue a broken system that is destined to fail. A universal single payer system will cover everyone. It could eliminate the need and costs of medical coverage under worker's compensation, and reduce auto insurance premiums by eliminating redundant medical coverage. Universal single payer health care is not a question of additional cost, but a reallocation of that which we already spend.

Richard Scheerer is President Intermediaries Plus