PHIMG Coalition - Grassroot voices demanding Medicare For All!

HEALTHCARE REFORM: YES WE CAN DO BETTER!

GROWING THE INDEPENDENT GRASSROOTS MOVEMENT THAT WILL WIN IMPROVED MEDICARE FOR ALL!

TEACH IN AND SUMMIT

WHEN: SATURDAY, APRIL 24, 2010, 10am to 4pm
WHERE: ST. LUKES HOSPITAL AUDITORIUM, Amsterdam Ave. and 113th St., NYC

WHY: Republicans call Obamacare 'evil socialism'. Democrats call it their 'crowning achievement'. We call it inadequate and describe its' main feature as a big sell out to corporate power. We must do better!

PHIMG's 3rd Annual Teach-In and Summit will seek to answer: How do We the People, in the great American tradition, solve the healthcare crisis for ourselves?

OPTIONAL RSVP: If you have facebook, RSVP here and invite all your friends to do the same! If you don't have Facebook, just show up!

FLYER: Click here to download. Please post and distribute widely.

SPEAKERS:

Dr. Margaret Flowers, Congressional Fellow, Physicians for a National Health Program (PNHP)

Richard N. Gottfried, NYS Assembly District 75, Chair, Committee on Health

Katie Robbins, National Organizer, Healthcare-Now!

Ajamu Sankofa, Chair, Private Health Insurance Must Go! Coalition

Dr. Andy Coates, Physicians for a National Health Program

Dr. Leonard Rodberg, Chair, Urban Studies Dept., Queens College, City University of New York

Marvin Holland, Director of Policy and Community Outreach, Transport Workers Union Local 100.

Convened By PHIMG, in collaboration with Healthcare-Now!, Physicians for a National Health Program (NY Metro Chapter) and Single Payer New York.

Lunch is available; donations accepted.

(If this is too small to read, click on the image to bring it up larger.)

Analysis by Don McCanne MD of PNHP:

Throughout the reform process members of Congress have been fighting over whether or not the reform legislation should include the option of purchasing a government-sponsored plan through the proposed insurance exchanges – the so-called “public option.” Since Congressman Alan Grayson introduced the “Public Option Act” or “Medicare You Can Buy Into Act” three days ago, a wave of enthusiastic support has been generated based on the perception that this is the perfect solution. Today’s comment briefly discusses this legislation, and it will sound really great at first blush, but do not draw any firm conclusions until you read through to the end.

Okay. What does this bill do? It simply allows any legal resident of the United States under age 65 to buy into Medicare. The program will be paid for by the premiums to be collected from the individuals purchasing the coverage. Six age brackets are established for purposes of pooling funds. This reduces the financial burden on younger, healthier individuals by requiring older individuals to pay the higher premiums that would be required to fully fund their less healthy risk pool.

Many are not aware of this, but Medicare already has a buy-in program. Under Title XVIII, Sec. 1818, individuals over 65 who have fewer than 40 quarters of Medicare-covered employment who would otherwise not be eligible for Medicare can still participate by paying a full premium for Part A coverage (hospital) or a reduced premium if they have 30 to 39 quarters of Medicare-covered employment. Likewise, under Sec. 1818A, disabled individuals whose entitlement ends due to having earnings that exceed the qualification level can also purchase Medicare Part A. Grayson’s bill adds a new Sec. 1818B to Title XVIII to expand the buy-in option to anyone under 65.

For 2010, the premium under Sec. 1818 and Sec. 1818A to buy into Medicare Part A is $461 per month. The premium for Part B (supplemental medical) is the same as for qualified retirees – $110.50 and up, based on income (ignoring the hold harmless exception). Thus the buy-in is about $571 per month, or more for those with higher incomes.

Although Medicare beneficiaries have a high rate of chronic disease plus the costs of end-of-life care, the risk pool is diluted with a very large number of healthy seniors, thus the premiums are not as high as one might think. On the other hand, it is likely that the risk pools for the older but still under 65 age groups in the Grayson proposal would be subject to adverse selection. Since the premiums must pay all costs, they may be higher, perhaps much higher, than the diluted post 65 risk pool. Grayson has not included any risk adjustment mechanism to compensate for this.

At any rate, the Grayson proposal seems to be the true public option, run by the government, that progressives have been fighting for. So what could be wrong with it?

The greatest concern of all is that it still does not fix our outrageously expensive, administratively wasteful, highly inequitable, fragmented method of financing health care. It merely provides another expensive option in our very sick system of paying for health care. Providing yet one more option that people can’t afford really hasn’t moved the process.

Although Medicare is a very popular program, it is highly flawed. It has an oppressive central bureaucracy. It fails to use more efficient financing systems such as global budgeting for hospitals and negotiation to obtain greater value in health care purchasing. There are serious questions about whether Medicare funds are being distributed equitably and in a manner to promote greater efficiency. Its benefit package is relatively poor, covering only about half of health care costs for our seniors. Most Medicare beneficiaries feel that they essentially are forced either to purchase Medigap plans, which provide the worst value of all private health plans, or to enroll in Medicare Advantage plans, which waste too many tax and premium dollars. It would be both much less expensive for all of us and better for Medicare beneficiaries if the extra benefits of these private plans were rolled into the traditional Medicare program. Part D should be stripped of its private market administrative and profit excesses and also be rolled into the traditional program. Medicare also has failed to introduce beneficial innovative programs such as the British NICE system, which would improve both quality and value in our health care.

When we advocate for an improved Medicare for all, we really aren’t advocating for Medicare with a few tweaks. We are advocating for replacing Medicare with a single payer national health program that covers everyone, which we can still call Medicare, just as the Canadians do. Adding another buy-in program to the two buy-in programs that already exist in our highly dysfunctional system will do virtually nothing to fix these flaws we now have. It does nothing to slow the growth in our national health expenditures, and the high premiums for a package of mediocre benefits will do little to reduce the numbers of uninsured.

For those who say that a Medicare buy-in is an incremental step towards health care utopia, explain precisely how that is going to work. Explain each problem that it solves. Explain how it is going to morph into a universal or near universal system in which each individual is paying the full actuarial value of the coverage. It won’t happen.

Playing with a Medicare buy-in is an unnecessary diversion at a time that we need to get serious about reform. We need to fix Medicare and expand it to cover everyone.  Nothing less will do.

When Obama came to my neighborhood this week to press for public support for his health “reform” bill, he wasn’t just greeted by teaparty hecklers. Speaking to a large group of mostly supportive students and local residents at Arcadia University in Glenside, the president at one point mentioned that “people on the left” want “single-payer.” But before he could add that that approach wasn’t going to happen, he found himself drowned out by cheers calling for Medicare for all and single-payer.
That kind of says it all.

I’m with Marcia Angell, editor of the New England Journal of Medicine. The Obama plan for health care “reform”, as well as the two versions passed by the House and the Senate, are all devious disasters that do nothing to solve the nation’s burgeoning health care crisis, and in fact, will make it worse.

The only thing to do at this point is to take the whole stinking pile of paper and put it in the compost heap. Kill it.

This whole effort was never about reform from the day last March when the new president called on Congress to begin deliberations on health care reform. It was about catering to the wishes of the big players in the Medical Industrial Complex--the big pharmaceutical multinationals, the hospital companies, the physicians and, most of all, the insurance industry. People and their health care needs had little or nothing to do with this.

That’s why we’ve ended up with proposals that would do nothing to control costs, that would force health young people to buy unregulated, high-cost and high-profit plans that would be money in the bank for the insurance industry, and that would finance any subsidies for the poor by cutting back on benefits for the only group of Americans who currently have a form of single-payer insurance--the elderly with their Medicare.

President Obama began this whole obscene nightmare with a lie, when he said that even though single-payer systems clearly work to open access to all and keep costs down while providing better overall health results in places like Canada and some European countries, they cannot be applied in America “because that would mean starting over from scratch.” He knew when he said it that this was a lie. America already has a well-run and successful single-payer healthcare program in place that is bigger than the entire Canadian health care system, and that’s Medicare, which was established in 1965, and which currently finances the care of 45 million Americans. You just have to be 65 or disabled to be eligible for it.

As Dr. Angell pointed out on a recent Bill Moyers Journal segment, the simplest way to solve America’s health care crisis would be to just start a gradual expansion of Medicare, say by lowering the age of coverage to 55, and then 45, and then 35, until everyone was covered and the insurance industry was pushed out of the health sector. The right-wing couldn’t use their scare tactics about a “government takeover of your medical care,” because the elderly love Medicare, and besides, far from “inserting a government bureaucrat between you and your doctor,” Medicare gives the elderly a freer choice of physician and treatment than any but the most gold-plated private insurance executive health care plan.

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