Doctor Susanne L. King, M.D. advocating for single-payer healthcare from the beautiful Berkshires. Also, see DAVID LOTTO & Berkshire Mass-Care.

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"Asking about single-payer"
By Dr. Susanne King
Friday, February 15, 2008

I often talk with people about health care reform, advocating for single-payer health care as the only answer to problems that include 47 million uninsured people in the United States, and an even greater number of underinsured; the economic pressure on businesses; and the rising costs of health care for our country, states, towns and individuals. Here are the questions people most frequently ask.

1) What is single-payer health care?

"Single-payer" refers to the administration of the health care funds by one payer, rather than the current multiple insurance companies. This payer could be either the state or the federal government. Every other industrialized country in the world has a single-payer system.

2) Is this socialized medicine?

No, because hospitals would still be privately owned, rather than owned by the government, and doctors would still be in private practice. "Single-payer" refers to the taking in and paying out of the health care dollars, which would replace the current role of private insurance companies. Traditional Medicare is a single-payer system that has been in place for many years.

3) Doesn't Medicare have big problems?

Traditional Medicare has worked very well for patients, and they have been happy with it. However, the intrusion of private insurance companies into the administration of Medicare, first with the introduction of private HMOs in the 1980s, and then by President Bush with subsidies to the insurance companies for drug plans, has wrought havoc with the program.

The insurance companies now see Medicare as a cash cow, creating an economic burden on the program, to the tune of billions of dollars per year. Subsequently payments to doctors, the actual providers of care, have been cut.

4) Can we afford single-payer, if that means covering 47 million uninsured people?

We already pay enough for comprehensive coverage for everyone. We just don't get coverage for everyone, because 31 percent of our health care spending goes for administration through the patchwork of private for-profit insurance companies. Potential savings from eliminating the waste and astonishing profits of insurance companies (like Massachusetts' Blue Cross/Blue Shield's 2006 compensation of over $16 million to its retiring CEO William Van Faasen), has been estimated at $350 billion per year.

5) Won't there be waiting lines or rationing with single-payer?

The United States currently rations care based on ability to pay, and 18,000 Americans die every year because they lack health insurance. Canada has a single-payer system, and their waiting times for care are shorter than commonly believed. In 2005, the median wait for specialists or elective surgery was four weeks. Canadians live longer and are more satisfied with their health care than Americans, while paying half as much per person.

6) Won't our aging population break the bank in a single-payer system?

Japan and Europe both have a higher percentage of elderly citizens, yet they spend much less on health care than we do, and have better outcomes. Universal access through a single-payer system prevents more advanced stages of illness, and will pay for long-term care rather than costly hospitalization.

7) Some people like their insurance; why should they change?

Our current system is tied to employment; people change or lose jobs, which disrupts their coverage. Others find their coverage fails when they get sick: 75 percent of the one million Americans experiencing medical bankruptcy each year were insured when they got sick. And insurance premiums go up by double digits every year, for policies that cover less and less.

8) How would single-payer be financed?

Currently about 60 percent of our health care system is financed by public money (our taxes), 20 percent by private employers, and 20 percent by individuals. With a state or national single-payer health program, the public money would be retained. There would be a payroll tax on employers (approximately 7 percent) and an income tax on individuals (approximately 2 percent). The payroll tax would replace all other employer expenses for employee health care. The income tax would take the place of all current insurance premiums, co-pays, deductibles, and any other out-of-pocket payments.

For the vast majority of people, a 2 percent income tax is less than what they now pay for insurance premiums and out-of-pocket payments such as co-pays and deductibles, particularly for anyone who has had a serious illness or has a family member with a serious illness. Many small employers now have to pay 25 percent or more of payroll for health insurance, and large employers now pay roughly 8.5 percent. Everyone would have more comprehensive coverage: in addition to medical care and drugs, benefits would include mental health care, dental care, and long-term care.

9) Who would run a single payer plan?

It is a myth that with national health insurance the government will be making the medical decisions. The government would only be the administrator of the health care funds.

In a publicly financed, universal health care system, medical decisions are left to the patient and doctor, and the public has a say in how the system is run. Cost containment measures will be publicly managed at the state level by an elected and appointed body that represents the people of that state. This body, in consultation with medical experts in all fields of medicine, will decide on the benefit package, negotiate doctor fees and hospital budgets, and be responsible for health planning and the distribution of expensive technology. Right now, insurance companies make many health care decisions behind closed doors, and their interest is in profits, not our health care.

10) Won't doctors dislike a single-payer system?

Most doctors are very dissatisfied with the current system, because of its administrative burden, and because insurance companies create hurdles to providing care doctors think their patients need. Physicians would like to make medical decisions with their patients, without the intrusion of the profit-motivated insurance companies. In addition, doctors now provide care for which they don't get reimbursed, when patients are unable to pay because they are uninsured or underinsured. More and more physician groups are supporting single-payer. Physicians for a National Health Program now has 14,000 members.

11) How would we get to a single payer system?

There are bills in the state legislatures and in Congress. Single-payer legislation for our state is the Massachusetts Health Care Trust, Senate bill 703. Federal legislation is HR 676, now supported by 88 congressmen, including Rep. John Olver.

In Canada, single-payer health was introduced province by province, rather than at the national level. Support for single-payer health care is increasing as people learn about the benefits of this solution for our broken health care system.

If you wish to learn more, visit the Web sites www.pnhp.org, www.masscare.org, or www.sickocure.org

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Susanne L. King, M.D., is a Lenox practitioner.
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"Support single-payer plan"
The North Adams Transcript - Letters
Friday, February 22, 2008

To the Editor:

I have supported the movement toward single-payer health care for many years.

Thanks to action by doctors Suzanne King and Michael Kaplan, this movement has gained momentum in Berkshire County.

To keep this momentum growing, it is up to all of us to give our support with letters to newspapers -- contacting your legislator and any other way we can.

The Maple Grove Civic Club in Adams this month has given Single Payer Health Care Trust its endorsement.

Please do the same. Thank you.

Roy Thompson
Adams, Massachusetts
Feb. 21, 2008

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"Predictable failure of 'reform'"
The Berkshire Eagle - Letters
Saturday, February 16, 2008

We at Berkshire Mass-Care, our local single-payer health insurance advocacy group, were pleased to see Clarence Fanto's op-ed piece in the Feb. 8 Eagle ("Money woes confront state health program,") about the problems facing the Massachusetts health care "reform." We have been predicting its failure from the outset, for precisely the reasons that are now starting to become clear. As long as private health insurance companies are allowed to be the middlemen siphoning off valuable health care dollars to cover their operating costs, their exorbitant CEO salaries, and profits for their shareholders, the Massachusetts health care plan will be faced with a severe funding shortfall.

There are three possible outcomes for the Massachusetts plan. One would be for the federal government to deliver a large pot of new money dedicated to funding it, which is the only way that it could come close to fulfilling its stated goals. As Mr. Fanto tells us, the chances of this scenario coming to pass are slim to none. The none would be if McCain wins the election. The slim is if either Obama or Clinton became president as both of them, at this time, are committed to a continuation of the private health care insurance system and could only afford to subsidize the Massachusetts plan (as well as any number of similar plans attempted by other states) with a massive tax increase. A highly unlikely prospect.

The other two choices are: either a large number of the uninsured who can't afford the going premiums for unsubsidized health care insurance (on average, about $5,000 a year for an individual or $12,000 for a family) will either be dropped from the program or will have their current subsidies drastically cut; or the amount of insurance coverage will be significantly reduced leading to much higher out of pocket costs (increased deductibles, co-payments, and services which are not covered at all) for those in the program.

Mr. Fanto tells us that Gov. Patrick came a bit closer to endorsing a single-payer system ("the rate of increase in premiums is a serious problem ... there's a view out there that as long as private insurance is a part of health-care reform, we're never really going to break the back of the pattern").

Even Jon Kingsdale, the head of the Commonwealth Connector, the entity which is charged with implementing the new law, when he spoke at BMC last summer, acknowledged that a single-payer system would be the best solution to providing affordable health care coverage to the people of Massachusetts.

So if so many politicians, legislators, health care policy experts, doctors, op-ed writers, in addition to a majority of the voting public, according to public opinion polls, are favorably disposed toward a single-payer system why isn't it closer to becoming a reality? Perhaps it has something to do with the existence of health insurance corporations which currently have annual revenues in this country of around $500 billion.

DAVID LOTTO
Pittsfield, Massachusetts

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"Reform has made a big step forward"
The Berkshire Eagle - Letters
Friday, February 22, 2008

I am writing in response to David Lotto's letter "Predictable failure of reform" of Feb. 16.

Since health reform was implemented in July 2006, over 240,000 previously uninsured Massachusetts residents have now been enrolled in the new insurance plans created under health reform. And compelled by the mandate over 60,000 additional individuals have enrolled in their employer sponsored health plans. While our success has created fiscal challenges, Gov. Patrick and the Massachusetts Legislature have committed to fully fund the new plans through FY 2009, with federal funds defraying one-half of anticipated costs. To address long-term funding concerns, House Speaker Salvatore DiMasi and Senate President Therese Murray are considering other funding mechanisms, including a cigarette tax increase.

Here is a local perspective. The primary access point for public health coverage in North Berkshire is the nonprofit organization, Ecu-Health Care. We have been designated to provide outreach and enrollment services for all public programs. In 2005, prior to health reform, 1,142 uninsured residents sought health coverage through Ecu-Health Care. While 663 residents were found eligible for state-sponsored health plans, 479 individuals, or 41 percent, remained uninsured. In 2007, after health reform was implemented, 2,435 uninsured residents sought coverage. Of these individuals, 2,344 were eligible for state-sponsored plans created under health reform. Only 91 individuals, or 4 percent, were left uninsured. This is a remarkable turn-around.

Yes, we face serious challenges. The long-term cost containment issues are very real. But, we are also learning that in Berkshire County, and throughout the rest of the state, with effective outreach, education, and enrollment assistance, we can significantly decrease the number of individuals who previously have not had access to health insurance. This is a big step forward and should not be considered a failure.

CHARLES JOFFE-HALPERN
North Adams, Massachusetts
The writer is executive director, Ecu-Health Care.

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"How the UK's single-payer system killed 17,000 Britons"
By DEROY MURDOCK, Scripps Howard News Service, February 22, 2008

Before American voters embrace either Hillary Rodham Clinton's universal-health scheme or Barack Obama's single-payer proposal, they should consider the avoidable deaths that plague the mother of all state-run medical programs: Great Britain's big-government National Health Service. Low-quality, taxpayer-funded health care killed more than 17,000 Britons in 2004, according to the TaxPayers' Alliance in London.

The TPA examined the World Health Organization's latest-available data to contrast the NHS with the Dutch, French, German and Spanish health systems, which are less government-dominated. Specifically, the pro-market group measured "mortality amenable to health care" -- those deaths that a medical organization realistically should prevent.

While those four countries averaged a 106.6 amenable mortality rate, Britain was almost 29 percent deadlier, with its rate of 135.3. The TPA thus calculates that the NHS took the lives of 17,157 Britons who otherwise would have survived were they treated by doctors across the English Channel. This figure is more than two-and-a-half times Britain's yearly alcohol-related deaths, and is quintuple its annual highway fatalities. Comparing 60 million Brits to 300 million Yanks, this is like a federally operated health agency eliminating 85,785 Americans in 2004.

"Anyone looking to reform the American health-care system should learn lessons from the European experience," says Matthew Sinclair, the TPA policy analyst who authored this study. "Britain's NHS has produced dismally poor results. Thousands die every year, thanks to its poor performance and its failure to make good use of new resources. Other European health-care systems deliver greater competition, decentralization and independence from political meddling."

No one can complain that the NHS is underfinanced. This year's budget is $210 billion -- about $1.05 trillion if adjusted to match America's population. NHS funding climbed 221.7 percent between 1996 and 2006. Despite such largesse, "we have not increased the pace of improvement in the most important measurement of its output -- its ability to save lives," laments professor Karol Sikora, a leader of Doctors for Reform, which hopes to inject competition and choice into British medicine.

Such goals are rare in a sector ensnared in bureaucracy. The British Department of Health supervises the NHS. In turn, the NHS includes Primary Care Trusts, NHS Trusts and Regional Strategic Health Authorities. Drugs are controlled by the National Institute for Health and Clinical Excellence (warmly nicknamed "NICE"). The NHS Pay Review Body oversees staff compensation. Connecting for Health runs the National Program for IT, reportedly Earth's single, largest information-technology initiative. Within this maze, it is no surprise that patient needs often yield to the wants of politicians and medicrats.

The consequences for these political considerations can be ugly.

Poor sanitation has become the NHS' latest worry. The BBC's Danielle Glavin worked undercover at a government hospital in Kent. "On my first day, as I emptied bins, swept and mopped, I noticed old blood stains ingrained on the floor," Glavin reported. In one surgical theater, "a blood-stained gown was left on a trolley for 24 hours, and used medical instruments were discarded in a sink for a day."

This helps explain why the British government estimated that 9 percent of inpatients in 2000 suffered hospital-acquired infections. The bacterium Clostridium difficile often is associated with hospital outbreaks and extended medical stays. English and Welsh death certificates citing C. diff as a cause or contributing factor grew from about 1,000 in 1999 to 3,807 in 2005.

Diseases snuff Britons sooner than they do others in the developed world. A September 2007 Lancet Oncology article found 66.3 percent of American men alive five years after cancer diagnosis. Among male Finns, that figure was 55.9 percent, while only 44.8 percent of Englishmen survived after five years. Across the European Union, 20.1 females per 100,000 under 65 died prematurely of circulatory disease. Among British women, that number was 23.6.

Collectively, these data strongly rebuff the notion that America's imperfect health-care industry needs a booster shot of mandates and regulations. What it sorely lacks is more choice, competition and freedom -- and loads less government.

John McCain's ideas -- among them, expanded health-savings accounts; individually owned, portable health-insurance policies available across state lines; and medical-lawsuit reform -- are the antidote to the "health care with a British accent" that Clinton or Obama would import, unless American voters stop them.

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(New York commentator Deroy Murdock is a columnist with the Scripps Howard News Service and a media fellow with the Hoover Institution on War, Revolution and Peace at Stanford University. E-mail him at deroy.murdock@gmail.com.)
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The Berkshire Eagle Online, Op-Ed0
"Health insurers are the issue"
By Susanne L. King, M.D.
Monday, March 31, 2008
LENOX, Massachusetts

Is it time for your annual health insurance renewal? Have you noticed that your premium has gone up, while the coverage you receive is less than the coverage you had last year? Have you noticed that you are paying more, but getting less; that before you can even use your insurance, you have to pay a sizable deductible; and that if you visit your doctor or buy medication, your co-payment has increased?

Welcome to the land of "cost-sharing," an insurance euphemism for sticking you with the rising costs of health care, without touching insurance company profits.

Massachusetts state Senators Theresa Murray and Richard Moore have introduced legislation to attempt to address rising health care costs in our state. One provision of the bill would create a panel to review insurance company premium rate increases, and hold them to an annual 7 percent increase. If the legislation passes, you know the inevitable result: your deductibles and co-payments will rise even more, at the same time as CEOs like William Van Faasen of Blue Cross Blue Shield of Massachusetts will continue to take home $16.4 million in retirement benefits in a single year. Health insurance companies will continue to get returns for their investors that will maintain their place near the top of the Fortune 500.

We continue to hand over shocking amounts of our health care dollars to insurance companies to do nothing more than to administer our health care funds. Insurance companies provide no health care: they merely handle the money, deny coverage and care, and make huge profits while doing so. The current Massachusetts health care reform, and Murray's proposed legislation to control health care costs, only perpetuate our dysfunctional system because they do not eliminate health insurance companies.

With true health care reform, as in a single-payer health care system, health insurance companies would be eliminated, and either the state or federal government would administer our health care funds. "Single-payer" simply means that one payer would be the administrator, eliminating the hundreds of insurance company payers we now have. Nationally, this would save over $350 billion per year in administrative costs alone, enough money to cover the 47 million uninsured in our country and provide more comprehensive benefits for all of us.

Expanding coverage as we have done in Massachusetts, without controlling administrative costs, is not a sustainable policy. Unfortunately both of the Democratic presidential candidates are proposing a Massachusetts-style health care policy for our country: Neither Clinton nor Obama propose true reform of our health care system.

There are those who say that single-payer health care reform is not politically feasible, and I would guess the presidential candidates believe this. What they are not considering are the polls that show strong majority support for single-payer health care, when people are fully informed about this option.

What do people want in health care reform? They want choice of doctors and hospitals, not of a bewildering array of health care plans. They want to be able to keep their doctors, and to know that the treatment he or she recommends will be paid for, without deductibles and co-payments. They want lower prescription drug costs. They want to know that the quality of their health care is the best. They want their health insurance to remain the same, whether they change jobs, work part-time, retire before being eligible for Medicare, or develop a major disease. And they want affordable health care.

Hard-working middle-income taxpayers are feeling the squeeze. They are not seeing 7 percent increases in their wages, even as their share of the cost of their insurance premiums is rising. Small businesses are floundering as they try to provide insurance for their employees. Towns and cities are crippled by health care costs for their employees and retirees.

The current Massachusetts health care legislation does not address any of these issues. We need to divorce health care insurance from employment and eliminate private for-profit insurance companies. Only a single-payer health care program will provide affordable, comprehensive, portable, and accessible coverage for everyone. The current Massachusetts health care reform is not a viable model for the nation.
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Dr. Susanne King is a Lenox-based practitioner.
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"Insurers: Women are just too risky"
By Susanne L. King, M.D., Tuesday, July 08, 2008, LENOX, Massachusetts

Women readers, get ready to fight. As reported in the Los Angeles Times, Blue Cross Blue Shield of California has decided to charge women more for health care insurance than men. A California woman, Tova Hack, works part-time, and has to buy her own individual health care policy because her employer doesn't provide health insurance for her. She found out that the cost of her high- deductible, bare-bones individual policy was going up 20 percent. The increase couldn't be due to the possibility of pregnancy, because her policy didn't cover pregnancy-related expenses. Blue Cross Blue Shield simply discovered that women are more expensive to insure than men and decided to stick them with the costs.

Blue Cross Blue Shield's reasoning was straightforward. Insurance companies encourage preventive services. However, their actuarial studies show that, unlike seniors who don't use insurance company rebates to sign up to join a gym and save the company money, women actually use preventive services, like mammograms and pap smears that cost the insurance company money.

And if, unlike Tova's policy, their insurance policies do cover prenatal and obstetric services, women understandably seek that care when they are pregnant. Blue Cross Blue Shield of California concluded that women should pay more for their insurance policies than men, since women contribute more to the insurance company's "medical losses." ("Medical loss" is insurance-speak for money the company has to pay out for medical care. The ideal scenario for an insurance company is for no one to use the money paid in premiums for actual health care). Insurance companies carve out risk pools to reduce the likelihood that the people they insure will use health care services. Women, it seems, are just too risky.

Meanwhile health insurance company CEOs are receiving benefits that defy belief. For example, Larry Glasscock of Wellpoint left the company in 2007 with a farewell package of $23.9 million. And health insurance company stocks continue to provide revenue for their shareholders, even as primary care doctors, who actually provide medical care, earn less and less.

The Kaiser Foundation health tracking poll recently found that 25 percent of people reported having problems paying for health care and health insurance, and 59 percent said, "We need to get everyone into the same insurance pool so we can spread the costs of sick and healthy people over the whole population."

If we eliminate the multiple, for-profit insurance companies and have a single-payer health care system, funded and administered by the government, everyone would be in the same risk pool. Women would not have to pay more for health insurance because they take good care of themselves by getting pap smears, mammograms and prenatal care. Women would not be discriminated against because they are the ones who get pregnant, have babies, and use obstetrical services. Women would not be punished just for being women.

If the multiple private health insurance companies were eliminated, $350 billion in administrative funds would be saved. These funds could be used to cover everyone with a universal, comprehensive, single-payer health insurance that would provide not only medical care and prescription drugs, but would also pay for long term care for our seniors.

Recently, at the national convention of the League of Women Voters, women voted unanimously to make advocacy for, and education about, health care reform a top priority. Women have fought long and hard for their rights in the past decades. It is time for them to take on the insurance companies, and fight for their right to affordable and accessible health care.
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Susanne L. King, M.D., is a Lenox practitioner.
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The Boston Globe, Op-Ed
SUSANNE L. KING
"Massachusetts healthcare reform is failing us"
By Susanne L. King, March 2, 2009

MASSACHUSETTS HAS been lauded for its healthcare reform, but the program is a failure. Created solely to achieve universal insurance coverage, the plan does not even begin to address the other essential components of a successful healthcare system.

What would such a system provide? The prestigious Institute of Medicine, part of the National Academy of Sciences, has defined five criteria for healthcare reform. Coverage should be: universal, not tied to a job, affordable for individuals and families, affordable for society, and it should provide access to high-quality care for everyone.

The state's plan flunks on all counts.

First, it has not achieved universal healthcare, although the reform has been a boon to the private insurance industry. The state has more than 200,000 without coverage, and the count can only go up with rising unemployment.

Second, the reform does not address the problem of insurance being connected to jobs. For individuals, this means their insurance is not continuous if they change or lose jobs. For employers, especially small businesses, health insurance is an expense they can ill afford.

Third, the program is not affordable for many individuals and families. For middle-income people not qualifying for state-subsidized health insurance, costs are too high for even skimpy coverage. For an individual earning $31,213, the cheapest plan can cost $9,872 in premiums and out-of-pocket payments. Low-income residents, previously eligible for free care, have insurance policies requiring unaffordable copayments for office visits and medications.

Fourth, the costs of the reform for the state have been formidable. Spending for the Commonwealth Care subsidized program has doubled, from $630 million in 2007 to an estimated $1.3 billion for 2009, which is not sustainable.

Fifth, reform does not assure access to care. High-deductible plans that have additional out-of-pocket expenses can result in many people not using their insurance when they are sick. In my practice of child and adolescent psychiatry, a parent told me last week that she had a decrease in her job hours, could not afford the $30 copayment for treatment sessions for her adolescent, and decided to meet much less frequently.

In another case, a divorced mother stopped treatment for her son because the father had changed insurance, leaving them with an unaffordable deductible. And at Cambridge Health Alliance, doctors and nurses have cared for patients who, unable to afford the new copayments, were forced to interrupt care for HIV and even cancers that could be treated with chemotherapy.

Access to care is also affected by the uneven distribution of healthcare dollars between primary and specialty care, and between community hospitals and tertiary care hospitals. Partners HealthCare, which includes two major tertiary care hospitals in Boston, was able to negotiate a secret agreement with Blue Cross Blue Shield of Massachusetts to be paid 30 percent more for their services than other providers in the state, contributing to an increase in healthcare costs for Massachusetts, which are already the highest per person in the world. Agreements that tilt spending toward tertiary care threaten the viability of community hospitals and health centers that provide a safety net for the uninsured and underinsured.

There is, though, one US model of healthcare that meets the Institute of Medicine criteria: Medicare. Insuring everyone over 65, Medicare achieves universal coverage and access to care, is not tied to a job, and is affordable for individuals and the country. Medicare simplifies the administration of healthcare dollars, thereby saving money. We need to improve Medicare, and expand this program to include everyone.

A bill before Congress, the United States National Health Insurance Act, would provide more comprehensive coverage for all. The bill includes doctor, hospital, long-term, mental health, dental, and vision care, prescription drugs, and medical supplies, with no premiums, copayments, or deductibles.

People would be free to choose doctors and hospitals, and insurance would not be tied to a job. Costs would be controlled because health planning in a national health program can reestablish needed balance between primary/preventive care and high-tech tertiary care. A modest, progressive tax would replace what people currently pay out of pocket. This program would pay for itself by eliminating the wasteful administrative costs and profits of private insurance companies, and save $8 billion to $10 billion in Massachusetts alone.

We must let Congress know we want improved access to affordable healthcare for all, not more expensive private health insurance we can't afford to use when we are sick. Massachusetts healthcare reform fails on all five Institute of Medicine criteria. Congress should not make it a model for the nation.
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Susanne L. King, M.D., practices in Berkshire County.
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www.boston.com/bostonglobe/editorial_opinion/oped/articles/2009/03/02/mass_healthcare_reform_is_failing_us/
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www.boston.com/bostonglobe/editorial_opinion/oped/articles/2009/03/02/mass_healthcare_reform_is_failing_us?mode=PF
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READERS' COMMENTS:
http://people.boston.com/articles/oped/?p=articlecomments&activityId=8224553467046199120
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CHECKING THE PULSE OF HEALTHCARE REFORM
"Not surprised state's law would be deemed a failure"
March 5, 2009

DR. SUSANNE L. King's March 2 op-ed "Mass. healthcare reform is failing us" is the verdict on Massachusetts' required health insurance law that I've been waiting to see. I haven't been in a position to track the actual results - and I'd been hoping to be proved wrong - but the basic logic was pretty obvious when the law was first debated: Requiring everyone to buy health insurance would not result in better access to care for everyone. Instead, it removes the incentive for insurers to offer plans that give good value, and creates a huge market for plans that meet the letter of the law at the lowest cost, such as the high-deductible plans King cites that people can't afford to actually use. Healthcare coverage that is useful then becomes a perk of the ever-scarcer cushiest jobs.

That was my private prediction, and it looks as if Susanne King, at least, thinks I was right.

Jonathan Gilbert
Arlington, Massachusetts

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READERS' COMMENTS:

"Why the US doesn't follow France's example of single payer, a bit higher taxes, one computer system, one health form, excellent doctors I will never know."
- by "dlnelson" March 5, 2009, 7:03 A.M.

"Jesus told the rich man that to save himself he must sell everything and give his money to the poor. We have an ethical obligation to provide good health care to those who haven't the ability to provide it for themselves. The Mitt Romney/Massachusetts health insurance route demands that the poor provide for themselves. It's not ethical."
- by "Recifense-2" March 5, 2009, 8:42 A.M.

"Why won't anybody talk about the elephant in the room?

"This 'reform' was nothing but a Presidential campaign gimmick from our 'just passing through' ex-Governor [WILLARD Mitt Romney]. He never concerned himself with whether or not it would work, because he knew the results would come out after the campaign was over. In that context, repealing this insanity should be an easy decision."

- by "gotham23", March 5, 2009, 9:39 A.M.

"I agree 100% Recifense, The bible says it is harder for a rich man to get into heaven than for a camel to go through the eye of a needle. So why does everyone want to get rich now. Right now for Presidents of banks and medical centers I really doubt they feel like they're in heaven. And Bernard Madoff is a good example of what happens to people when they keep all their wealth for themselves. This insurance plan is more than anyone can afford, and most of all it doesn't bring us good health. If you want good health, well if you're depressed buy your foods with Omega 3 and omega 6. That is cheaper than seeing a psychiatrist. If you've got a cold get Lotus seeds, vitamin C enriched drinks and Echinacea tea to improve your immune system. Why is it that we'll spend more than people in any other country giving our money to rich insurance company owners and rich medical center owners, but we do less than almost any other country to eat a healthy diet and get exercise that will keep us from getting sick. It is amazing how weak our immune systems have gotten. Medicine doesn't help that. That is the fault of our own diets. And doctors never discuss that. If they did it would hurt their business."

- by "jlitvlnvla" March 5, 2009, 10:26 A.M.

Re: "Why the US doesn't follow France's example of single payer, a bit higher taxes, one computer system, one health form, excellent doctors I will never know. "

Sadly, "dinelson", I believe the answer is pure unmitigated greed.

- by "djmojo", March 5, 2009, 3:23 P.M.

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CHECKING THE PULSE OF HEALTHCARE REFORM
"Critic overstates program's cost"
The Boston Globe, Letters, March 5, 2009

THIS YEAR'S cost for the government-subsidized Commonwealth Care program is actually projected to be about $500 million less than Susanne L. King claims. It makes you question what other liberties she has taken to justify her particular point of view.

Massachusetts now has the lowest rate of uninsured in the nation at only 2.6 percent. It's no wonder so many are studying our landmark law to determine what aspects of it can be used to benefit the entire country.

Joan Fallon
Chief communications officer
Commonwealth Health Insurance Connector Authority
Boston, Massachusetts

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READERS' COMMENTS:

"Forcing people to buy health insurance has led to a proliferation of programs with high deductables coupled with large co-pays. Everyone in the PR and accounting ends of the health care industry are crowing about the lower uninsured rates, when in reality many of these plans leave the newly insured with no viable and affordable care. But those bottom lines are still growing, and after all, isn't that what it's all about?"
- by "waltjones", March 5, 2009, 7:21 A.M.

"And let's all give a round of applause to the Commonwealth's smokers, who's financial sacrifices made it all possible. How long does our government want people to keep smoking to pay for someone else's health insurance?"
- by "gotham23", March 5, 2009, 9:26 A.M.

"What a total crock this law is. Look we're taxing people to death and then penalizing them if they can't afford to spend their money on health insurance. Give me a break. Meanwhile the representatives,senators, and the governor will receive health insurance gratis of the taxpayers."
- by "alfdmas", March 5, 2009, 9:42 A.M.

"The law requires me to have insurance but the insurance company continues to deny claims for an accident my wife had. They expect me to come up with 30K, isn't that what I pay them for? You require me by law to purchase their services but have no law to protect me when they refuse to honor legitimate claims."
- by RTM-2 March 5, 2009, 11:31 A.M.

"Is this writer getting high on ink or something ? Trust me, noone is studying your failed healthcare system except as a "what not to do" scenario."
- by bhubbard March 5, 2009, 4:06 P.M.

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"Single-payer advocates plan to protest health care forum"
By DANIEL BARLOW, VERMONT PRESS BUREAU, rutlandherald.com, Article published: March 13, 2009

MONTPELIER – Vermont doctors and other medical professionals who support a single-payer health care system plan to protest next week's Burlington health care reform forum organized by President Barack Obama's administration.

Deb Richter of the organization Vermont Health Care for All said Thursday that some single-payer advocates have been invited to attend the forum, moderated by Vermont Gov. James Douglas and Massachusetts Gov. Deval Patrick, but that the issue will not be seriously considered.

"It's clear that a single-payer approach is not favored by inside the beltway politicians and the two governors headlining the event," said Richter, a physician. "We saw the same thing with their health care event in D.C. … supporters of a single-payer system were shut out of the meeting."

Douglas, a Republican, and Patrick, a Democrat, were handpicked by Obama earlier this month to headline the health care reform forum – one of five that will be held across the country as the new president prepares an overhaul of the system.

Douglas walks a fine line on health care reform. He vetoed a major public expansion of health care pushed by Democratic lawmakers several years ago and later compromised with the same lawmakers on the creation of Catamount Health, a public-private insurance program for the uninsured.

But next week's forum comes at the same time as Douglas has proposed eliminating 38 Vermont Department of Health employees as part of his 2010 budget plan, including several who work on the Blueprint for Health – one of Vermont's top health care reform efforts that Douglas is expected to promote next week.

"I find it particularly ironic you would propose to cut people in a program you are going to be bragging about next week," House Speaker Shap Smith said.

Douglas said he hopes all such layoffs will be avoided by the union agreeing to pay cuts and other concessions.

"This is not an easy process," said Douglas, who added that departments and agencies make recommendations about where to make cuts. "Yesterday was a very difficult one for my team."

Christine Finley, deputy commissioner for public health, said that the potential layoffs — a couple of which may involve positions that work on the blueprint — will not weaken the state's commitment to the program. The department is now working on how to manage those cuts if the layoffs do prove to be necessary, she said.

"The work of the blueprint is clearly a priority for the health department," Finley said. "We have not changed our priority."

It is hard to define how many health department workers help on the blueprint because most of those engaged in the department in helping Vermonters manage or avoid chronic diseases — from asthma work to anti-tobacco efforts — work on the blueprint in some capacity.

"It really is our effort to prevent chronic disease in the state and it cuts across what we do," Finley said.

The single-payer demonstration will begin around noon outside of the Davis Center on the University of Vermont campus, according to Richter, and end around 1 p.m., the start time of the forum inside.

Richter said she was invited to the session earlier this week and will attend. But with a running time of 90 minutes – and an expected televised message from Obama to kick start the session – there is no way a massive overhaul of the health care industry can be debated that day, she said.

"We need a massive overhaul," Richter said. "These Band-Aids will not work anymore."

Richter said she expects doctors and health professionals from Massachusetts, Maine, New Hampshire, New York and Connecticut to travel to Burlington next Tuesday to participate in the demonstration.

During his weekly press conference Thursday, Douglas was surprised to hear that single-payer advocates will demonstrate outside of the forum. While he noted that Obama does not prefer the single-payer approach for this round of reforms, he said advocates with that position have been invited to the session.

"There will be single-payer advocates at the meeting," Douglas said. "We are interested in hearing a broad range of viewpoints."

Rebecca Deusser, the deputy press secretary for Gov. Patrick, had no comment Thursday on next week's demonstrations or the governor's position on single-payer health care. She said Patrick supports Obama's approach to health care reform.

"Successful health care reform in Massachusetts has become a national model – with more than 98 percent of residents covered by health insurance," she said in a prepared statement. "The governor looks forward to joining the discussion on how best to make quality health care available to all Americans, while containing skyrocketing costs."

The Vermont Public Interest Research Group, a Montpelier organization that has advocated for a single-payer health care system, will be participating in next week's forum – although they share the concerns of others that the issue will not be given a full hearing.

Susan Baker, the health care advocate for VPIRG, said the group's ultimate goal is a single-payer system, but they recognize that an incremental approach that relies on a partnership between governments and the private insurance companies has stronger public support.

"We think it is great that people will be demonstrating outside and pushing the issue," Baker said. "But we also believe that it will be productive to be inside and part of the discussion."
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Louis Porter contributed to this report.
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daniel.barlow@timesargus.com
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Source: www.rutlandherald.com/article/20090313/NEWS02/903130355/1004/NEWS03
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"Boston Health News"
March 13, 2009 — by Tinker Ready

Next Tuesday (3/17/2009)in Burlington Vermont, Massachusetts Governor Deval Patrick and Vermont Governor Jim Douglas will convene a New England Health Summit as part of President Obama’s national push for health reform.

While Governor Douglas has now invited single payer advocacy groups from Vermont - including Physicians for a National Health Program and the Vermont Citizens Campaign for Health - Governor Patrick has not included any single payer groups on his invitation list from Massachusetts.

Please call and/or email the Governor’s office and ask them to include Mass-Care, Massachusetts Physicians for a National Health Program, and the Massachusetts Nurses Association in this important dialogue about the future of our health care system…

At the recent White House summit on health reform, no single payer advocate was invited until thousands of messages reached the White House, including word that doctors were going to protest on the sidewalk. At the last minute, two single payer supporters were invited…

Two hours later, this arrived:

At 5:30P.M., we received an invitation from Governor Patrick’s Office of Government Affairs.

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Source: http://tinkerready.wordpress.com/2009/03/13/action-for-single-payer-advocates-and-money-for-young-scientists/
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"Boston Health News"
March 9, 2009 — by Tinker Ready

Single-payer national health insurance is a system in which a single public or quasi-public agency organizes health financing, but delivery of care remains largely private.

Currently, the U.S. health care system is outrageously expensive, yet inadequate. Despite spending more than twice as much as the rest of the industrialized nations ($7,129 per capita), the United States performs poorly in comparison on major health indicators such as life expectancy, infant mortality and immunization rates. Moreover, the other advanced nations provide comprehensive coverage to their entire populations, while the U.S. leaves 47 million completely uninsured and millions more inadequately covered.

The reason we spend more and get less than the rest of the world is because we have a patchwork system of for-profit payers. Private insurers necessarily waste health dollars on things that have nothing to do with care: overhead, underwriting, billing, sales and marketing departments as well as huge profits and exorbitant executive pay. Doctors and hospitals must maintain costly administrative staffs to deal with the bureaucracy. Combined, this needless administration consumes one-third (31 percent) of Americans’ health dollars.

Single-payer financing is the only way to recapture this wasted money. The potential savings on paperwork, more than $350 billion per year, are enough to provide comprehensive coverage to everyone without paying any more than we already do.
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Source: http://tinkerready.wordpress.com/2009/03/09/health-reform-single-payer-and-our-fair-city/
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Newsday.com
"Health care bills suffer conspiracy of silence"
Saul Friedman - Gray Matters, February 21, 2009

Too often journalism ignores or belittles reports or proposals as outside the mainstream and bound to fail, thus assuring they will remain outside the mainstream and fail.

That, I believe, is what has been happening to proposals by three Democratic members of the House of Representatives to provide health care for all Americans through a system like Medicare, rather than depending, as now, on many private insurance companies.

The lawmakers, among the most senior House members, are Pete Stark of California, chairman of the health subcommittee of Ways and Means; John Dingell of Michigan, the longest-serving member of the House and chairman emeritus of Energy and Commerce, and Judiciary Committee chairman John Conyers, also from Michigan.

Last month, Stark reintroduced his proposal, called Americare, which would open Medicare Parts A and B to everyone, but allow people to keep their employer-based insurance. A few days later, Dingell and Conyers reintroduced their bills, which would expand Medicare to become the nation's comprehensive health care program, paid for by premiums and taxes. The Conyers bill has dozens of co-sponsors and the support of most AFL-CIO unions.

On Jan. 28, a coalition of advocacy groups representing 15,000 doctors and more than 50,000 nurses, met at the Capitol to present a new study asserting that the Conyers' bill, called the National Health Insurance Act (HR 676), could create 2.6 million new jobs and would cost far less than the private insurance currently paid for by individuals and employers.

Only Congressional Quarterly covered it. The Kaiser Family Foundation's daily online report on health care developments at kff.org didn't mention it. Nor has Kaiser, the most comprehensive online source of health care information, made any mention of "single-payer" (the government as the payer), or the Conyers bill since it was introduced in 2003, despite widespread support for such a plan according to Kaiser's own polls. (After my insistent inquiries, Kaiser says it will publish charts next month comparing the Stark and Conyers bills.)

AARP, another key source of health care information, briefly mentioned single-payer in the AARP Bulletin, sent to its 35 million members. But neither single-payer nor the Conyers bill have been discussed in any of its other publications or its advocacy materials at aarp.org.

Why? Many health care writers and advocates believe it's because single-payer and the Conyers bill would bar any role for private insurance companies, which would have central roles in all the other proposals under discussion.

The Kaiser Family Foundation was founded with insurance money, but its president, Drew Altman, says it receives no money from and has no connection with Kaiser Permanente, a large health insurer. And AARP's chief strategist, John Rother, insists that its $700 million insurance business, mostly with UnitedHealth Group, does not affect its policies.

But reader Elaine Fox of Southampton, a physician and health care activist, contends there is evidence the health insurance industry opposition to government-sponsored health care has contributed to the effort to black out discussion of the Conyers bill.

She noted that in "An Analysis of Leading Congressional Health Care Bills, 2007-2008," an online article posted in January by the Commonwealth Fund, a nonpartisan public policy research organization (www.commonwealth fund.org/index.htm), the Conyers bill was ignored. The Stark bill, which includes an insurance option, was analyzed. But Conyers' bill and single-payer were not discussed in the analysis, which was done for Commonwealth by the Lewin Group, health care consultants.

As Fox pointed out, the Lewin Group had been independent and in 2005 its analysis supported passage of a single-payer bill in California. In 2007, Fox said, Lewin was purchased by Ingenix, a health information firm that helps set the rates insurance companies pay providers. Ingenix is owned by one of the nation's largest insurers, UnitedHealth (which recently paid a $50 million fine in New York to settle a charge that Ingenix underpaid out-of-network doctors who provided service for United's subscribers).

On Jan. 13, Fox said, the RAND Corp., a think tank, launched an online tool for policy makers to compare health care proposals called "Comprehensive Assessment of Reform Efforts," or COMPARE. It did not include the Conyers bill or any single-payer alternative. RAND acknowledged that COMPARE is funded in part by AARP and health insurers, including UnitedHealth. A RAND spokesman said COMPARE will "get around to including" single-payer plans.

AARP's Rother cites other reasons than the insurance industry for the blackout. He's in favor of a single-payer system, he says, but insists he's not encouraging such proposals because they're outside the mainstream and are not likely to pass. Despite broad support for national health insurance and Medicare, Rother says, "This is simply a matter of pragmatism. Single-payer advocates could play a destructive role in the coming debate."

Fox argues: "There cannot be a credible debate when one side disappears."
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WRITE TO Saul Friedman, Newsday, 235 Pinelawn Rd., Melville, NY 11747-4250, or by e-mail at saulfriedman@comcast.net.
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"Single-payer advocates rally outside forum"
By Associated Press, Tuesday, March 17, 2009, www.bostonherald.com, Local Politics

BURLINGTON, Vt. — A forum on how to overhaul the nation’s health care system drew no shortage of suggestions, with patients, doctors and providers turning out in Vermont to give their views.

The forum, held Tuesday in Burlington, featured about 400 people in a town hall-style meeting. Among them was 66-year-old Sandra Burt, of Concord, New Hampshire, who says the loss of her job and health insurance has left her unable to pay the $2,730-a-month tab for medication to treat her autoimmune disorder.

The governors of Massachusetts and Vermont hosted the invitation-only forum, one of five being held across the nation.
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Article URL: www.bostonherald.com/news/politics/view.bg?articleid=1159222
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"Sanders and single-payer"
By Susanne L. King, M.D., The Berkshire Eagle, Op-Ed, Saturday, April 4, 2009
LENOX, Massachusetts

Sen. Bernie Sanders, a Vermont Independent, has just introduced a single-payer health care reform bill into the United States Senate. This legislation stands in sharp contrast to the reform models offered by the White House and Sen. Max Baucus, which are similar to our current Massachusetts reform. Unlike Massachusetts, the Sanders bill would eliminate the many private insurance companies and create a "single payer" to administer health care funds.

Single-payer health care would save American taxpayers $400 billion in administrative costs, says Sanders, which would be enough money to provide health care coverage for everyone in our country. Sanders is a senator who knows how to save money at a time when taxpayers are paying billions to keep AIG afloat.

As we know from our Massachusetts experience with health care reform, preserving the role of private health insurance companies does not lead to universal coverage or contain rising health care costs. The Massachusetts reform program has not been affordable for the individual or for the state, and access to health care continues to be problematic, with nearly a quarter of the state's residents saying they had difficulty getting care in 2008.

The provisions of Senator Sander's bill are: (1) universal coverage; (2) comprehensive benefits, including mental health, dental and prescription drug coverage; (3) patient choice of doctors and hospitals; (4) fully-funded community health centers to provide access to care for the 60 million people living in rural and other underserved areas; and (5) resources for the National Health Service Corps to train 24,000 new health professionals to address the shortage of primary care doctors and dentists.

Massachusetts continues to have a critical shortage of primary care doctors, and providing health insurance for the uninsured through our current program has only made that deficiency more visible. Having health insurance in Massachusetts doesn't guarantee health care if you can't find a doctor when you are sick. Others with insurance can't get care because they can't afford their co-payments and deductibles.

Sanders' program would be paid for by taking the current sources of government health care spending, and combining them with modest new taxes that would be less than people now pay for insurance premiums and other out-of-pocket expenses. Four hundred billion dollars would be saved annually by eliminating insurance company profits and overhead, as well as the paperwork that burdens doctors and hospitals.

Dr. Uwe Reinhardt said at a hearing before the U.S. Senate Finance Committee, "We have 900 billing clerks at Duke (a 900 bed university hospital). I'm not sure we have a nurse per bed, but we have a billing clerk per bed. . . it's obscene."

Doctors and hospitals are sick of the paperwork and the health care dollars that don't go for health care delivery. And everyone hates the intrusion of insurance companies into health care decisions. A poll published in the Archives of Internal Medicine found that 64 percent of doctors in Massachusetts now support single-payer health care.

Sen. Bernie Sanders' legislation is a bold step forward. Five hundred physicians in Massachusetts have signed a letter to Sen. Kennedy, asking him to support a single-payer reform similar to Sanders' bill. Kennedy supports universal coverage, but would leave the current dysfunctional system of multiple insurance company payers intact. Kennedy has said, "Health care is not just a commodity . . . to be rationed based on the ability to pay. It is time to make universal health insurance a national priority, so that the basic right to health care can finally become a reality for every American."

Unfortunately, leaving the current system intact would not save the $400 billion now lost to administrative expenses. We ask Sen. Kennedy to listen to Massachusetts physicians and reject the lobbying forces of the profit-driven insurance industry. We also ask him to join Sen. Sanders in sponsoring the only solution for health care reform that will cover everyone at a cost we can afford.
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Susanne L. King is a Lenox-based practitioner.
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Vermont
"Health care a 'right': Hundreds demand universal coverage"
The Associated Press, Saturday, May 02, 2009

MONTPELIER, Vt. (AP) — The contention that "health care is a human right" brought hundreds of people to the Statehouse steps on Friday to demand that Vermont implement universal health care coverage.

Friday's event, organized by the Vermont Workers' Center and other progressive-leaning groups, included some disruption as chanting demonstrators entered the Statehouse and were admonished by officials for disrupting business in parts of the building. There were no arrests.

Speakers ranged from Sen. Bernie Sanders, I-Vt., a longtime advocate for single-payer health care, to nurses from Vermont's largest hospital, Burlington's Fletcher Allen Health Care.

Sanders called fight for universal health care "the great civil rights struggle of our time."

"When Wall Street gets into financial distress, we have a system to bail them out and pay the CEOs millions in bonuses," said Sanders, an independent and self-described democratic socialist. "When a working person with no insurance or inadequate gets sick, they're on their own."

Many in the crowd appeared to support Sanders' suggestion that as health care reform is pursued on a national level by the Obama administration and congressional Democrats, that Vermont should be allowed to host a pilot project in which single-payer, universal health care is tried out.

Burlington Mayor Bob Kiss, who grew up in Wisconsin, said he was in Saskatchewan in 1964 when it became the first Canadian province to create such a health care system — which has since spread across Canada.

He quoted a Quebec official who scoffed at the term "socialized medicine," used by some to describe the Canadian system, instead calling it "civilized medicine."

"They have preventative care for a lifetime," Kiss said of Canadians. "There's no doubt they have better lives as a result."

The demonstration included ample theatrics, with skits, music and signs with slogans like "Health care is a human right" and "Health care for all."
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www.topix.net/forum/source/berkshire-eagle/TT3TRDC747JAVF3B4
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RUMBLINGS OVER A US HEALTH PLAN
"Who needs insurance companies?"
The Boston Globe, Letters, May 27, 2009

REGARDING "ONE Obama healthcare goal elusive" (Page A1, May 21), about the health insurance industry's vague promise to reduce the rate of growth of its vast profits, here's my question: Why do we need the insurance companies anyway?

How is it that so many developed countries are able to cover everyone, spend less on healthcare, and have significantly better health outcomes? They eliminated private insurance and instituted a public single-payer plan. But according to the article, Congress is apparently balking at an even tamer option: a public plan that would compete with the insurance industry. Why is Congress so reluctant to adopt a public plan? Follow the money that the health insurance and pharmaceutical companies "contribute" to members of Congress. There's your answer.

Kate Cloud
Somerville, Massachusetts

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RUMBLINGS OVER A US HEALTH PLAN
"$2 trillion in savings, or preventive 'care'?"
The Boston Globe, Letters, May 27, 2009

IT WAS fascinating to see how quickly all the relevant industry groups jumped on the bandwagon to slow the growth of healthcare costs, thus pledging to "save" $2 trillion over the next 10 years. Somehow, I don't think this grand announcement was motivated by altruism or patriotism. Am I being cynical, or is this just a preventive measure taken by healthcare industry players to avoid the much larger cuts they know would occur if Congress actually got serious about the issue?

And if they can identify such large savings so easily, why haven't these been implemented already?

Stephan Goldstein
North Reading, Massachusetts

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"The hijacking of health reform"
By Susanne L. King, M.D., The Berkshire Eagle, Op-Ed, Tuesday, July 7, 2009
LENOX, Massachusetts

Headlines in the Berkshire Eagle recently proclaimed that Berkshire Health Systems (BHS) is cutting the equivalent of 65 full-time jobs, and will lose $3 million this year. This is neither good for employment nor for the health of our population in the Berkshires. The culprits are the cuts to Medicaid and Medicare, the programs that cover 70 percent of the BHS population.

BHS president David Phelps reports that financial problems at Berkshire Medical Center have been aggravated by Massachusetts health care reform. While more patients have enrolled in insurance plans, the reimbursements for these plans are similar to Medicaid rates, which don't actually cover the cost of care.

As the major non-profit provider of health care for the Berkshire community suffers financially, the for-profit insurance industry, (which only administers the funds, and provides no actual health care services), is raking in the money. In the current economic and health care crisis, United Health Group, America's largest health insurance company, enjoyed an increase of 8 percent in revenues for the first quarter of 2009, with a net profit of $984 million. There is something wrong when the administrators of the health care funds are making exorbitant profits, while the providers of the health care services are struggling to remain solvent.

The private for-profit insurance industry diverts roughly $400 billion/year from medical services. In addition, the Senate Commerce Committee recently released a staff report about how health insurers have forced consumers to pay billions of dollars in medical bills that the insurers should have paid themselves.

Will the current health care reform being formulated in Washington address these issues? Not a chance, even if President Obama gets a public plan option into the reform legislation. Dr. Steffie Woolhandler, a founder of the 16,000-member Physicians for a National Health Program, stated in her testimony to Congress: "Insurers compete by not paying for care: by denying payment and shifting costs onto patients or other payers. These bad behaviors confer a decisive competitive advantage. A public plan option would either emulate them -- becoming a clone of private insurance -- or go under. A kinder, gentler public plan option would quickly fail in the marketplace, saddled with the sickest, most expensive patients, whose high costs would drive premiums to uncompetitive levels."

In addition, the overhead for a public plan option would be higher than for Medicare, which automatically enrolls seniors at 65, deducts premiums from Social Security checks, and does no marketing. The administrative costs for the whole health care system would remain astronomical, as health care providers would continue to struggle with mountains of paperwork and denials of payment from multiple insurance companies. A public plan option would not curb the escalating costs of new technology, and would not address variability in the quality of care.

The only way to attain universal health care coverage, while containing escalating health care costs and standardizing quality of care, is to eliminate the insurance companies, and establish a single-payer "Improved Medicare for All" program. Hospitals, doctors and other providers must be adequately reimbursed for their medical services. This would be possible if the profiteering and waste of the health insurance industry were eliminated, and those health care dollars went to the actual provision of medical care. And hospitals could be paid like fire departments, with a single monthly check and little billing. There is federal legislation for a national health program in both houses of Congress, John Conyers bill, HR 676, and Bernie Sanders bill in the Senate, S.703.

Last year a survey of doctors showed that 59 percent support a national health plan, up from 49 percent in 2002. (Only one in five doctors are in the American Medical Association, which opposes a national health plan). So why is single-payer health care reform "off the table"' as Senator Max Baucus, chairman of the Finance Committee, said, before he threw eight single-payer advocates, including several doctors, out of a "public roundtable discussion" and had them arrested. Could it be related to the more than $1 million in donations Baucus received from the insurance and pharmaceutical industries in the 2008 election year cycle?

Wendell Potter, a former health insurance industry insider has this to say, ". . . big for-profit insurers have high-jacked our health care system and turned it into a giant ATM for Wall Street investors, and . . . the industry is using its massive wealth and influence to determine what is (and is not) included in the health reform legislation members of Congress are now writing."

What is going on in Washington right now is not in the best interests of patients, or the doctors and hospitals that serve them. Patients have no lobbyists speaking for their interests in Congress. Most doctors do not want the AMA to speak for them. Contact your congressmen and ask them to sponsor HR 676 and Bernie Sander's bill. (On his Web site, Sanders also has an online petition you can sign and pass along to your friends).
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Susanne L. King, M.D., is a Lenox-based practitioner.
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www.topix.net/forum/source/berkshire-eagle/TI7T2GPGB8O5PIV9T
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"The hijacking of health reform"
The Berkshire Eagle, Op-Ed, By Susanne L. King, M.D., Tuesday, July 7, 2009
LENOX, Massachusetts

Headlines in the Berkshire Eagle recently proclaimed that Berkshire Health Systems (BHS) is cutting the equivalent of 65 full-time jobs, and will lose $3 million this year. This is neither good for employment nor for the health of our population in the Berkshires. The culprits are the cuts to Medicaid and Medicare, the programs that cover 70 percent of the BHS population.

BHS president David Phelps reports that financial problems at Berkshire Medical Center have been aggravated by Massachusetts health care reform. While more patients have enrolled in insurance plans, the reimbursements for these plans are similar to Medicaid rates, which don't actually cover the cost of care.

As the major non-profit provider of health care for the Berkshire community suffers financially, the for-profit insurance industry, (which only administers the funds, and provides no actual health care services), is raking in the money. In the current economic and health care crisis, United Health Group, America's largest health insurance company, enjoyed an increase of 8 percent in revenues for the first quarter of 2009, with a net profit of $984 million. There is something wrong when the administrators of the health care funds are making exorbitant profits, while the providers of the health care services are struggling to remain solvent.

The private for-profit insurance industry diverts roughly $400 billion/year from medical services. In addition, the Senate Commerce Committee recently released a staff report about how health insurers have forced consumers to pay billions of dollars in medical bills that the insurers should have paid themselves.

Will the current health care reform being formulated in Washington address these issues? Not a chance, even if President Obama gets a public plan option into the reform legislation. Dr. Steffie Woolhandler, a founder of the 16,000-member Physicians for a National Health Program, stated in her testimony to Congress: "Insurers compete by not paying for care: by denying payment and shifting costs onto patients or other payers. These bad behaviors confer a decisive competitive advantage. A public plan option would either emulate them -- becoming a clone of private insurance -- or go under. A kinder, gentler public plan option would quickly fail in the marketplace, saddled with the sickest, most expensive patients, whose high costs would drive premiums to uncompetitive levels."

In addition, the overhead for a public plan option would be higher than for Medicare, which automatically enrolls seniors at 65, deducts premiums from Social Security checks, and does no marketing. The administrative costs for the whole health care system would remain astronomical, as health care providers would continue to struggle with mountains of paperwork and denials of payment from multiple insurance companies. A public plan option would not curb the escalating costs of new technology, and would not address variability in the quality of care.

The only way to attain universal health care coverage, while containing escalating health care costs and standardizing quality of care, is to eliminate the insurance companies, and establish a single-payer "Improved Medicare for All" program. Hospitals, doctors and other providers must be adequately reimbursed for their medical services. This would be possible if the profiteering and waste of the health insurance industry were eliminated, and those health care dollars went to the actual provision of medical care. And hospitals could be paid like fire departments, with a single monthly check and little billing. There is federal legislation for a national health program in both houses of Congress, John Conyers bill, HR 676, and Bernie Sanders bill in the Senate, S.703.

Last year a survey of doctors showed that 59 percent support a national health plan, up from 49 percent in 2002. (Only one in five doctors are in the American Medical Association, which opposes a national health plan). So why is single-payer health care reform "off the table"' as Senator Max Baucus, chairman of the Finance Committee, said, before he threw eight single-payer advocates, including several doctors, out of a "public roundtable discussion" and had them arrested. Could it be related to the more than $1 million in donations Baucus received from the insurance and pharmaceutical industries in the 2008 election year cycle?

Wendell Potter, a former health insurance industry insider has this to say, ". . . big for-profit insurers have high-jacked our health care system and turned it into a giant ATM for Wall Street investors, and . . . the industry is using its massive wealth and influence to determine what is (and is not) included in the health reform legislation members of Congress are now writing."

What is going on in Washington right now is not in the best interests of patients, or the doctors and hospitals that serve them. Patients have no lobbyists speaking for their interests in Congress. Most doctors do not want the AMA to speak for them. Contact your congressmen and ask them to sponsor HR 676 and Bernie Sander's bill. (On his Web site, Sanders also has an online petition you can sign and pass along to your friends).
-
Susanne L. King, M.D., is a Lenox-based practitioner.
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www.topix.net/forum/source/berkshire-eagle/TI7T2GPGB8O5PIV9T
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"Support single-payer reform today"
The Berkshire Eagle, Letters, Wednesday, July 15, 2009

As a constituent, I am calling upon Sen. Kennedy, Sen. Kerry and Rep. Olver to pass HR 676, the United States National Health Insurance Act, which would create a publicly financed, privately delivered system, that guarantees comprehensive health care for all Americans. Conservatives and liberals have endorsed this plan, as have Democrats and Republicans.

For too long, private insurance companies have denied care, bankrupted hard-working families, and inflated costs, leaving nearly 50 million Americans uninsured and tens of millions more with insurance still unable to afford care. A single-payer system of national health insurance that eliminates private insurance would save nearly $0.4 trillion now wasted annually on administrative costs, enough to pay for high quality, comprehensive care for all.

This country has seen a groundswell of support for the single-payer solution. At town hall meetings and rallies throughout the country, Americans have demanded to know why Congress has failed to consider the most popular health reform proposal, one supported by a majority of the public. The American people are demanding change to a single-payer health care system.

Inviting single-payer advocates to speak at hearings with so-called "stakeholders" -- the insurance and pharmaceutical lobbyists -- doesn't go nearly far enough. We demand that the Congressional Budget Office immediately evaluate HR 676 along with any other reform proposals, which is the next crucial step toward including single-payer in an honest, transparent debate on health care reform. It is essential to compare the cost of single-payer with the cost of other health reform proposals being considered right now. The real "stakeholders" are we, the American people.

If a single-payer health care system cannot pass, at least pass a public option for health care insurance. I strongly urge the senators, congressmen and their staffs to look at the Bill Moyers' Journal program of July 10 on the pbs.org Web site.

THOMAS D. MARINI
Pittsfield, Massachusetts
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www.topix.net/forum/source/berkshire-eagle/THVGP0JVFQUEIHELJ
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"Everybody in, nobody out"
By Susanne L. King, M.D., The Berkshire Eagle, Op-Ed, 9/4/2009

The disruptions at town meetings in August were not just the work of conservative hecklers and their corporate backers. The wave of anger also revealed that many Americans feel left out during the current recession. It is not just the 50 million people who are left out because they don't have health insurance, or the tens of millions who are left out because they have inadequate health insurance, or even the many people who have been bankrupted by their medical bills (the most common cause of bankruptcy in the United States).

Millions of other Americans also feel left out and angry, frustrated by the bailouts for Wall Street and other corporations which profit from the tax dollars of struggling Americans.

The current health insurance reform bill being created in Congress is looking like just another bailout - this time for health insurance and pharmaceutical companies. With their lobbying dollars and influence, these companies are crafting health insurance legislation to expand their profits and power.

A proposed individual mandate to force 47 million citizens to buy health insurance will be a windfall for private health insurance companies, and will be partially paid for with taxpayer dollars for subsidies to support premiums for people who can't afford health insurance.

And the drug companies pulled a real coup. President Obama agreed to a promise of $80 billion from the pharmaceutical companies over ten years in exchange for an agreement with the government to not bargain down medication prices for Medicare, and to not allow people to buy cheaper drugs from Canada. The drug companies did not give the government $80 billion, nor agree to cut prices, but only to reduce the amount they would otherwise have raised prices. $80 billion over ten years translates into savings of only 2 percent of the projected U.S. spending on prescription drugs. What was Obama thinking?

What ordinary people seem to be thinking is, "We've given enough bailouts to the private sector, and we are sick of our government continuing to subsidize private corporations."

At a "Community Meeting for Healthcare" in New Hampshire during his campaign for president in 2007, Barack Obama talked with 200-plus people about health care reform. He said, "I want to be held accountable for establishing a universal health care plan by the end of my first term, but I have to insist on the voters rallying for this change. When I take office I have to feel I have a mandate for change."

According to the Associated Press, his audience at the community meeting was "almost single-mindedly focused on a single-payer system." What we know from polls is that 59 percent of Americans support a single payer national health insurance program, an improved "Medicare for All." So why have our president and Congress abandoned single payer health care when the majority of Americans support it?

Representatives John Conyers and Dennis Kucinich are sponsoring HR 676, the single-payer, not-for-profit health insurance bill in the house, along with 85 other representatives. Kucinich says, "Insurance companies will stop at nothing to hold on to the American people's wallet when it comes to health insurance." He believes that health care reform needs to come from public input, not the special interest groups who are driving the legislation in Congress.

He recommends that we step back and start over on health care reform, and that congressmen should go back to the people and listen to their stories. They need to talk to all their constituents, not just those who scream the loudest. They need to hold town meetings where civil discourse prevails.

For those of us who support single payer health care, we can make it clear to our representatives in Congress that this will be an important issue in their re-election as we go to vote next year.

Since health insurance lobbyists have effectively squelched discussion of single payer bill HR 676 as an option for health care reform in Congress at this time, Rep. Anthony Weiner, a single payer supporter, has filed an amendment to the health reform legislation recently created in the House, HR 3200. Weiner's amendment would effectively change HR 3200 into a single payer bill.

Speaker Nancy Pelosi has promised an up or down vote on this amendment in September. If you support single payer health care, please call your representative, or go to www.pnhp.org and send an email asking him to support the Weiner amendment to HR 3200.

If we had an improved "Medicare for All" program, everyone would have comprehensive coverage, including medical and dental care, prescription drugs, and long term care, all without deductibles and co-payments. This approach would not add to our burgeoning national deficit, but would save $400 billion in administrative costs alone by eliminating for-profit health insurance companies.

The current Medicare program is financially threatened: Medicare viability would be enhanced by including everyone in the system, rather than siphoning off healthy workers to the for-profit insurance industry. Only with a single payer national health program will we have "everybody in and nobody out."

There is a moral imperative to providing comprehensive health care to everyone. Health care should be a human right, not a market good. As Senator Teddy Kennedy said, "For all those whose cares have been our concern, the work goes on, the cause endures, the hope still lives, and the dream shall never die."
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Susanne L. King is a Lenox-based practitioner.
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www.topix.net/forum/source/berkshire-eagle/TN0HCQH716TFQHJ94
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"Bailout under a blue cross"
The Berkshire Eagle (Online), Op-Ed, By Dr. Susanne L. King, M.D., 11/11/2009
LENOX, Massachusetts

Everyone is talking about health care reform and trying to decipher the differences between the bills in the House and the Senate. The "public option" is praised by some and derided by others. Politicians are influenced by the financial support of various interest groups who are lobbying furiously to retain or extend their turf.

Regardless of the legislation Congress passes, the health insurance industry is primed to expand its consumption of U.S. health care dollars by selling more insurance policies to people who are currently uninsured. And American taxpayers are going to subsidize many of these policies, a windfall profit for private insurance companies.

In a statement about why he voted against the House Bill (H.R. 3962) passed this weekend, Rep. Dennis Kucinich said, "In H.R. 3962, the government is requiring at least 21 million Americans to buy private health insurance from the very industry that causes costs to be so high, which will result in at least $70 billion in new annual revenue, much of which is coming from taxpayers. This inevitably will lead to even more costs, more subsidies and higher profits for insurance companies -- a bailout under a blue cross."

Few others in power are discussing the important question, "Is all of this legislation real reform or phantom reform?" Universal coverage is important, but what are the other necessary components of health care reform that American people desire? There are four other important elements beyond universal coverage: choice, adequate coverage, security, and cost-effectiveness.

First, phantom reform does give you choice, but it is the choice between many HMOs and other private, for-profit insurance plans. Real reform would give patients the choice they actually want, which is to choose their doctors and hospitals. Americans don’t want a choice of insurance company bureaucrats; they want a choice of health care providers.

Second, phantom reform does give you insurance coverage, but with deductibles and co-pays, as well as exclusions for various services. Real reform would provide coverage with no out-of-pocket costs; i.e., comprehensive care for all medically necessary services, as decided by you and your doctor, not a faceless bureaucrat in an insurance company intent on maximizing its profits.

Third, phantom reform provides illusory security. Sure, you get an insurance policy, but if you can’t work or pay, you lose your insurance. Real reform would provide security for everyone, for as long as they needed care, just as Medicare does now for those over 65.

Fourth, phantom reform saves money by providing less care. "Medical loss" is the term insurance companies use for the dollars they pay out to health care providers and hospitals for their services, at times resorting to criminal means to hold on to the money patients have paid for insurance to cover the health care services they need . Real reform would save $400 billion per year by eliminating private, for profit health insurance, if the government were the non-profit single payer of the health care funds.

Real reform is a single-payer national health insurance program that would be comprehensive, universal, and cost-effective. Phantom reform is what Congress is now hotly debating, and the public option is a red herring in the pursuit of real reform.

According to Dr. Steffie Woolhandler of Harvard Medical School, who has studied the financing of health care reform, the public option would deliver very little of the administrative savings possible in a single-payer program. There would be no savings on hospital billing or the administrative bureaucracies of nursing homes and doctors’ offices. In reality, the public option would save only a fraction (1/7th) of the $400 billion savings available through a single-payer program, even if half of the privately insured were to switch to a public option.

In addition, our experience with Medicare HMOs shows that private insurance plans avoid patients who are seriously ill and have high medical costs. Despite regulations, private insurance companies undermine fair competition. There is no reason to believe the public option would fare any better in this arena.

Unlike politicians, the American people know real reform when they see it. In 2009, a CBS News/ New York Times poll showed that 59 percent of Americans support national health insurance, up from 40 percent in 1979. And Americans know that we have what it takes in the United States to deliver top-notch care: excellent hospitals, well-trained professionals, and superb research.

We already spend at least twice as much per person for health care as other wealthy countries. Even our public spending is greater than the total spending in other nations. We have the money for health care for everyone. The money just needs to be spent on health care delivery, rather than bureaucracy and profits for insurance companies.

If you cannot afford insurance, or your health insurance premiums keep rising, along with your out-of-pocket costs, consider our neighbor to the north. Canada has Medicare for all, a single-payer national health program that provides universal, comprehensive coverage. Canadians also have a life expectancy two years longer than Americans, infant deaths 25 percent lower, more doctor visits and hospital care per person, and a quality of health care equivalent to that of insured Americans. Canada spends half the amount per person that we spend on health care. Now that is real reform.
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Susanne L. King, M.D., is a Lenox-based practitioner.
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"Another win for insurers"
By Dr. Susanne L. King, The Berkshire Eagle, Op-Ed, April 28, 2010
LENOX, Massachusetts

The passage of the "health insurance" bill has been a huge political success for President Obama and the Democrats and has been compared to the historic passage of Medicare and Social Security. Unfortunately, this bill is not in the same league as those successful programs, which provide medical and financial security to every elderly and disabled American. This is not a "health care" bill; it is a "health insurance" bill, which will hand out $447 billion in taxpayer money to insurance companies as subsidies to purchase inadequate insurance products. And the bill will require millions of Americans to buy these substandard products. The insurance companies are the big winners in this legislation.

We did not need to create this scenario to obtain the useful measures in the bill, like additional funding for community health centers, expansion of Medicaid, reduction of the "donut hole" in prescription drug coverage for Medicare patients, and allowing young adults to stay on their parents' health insurance plans until age 26. These fixes could have been done separately. Instead, they were inserted into a 2,000-page bill that will further enrich and empower the insurance industry.

Sen. Max Baucus recently praised his aide, Elizabeth Fowler, former vice president of the giant health insurer Wellpoint, for her pivotal role in crafting this legislation. While middle class families were struggling to pay their escalating health insurance premiums, rising deductibles and co-payments, Wellpoint's profits increased by $2.3 billion in 2009, 91 percent more than the previous year. Not content with this level of profiteering, Wellpoint's subsidiary, Anthem Blue Cross of California, seeks to increase profits even more by raising its premiums by an astounding 39 percent this year.

Wall Street loves the law. Mutual fund analysts say it is beneficial for health industry stocks, particularly for pharmaceutical and medical equipment companies, because there are no "onerous cost controls." Health insurance company stocks continue their upward trend, and CEO salaries remain astronomical.

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In addition to the bill's handout to the insurance industry, this legislation has many shortcomings:

* Twenty three million people will remain uninsured, which translates into 23,000 unnecessary deaths every year.

* Millions of middle-income people will have to buy health insurance policies, costing up to 9.5 percent of their income, but covering an average of only 70 percent of their medical expenses, because of high deductibles and co-payments.

* People with employer-based coverage will still not be able to choose their doctors and hospitals, and eventually face steep taxes on their benefits as the cost of insurance grows.

* Health care costs will continue to skyrocket, as we have seen here in Massachusetts after the passage of Chapter 58, which did nothing to contain costs.

* The insurance regulations are riddled with loopholes, as one might expect when insurers helped to craft the bill. For example, older people will be charged three times more than their younger counterparts, and large companies that have more female workers will continue to pay higher rates until 2017.

The American people did not have to be saddled with an expensive package of individual mandates, taxes on workers' health plans, sweetheart deals with insurers and Big Pharma, and a perpetuation of our current dysfunctional and unsustainable system. President Obama did not seize his chance to inherit the mantles of Presidents Roosevelt and Johnson, with their historic fashioning of legislation for Social Security and Medicare. This bill's passage reflects political considerations, not sound health care policy.

Sooner or later, our nation will have to adopt a single-payer national insurance program, an improved Medicare for all. We could save $400 billion annually in administrative costs, enough to provide comprehensive coverage for everyone. And only a single-payer system provides the tools for cost control, like bulk purchasing, negotiated fees, global hospital budgeting, and capital planning.

Polls show that almost two-thirds of the American public supports this approach, and a recent survey shows that 59 percent of U.S. doctors do as well. Inevitable price increases by the insurance industry will expand the popularity of the single-payer movement. Ultimately we will have a national health insurance program. Single-payer health care is the only coverage that is universal, comprehensive, and affordable.

Susanne L. King, M.D. is a Lenox-based practitioner.

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Cast a vote for single-payer
By Susanne L. King, M.D., Op-Ed, The Berkshire Eagle, October 27, 2010
LENOX, Massachusetts

On Nov. 2, you will be able to vote for "single-payer" health care if you live in the 2nd or 4th districts of Berkshire County. This referendum is non-binding, but will send a strong message to our legislators and governor.

A single-payer health care program would be an expanded and improved Medicare system for everyone, not just senior citizens. The government would be the only administrator of the health care funds (the "single payer"), rather than the hundreds of for-profit health insurance companies which currently administer our health care dollars.

The insurance companies add to the enormous cost of health care by keeping 20-30 percent of our health care dollars for their administration, profits and exorbitant CEO salaries. In contrast, Medicare uses less than 1.5 percent of our health care funds for administration. "Single payer" refers only to the administration of health care dollars, not to the delivery of care, which would remain in the hands of health care providers.

Who will benefit from a single-payer system?

First, patients will experience cost-savings and better access to care. Rather than paying insurance premiums that increase in price each year for policies that provide less coverage with higher deductibles and co-payments, everyone will pay a modest income tax that will cost less than current premiums for health care insurance. Plus, patients will be able to choose their own doctors.

Second, doctors and hospitals will benefit, because they will no longer have to hire legions of office workers for administrative tasks. Doctors will be relieved of the onerous paperwork demands from multiple insurance companies, freeing them to spend more time with their patients.

A majority of doctors support single-payer health care. The annual study by the Massachusetts Medical Society found doctor shortages throughout our state, especially in the Berkshires, and especially in primary care. Doctors were asked about their preferences for a health care system: they picked single-payer health reform over a public option, over high-deductible plans, and over the Massachusetts health reform -- in short, over every other option presented. The current Massachusetts health reform was least favored.

Third, business will benefit, especially small business owners who view rising health insurance costs for their employees as their greatest concern. If everyone were covered by a single-payer program, payment for health care would no longer be tied to employment, and business owners would be freed from an expensive, complicated responsibility.

Fourth, towns and cities will benefit because they will not need to provide health insurance for their active and retired employees; instead, that money can be used to improve other services such as education.

Fifth, our state will benefit. The recent health care legislation that extended health insurance to 97% of our state population has required enormous infusions of cash to provide subsidies for those unable to afford health insurance policies. As a result, we have filled the coffers of the private health insurance industry, while seriously straining the state budget.

Sixth, even though the Massachusetts referendum is not a national vote, the United States would benefit from a single-payer national health program by saving $400 billion per year in administrative costs alone; a serious consideration for a financially-strapped country. The legislation just passed by President Obama and Congress, the Patient Protection and Affordable Care Act (PPACA), makes only minor improvements to an unsustainable for-profit health insurance system. Similar to the Massachusetts legislation in its laudable attempt to provide universal coverage, this legislation is not cost-effective.

Our government will subsidize private insurance premiums for the "near poor," channeling $447 billion of taxpayer dollars to private insurers over the next decade. As Drs. Steffi Woolhandler and David Himmelstein (founders of Physicians for a National Health Program) have written, "Morphine has been dispensed for the treatment of cancer -- the reform (PPACA) may offer a bit of temporary relief, but it is certainly no cure."

Another physician, Dr. Edward Ehlinger, wrote, "Insurance is a strange model for health care. (Insurance) is meant for life's uncertainties, but illness is a pretty sure thing." That's why we don't use the insurance model for fire and police protection or for education. Health care should also be in the category of essential services we will all need someday.

The only loser after single-payer health care is enacted will be the health insurance industry, the middlemen who provide no medical care and siphon our hard earned premiums into their own exorbitant profits.

If you are in favor of a single-payer health care system for Massachusetts, I urge you to vote "Yes" on Question 4 on Tuesday, Nov. 2.

Susanne L. King, M.D. is a Lenox-based practitioner.

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"Vermont leads the way"
By Suzanne L. King, M.D., The Berkshire Eagle, Op-Ed, March 22, 2011
LENOX, Massachusetts

Writing about the Massachusetts health care reform program in a 2009 issue of the Wall Street Journal, Governor Deval Patrick stated, "Because of our reform, families are less likely to be forced into bankruptcy by medical costs." Both Governor Patrick and President Obama have used the benchmark of medical bankruptcy as a key measure to prove the success of their health insurance reforms.

Unfortunately, according to a study this month from Harvard University by Dr. David Himmelstein and associates, the absolute number of medical bankruptcies in Massachusetts increased between 2007 and 2009, the years after health care reform had been enacted. Dr. Himmelstein commented, "Massachusetts health reform, like the national law modeled after it, takes many of the uninsured and makes them under-insured, typically giving them a skimpy defective policy that's like an umbrella that melts in the rain. The protection's not there when you need it."

For example, in Boston, the least expensive individual coverage available to a 56-year-old carries an annual premium of $5,616 and a deductible of $2,000, and even then only covers 80 percent of the next $15,000 cost for covered services. Therefore, someone with a chronic condition like diabetes could have to pay $10,000 annually out of pocket, in addition to the premium.

The current Massachusetts heath care reform, on which President Obama has based his national reform legislation, is not adequate. Massachusetts reform has not ended medical bankruptcies in our state, a finding that strongly suggests that national reform won't reduce medical bankruptcies nationwide.
While individuals, small businesses and towns struggle to pay for inadequate health care insurance, CEOs of non-profit health insurance companies continue to walk away with obscene amounts of our hard-earned dollars. Blue Cross /Blue Shield's former chief executive, Cleve L. Killingsworth recently received an $11 million payout, while Blue Cross board members individually received up to $89,000 to rubber stamp Killingsworth's compensation.

As many states and congressional Republicans look for ways to roll back President Obama's signature health care law, Vermont is moving in a different direction. During his inaugural address, Governor Peter Shumlin proposed guaranteeing health insurance to all Vermonters, noting that current health care costs "[represent] an enormous hidden tax on families and small businesses across our state. If left untethered, the rising cost of health insurance will cripple us." Shumlin has proposed the creation of a single-payer system for Vermont in which private delivery of healthcare would continue, but the government would act as everyone's health insurer.

This "Expanded and Improved Medicare-for-all" option was barred from the national health reform debate by special interest groups. By choosing a single-payer program, Vermonters would divorce health insurance coverage from employment, and eliminate the administrative waste of private insurance companies, including outrageous CEO salaries.

Dr. William Hsiao, an international expert on health care reform at the Harvard School of Public Health, was commissioned by the Vermont Legislature to conduct a study about the best way to provide universal coverage, reduce the rate of cost increases, and create a primary care-focused, integrated delivery system. Hsiao stated, "The system capable of producing the greatest potential savings and achieving universal coverage was a single-payer system -- one insurance fund that covers everyone with a standard benefit package, paying uniform rates to all providers through a single payment mechanism and claims-processing system. Our analysis showed that Vermont could quickly save almost 8 percent in health care expenditures through administrative simplification and consolidation, plus another 5 percent by reducing fraud and abuse. . . All told, we estimated that Vermont could save 25 percent in health care expenditures over 10 years."

In the national health reform debate, Vermont, not Massachusetts, now leads the way.

Susanne L. King, M.D., is a Lenox-based practitioner.

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Michael Kaplan, M.D.: “State needs single-payer”
By Michael Kaplan, Op-Ed, The Berkshire Eagle, February 7, 2017

LEE — With an unpredictable president now in the White House, with no track record and conflicting promises about health care in the U.S., we must mobilize and lobby for health care changes that identify and fix what's wrong with our dysfunctional health care system. We must preserve what works, and never settle for a health care system that does not promise quality care to all Americans. We cannot go backwards.

As a family physician practicing in a rural, underserved region, I want to provide care to all, without the barriers our current system places in our patients' path to health. I would also like to do away with the restrictions that private insurance imposes on our practices, restrictions that cause uncountable administrative hassles, which can lead to physician burnout and exacerbate a shortage of primary care providers.

I work for Community Health Programs (CHP), a federally qualified health center (FQHC) that operates a network of health care practices in the Berkshires. Our practices, in North Adams, Adams, Pittsfield, Lee and Great Barrington, are primary care centers staffed by physicians and nurse practitioners specializing in family medicine, pediatrics and adult medicine. CHP also has two dental centers, a family service center and an obstetrics-gynecology practice.

CHP is licensed by the federal government to provide health care to a unique geographical region, and like more than 1,100 such FQHCs around the nation, is funded by private and subsidized insurance, Medicare and Medicaid, federal grants and donations. We have a mandate to provide care for all who need it, without regard to income, immigration status or disability.

Though the Affordable Care Act (ACA), also know as Obamacare, has expanded health care coverage for millions of Americans, and to many in our region, our system's ability to function well is seriously impaired by health care financing that was actually worsened under the ACA. The ACA funneled public dollars into the private insurance industry, with their high administrative costs and profit. We must instead develop tax-supported universal health insurance — an expanded and improved Medicare for All.

Since the advent of the ACA, our patients have experienced rising deductibles and a shrinking network of physicians and hospitals. Many specialists in our area are overbooked or are unwilling to accept the insurance plans, so our patients often are forced to travel as far as Worcester or Boston for care. Many patients from nearby New York state on ACA plans can no longer access CHP health care because of narrow networks. These are just some of the downsides for patients.

Collaborative approach

For physicians who are struggling with providing excellent care to our patients, the administrative burdens are unbearable. Each health plan requires its own excessive paperwork, simply to get our patients the treatment that they need.

For CHP, a bright spot in our network is our success in implementing the patient care standards of the Patient Centered Medical Home or (PCMH), a national initiative. Our Lee practice was recently recertified as a PCMH, which calls for integrated, team-based care that hearkens back to a time when family doctors were more easily able to coordinate care. As a result, our practice now includes many collaborators: on-site psychiatrists, social workers, physical therapists and nutritionists. We work together to provide coordination of care. CHP practices in Pittsfield and Great Barrington are also PCMH-certified.

A key piece of the PCMH effort is the integration of behavioral health with primary care. Research has shown that housing primary and mental health care in a single practice site can markedly improve overall community health — and we are already seeing results. Along with BMC and the Brien Center for Mental Health and Substance abuse, CHP received a federal grant in 2014 to increase mental health services on site at our primary care practices. In this model behavior health clinicians work shoulder to shoulder with primary care practitioners. Already we are seeing improved health among our CHP patients with this on-site mental health access.

All of the above, however imperfect, are endangered by an ineffectual health care financing system. The new administration in Washington plans to dismantle or undermine the ACA, weaken Medicare and Medicaid, and damage the patchwork of financing that has allowed FQHCs and other primary care practices to provide needed care to those who most need it.

Before it was passed, progressive Sen. Bernie Sanders and Rep. Dennis Kucinich arranged to add funding to the ACA to bolster health centers like ours. These men are proponents of true health care financing reform: a government-financed privately-run health care system that would cover all Americans. This system would be an expanded, improved Medicare for All — a single-payer system. The ACA permits states to adopt this approach, by applying for a waiver if all residents are provided with access to high quality, affordable health insurance while retaining the basic protections of the ACA.

A single-payer system would satisfy all these requirements and cover everyone. It would be cost effective and protect government from the ever-increasing expense of our disintegrating financing system. An expanded improved Medicare for All would eliminate deductibles and allow patients to go to any hospital or doctor. I would like to provide integrated care that is available to everyone without financial barriers. A single-payer system is the only way to achieve this goal. To establish this system for Massachusetts contact your legislators and ask them to support: "An act establishing improved Medicare for All in Massachusetts" SD698, HD 3249.

Dr. Michael Kaplan is a family physician.

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Susanne King, M.D.: “Medicare for all: The time is coming”
By Susanne King, M.D., op-ed, The Berkshire Eagle, January 15, 2019

Lenox — The majority of Americans and their doctors have long supported a national health program, an expanded and improved Medicare for All, that covers everyone, and is cost-effective, efficient and practical. This single payer program would cover every American for all medically necessary services, including mental health, rehabilitation and dental care, without co-payments or deductibles. Under such a program, patients would be able to keep their doctors and other health care providers: the delivery of health care would remain the same. Only the administration of the health care funds would change: from multiple insurance companies to the federal government, which becomes the "single payer" for all health care. This administrative change would free up billions of dollars currently spent for the bloated bureaucracy and profits of these private insurance companies.

The Affordable Care Act was forged under the promise "If you like your health plan, you get to keep it," but that promise no longer looks so great. More than half the people under 65 get their health insurance through an employer. In these employee-based plans, premiums rose sharply in 2017, with family premiums of $20,000 or more in some states. The amount workers have to contribute to those premiums has continued to rise, along with increasing annual deductibles. These payments by workers are eating into their take-home pay, with an average worker paying over 11 percent of their income for this out-of-pocket spending in 2017.

How would a Medicare for All program be cost-efficient, effective, and practical?

Cost-efficient: cutting administrative costs would generate $400 billion in administrative savings annually. Effective: even after full implementation of the Affordable Care Act, tens of millions of Americans remain uninsured, or only partially insured, so a national health program that covers everyone would be effective. Practical: everyone would have a card to present at the doctor's office or hospital, allowing for treatment without a co-payment or deductible.

Some think a single payer program may too costly for our country. However, a recent economic analysis of a Medicare for All program by the Political Economy Research Institute at UMass addresses this concern. It found that such reform would provide universal and comprehensive coverage without increasing overall health expenditures. This is in line with Congressional Budget Office estimates, and also with a study by the Mercatus Institute (funded by the Koch brothers), which concluded that a single payer program would realize significant savings..

The idea of a national health program is gaining more traction in the legislature. Last week Nancy Pelosi said through her spokesman that she supports holding hearings in the House on Medicare for All. Our state representative, Richard Neal, chairman of the Ways and Means committee, said last month that Medicare for All deserves "a conversation." And there is a class of new members of Congress who are vocal in their support. All this enthusiasm marks a major step forward for supporters of single payer.

There is a bill in the House, H.R.676, "The Expanded and Improved Medicare for All Act," which has a growing number of sponsors, because it is cost-efficient, effective and practical. You can support single payer health care by contacting Rep. Neal, who wants to protect Medicare. Ask him to go further, and sponsor this legislation for Medicare for All.

Susanne L. King, M.D., is a Lenox-based physician.

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Letter: "COVID demonstrates time has come for single-payer health care"

The Berkshire Eagle, December 22, 2020

To the editor: In the op-ed “COVID is killing people in more ways than one” in the Dec. 15 Berkshire Eagle, Peter R. Orszag correctly pointed out that excess mortality in the U.S. this year has not only been due to COVID-19 but also because “40,000 more Americans than expected died this year from diabetes, Alzheimer’s [disease], high blood pressure and pneumonia.”

This is because many, fearful of acquiring COVID-19 in hospitals and medical offices, are putting off health care or, in these difficult economic times, are unwilling to incur medical expenses. As with many aspects of this pandemic, these indirect consequences have disproportionately affected low-income and Black and Hispanic Americans, and these disparities have been far worse in the U.S. than in other developed countries.

A study by the Commonwealth Fund, published in the December issue of Health Affairs, compared the health experiences of lower income people and the effect of income-related disparities during the early part of the pandemic in the U.S. and 10 other high-income countries. By every metric in this study, America fared worse than the other countries. For example, during the past year, half of U.S. adults with lower income skipped doctor visits, recommended tests, treatment or follow-up care or prescription medication because of cost. In contrast, just 12 to 15 percent of lower-income adults in Germany, the U.K, Norway and France reported doing the same. This has been exacerbated by massive unemployment during the pandemic and therefore the loss of employer-sponsored health insurance for approximately 12 million Americans.

With our fragmented, inefficient health care system, with 27 million Americans lacking health insurance and many more with inadequate coverage, and with the high cost of health care in the U.S., many Americans put off medical care and were unable to afford prescription medications even before the pandemic. The authors of the study concluded that “Achieving greater health equity in the U.S. will likely require policies that extend insurance coverage, make health care easier to afford and strengthen primary care.”

They also suggested greater investments to address the social determinants of health — factors beyond traditional health care, such as housing, education and nutrition, that also affect people’s health. “The U.S.,” they say, “has much to gain from examining the experience of countries where universal health coverage ensures people have access to affordable health care.” We can do this without additional per capita spending by enacting and implementing a single-payer Medicare for All health care system.

Charles I. Wohl, M.D., Lenox

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"Berkshire doctors, activists, confront lawmakers about prioritizing single-payer health care legislation"

By Sten Spinella, The Berkshire Eagle, February 11, 2023

Local activists and doctors are frustrated with a perceived lack of passion among lawmakers for universal health care.

In the 2022 midterm election, voters in 20 Massachusetts state representative districts approved a nonbinding ballot question that instructs representatives of those districts to vote to create a single-payer health care system. It won with 75 percent of the vote in Pittsfield.

But lawmakers don’t sense much momentum for the proposed legislation around the Statehouse.

The ire from community members stems in part from a January meeting between local Medicare for All advocates and state Rep. Tricia Farley-Bouvier, the co-chair of the progressive caucus.

Henry Rose of Dalton, a retired physician and a member of Mass-Care, a nonprofit organization advocating for universal single-payer health care in the state, registered unease after the meeting. He and other community members felt Farley-Bouvier was not advocating for single-payer, which she favors, staunchly enough.

“She told us she will support the bill if it comes to the floor, but she won’t twist arms, especially with party leadership,” Rose said. “That doesn’t mean a lot unless all the members of the progressive caucus get together on this and promote it the best they can among their colleagues to try to get it out of committee.”

Rose and others want Farley-Bouvier to champion the bill and have implored her to co-lead it.

“That’s just not what we do in the caucus: twist each other’s arms on things,” Farley-Bouvier said. “We have a member of the caucus who is leading this effort on Medicare for All. Our job is to support her in her work.”

The caucus is not entirely unified on Medicare for All, Farley-Bouvier said, with a handful of holdouts, although most back the measure.

Mass-Care Director Stephanie Nakajima took issue with Farley-Bouvier saying that the job of wrangling the progressive caucus belonged to the House’s lead bill sponsor, state Rep. Lindsay Sabadosa, D-Northampton.

“One wonders what is even the point of having a progressive caucus? They dont want to move together progressively and hold each other accountable to be progressive,” Nakajima said.

Jeanne Kempthorne, former chief of appeals and public records officer in the Berkshire District Attorney’s Office, was present at the meeting. She took exception to Farley-Bouvier saying she wouldn’t push for the bill because the Speaker of the House wasn’t on board.

“The speaker would be most concerned about the impact of the legislation on community hospitals because that’s his key constituency and his greatest concern,” Kempthorne said, paraphrasing Farley-Bouvier. “Our directives to her [Farley-Bouvier] have fallen on deaf ears, and she’s forgotten who she works for. She doesn’t work for us, she works for the speaker.”

Farley-Bouvier said the speaker drives the House’s agenda.

“There are those who wouldn’t co-sponsor something unless they knew the speaker was on it,” she said.

Kempthorne and Rose noted that House Speaker Ron Mariano, D-Quincy, determines committee assignments, which can carry thousands of dollars in bonuses. The nonbinding ballot question passed with 61 percent of the vote in Mariano’s district.

Neither Mariano’s office nor Gov. Maura Healey's office responded to a request for comment.

“There’s a lot of people out there who don’t want it to change,” Farley-Bouvier said of the current system. “Blue Cross Blue Shield is a powerful entity in Massachusetts, what happens to them? There are bills out there without losers … In this situation there are winners and losers. I happen to think that the consumer, the taxpayer, medical professionals, are the winners, but the insurance industry would look very different.”

Massachusetts has debated single payer for decades: The first single-payer bill was introduced in 1986. Lawmakers point out that Massachusetts, which led the nation in mandating health insurance for residents in 2006, currently has near-universal coverage, with less than 3 percent of the population uninsured.

Massachusetts lawmakers weigh universal health care bill

“It’s a patchwork insurance with your co-pays, deductibles and high drug costs,” Rose said of the present system. “There are out-of-pocket costs that are beyond the reach of a lot of average citizens.”

Proponents of Medicare for All argue that for-profit insurance companies raise costs more than what it would cost in taxes to fund universal health care. Mass-Care writes of single-payer: “Medical care would be free at the point of service. All doctors and hospitals would be accessible to any resident without the restrictions currently imposed by insurance companies and employers. Fair, progressive taxation would replace premiums and co-pays.”

Single-payer could reduce health care costs by nearly 10 percent, according to a University of Massachusetts Amherst study. Nakajima noted that 41 percent of Massachusetts families struggle to afford health care right now.

The Berkshire delegation all publicly support Medicare for All in Massachusetts, but none of them have made it a priority.

Berkshire delegation on board with single-payer health legislation in Mass.

State Rep. John Barrett, D-North Adams, said he believes in the concept, but he isn’t sure of its efficacy with the projected costs for the program. He and other members of the delegation have long co-sponsored the legislation.

In addition to federal Medicare and Medicaid funds, under the bill, single-payer health care in Massachusetts would be paid for with a 7.5 percent tax on employers, with an additional half-percent on employers with more than 100 employees; a 2.5 percent tax on employees; a 10 percent tax on the self-employed; and a 10 percent tax on unearned income. These taxes are on all income above $20,000. Payroll taxes for employees would often replace what they pay into for their company health insurance.

“I’ve been a co-sponsor of that bill for 20 years in the legislature, but I think it’s a long shot,” state Rep. Smitty Pignatelli, D-Lenox, said. “We’ve got to find a balance of giving people quality health care and maintaining small hospitals in the Berkshires, making sure they’re financially stable.”

Pignatelli echoed the concerns of local activists on the outsized influence of insurance lobbies at the Statehouse.

“Insurance lobbies have way too much influence on politics period,” he said. 

According to the Boston Globe, In 2005, when the legislature took up health care legislation that later became Romneycare, “lobbyists for hospitals, insurance companies, and other major players in the healthcare industry were paid at least $7.5 million.”

Michael Kaplan, a doctor and the president of the Berkshire District of Massachusetts Medical Society, said he has seen insurance companies in the state funnel in millions of dollars over the years to defeat attempts at establishing Medicare for All.

No substitute for single-payer

“If the insurance companies become threatened, they have a lot of resources,” he said.

Kaplan thinks skepticism of universal health care comes from a lack of understanding.

“If you ask people the question, do you support a government-sponsored health plan that’s paid for by taxes, they say yes,” he said. “It would cost more in tax dollars because it’s tax-funded. But it replaces premiums and workers comp, so big picture, it doesn’t cost more. You have to raise taxes to pay for it, but the proposal doesn’t raise taxes on 95 percent of people.”

Kaplan said he believes the majority of physicians support single-payer. While some surveys buttress that belief, many doctors are split on the issue, though they have begun to come around to the idea more in recent years.

State Sen. Paul Mark said he sees a reluctance to become the first state to offer single-payer. He said there is a general concern among legislators about hurting the insurance industry.

“There’s from some a fear that we don’t want to be the first to take the leap because we don’t want to cause any harm to what is one of the five most important industries in the state,” he said, adding that hospitals and the health insurance industry “have a lot of sway in legislative circles.”

Mark doesn’t buy private committee meetings and votes as an obstacle to single-payer, as Nakajima and Kempthorne posited.

Nakajima said Mass-Care is planning on building grassroots support with labor groups.

“Organizing unions and other larger community groups will be the vanguard of the movement for Medicare for All,” she said. “It’ll be essential to passing it in the Statehouse.”

Sten Spinella can be reached at sspinella@berkshireeagle.com or 860-853-0085.

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Letter: "Don't dismiss benefits of single-payer health care for Massachusetts"

The Berkshire Eagle, March 9, 2023

To the editor: In her thoughtful March 1 letter to the editor, Lucy Kennedy brings up several important issues concerning a Medicare for All plan for Massachusetts.

She is concerned that the payroll taxes that might be used to pay part of the costs would cause businesses here to be less competitive. Actually, the opposite is true. About 10 years ago, a team led by Dr. William Hsiao, professor of economics at the Harvard School of Public Health, designed a single-payer system for Vermont. Their study projected an annual savings of 25.3 percent when compared to current state health spending levels, a reduction in employer and household health care spending by $200 million, creation of 3,800 jobs, and an increase of the state’s overall economic output by $100 million. Such a benefit would be even larger in more populous Massachusetts. Business taxes would increase, but would be more than offset because companies would no longer have to provide health insurance for employees. Unfortunately, the Vermont plan was not implemented, largely due to misinformation by the for-profit health insurance industry.

HD.1584, a state House bill, would consolidate all insurance plans, including Medicare and Medicaid, into a single state-organized plan, funded largely by payroll taxes. It would cover costs for essential health care services for everyone. For physician practices and hospitals, this would largely eliminate the inefficiencies and administrative costs of dealing with multiple plans. It would greatly reduce the five to eight hours per week physicians — even more for nurses — spend dealing with insurance-related issues, which would of course free up more time to see patients. Canadian physicians have found this to be a very attractive component of their single-payer system.

I agree with Ms. Kennedy that health care financing is a complex national problem. However, the Canadian single-payer system started in a single province: Saskatchewan. Because health care outcomes improved and per capita costs decreased in that province, it quickly spread to the rest of the country. Similarly, Massachusetts could serve as a model for establishing an efficient universal health care system with lower overall costs for businesses and patients, better health care outcomes and much less hassle and overhead for hospitals and physicians.

Please urge your state representative to work diligently to get HD.1584 passed.

Dr. Charles I. Wohl, Lenox

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Letter: "Support 'Medicare for All' legislation"

The Berkshire Eagle, April 22, 2023

To the editor: As former director of population health and community care for Berkshire Health Systems, I am writing in support of the 'Medicare for All' legislation (S.766/H.1267) and Massachusetts campaign for single-payer health care.

I have been a physician-educator in the Berkshires for 35 years. In that time, in diverse clinical leadership roles, I cared for many individuals and families confronting advanced chronic complex disease. I experienced the profound impact that social determinants of health like food and housing insecurity, trauma, health literacy and addiction have on overall health and quality of life.

Research from Robert Wood Johnson would suggest social determinants of health as the primary drivers of health behaviors and ultimately health outcomes, including cost of care. While the Berkshires' clinical-community integration and services have evolved to better address these needs, they are usually supported by grants and time-limited funding.

We spend far more per capita and have poor public health measures compared to countries with similar GDP per capita. America is not in good health, and we spend trillions on a delivery system that is not designed to create health. The COVID pandemic further lifted the veil on how tenuous it is to tie health care insurance to employment. Even when insured, many people avoid essential health services due to the fear of costs. We have seen the consequences of delaying essential care as one of many lessons learned from COVID.

The Medicare for All legislation provides a timely and thoughtful solution, and Massachusetts could be at the vanguard of health care transformation, as it has for the last 200 years. This legislation would provide universal coverage without deductibles and co-pays. A substantial amount of resources that maintain this administrative behemoth could be allocated to better support community-clinical integrative models of care that more effectively address the drivers of disease and the costs of care that continue to burden individuals and business around the commonwealth.

We do not need to spend more on health care. We need to be spending more wisely. There will be great opposition from industries that have benefitted greatly from the current model of care. A Medicare for All system is both more efficient with its elimination of administrative burdens and more equitable with elimination of cost as a barrier to care. Our Berkshire legislators have co-sponsored and supported this legislation. The time has come to be bold and to make it happen.

Dr. Mark Pettus, Dalton

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