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James Floyd, M.D.

James Floyd, M.D.

Posted February 27, 2009 | 10:39 AM (EST)

Behind Closed Doors, Repeating Mistakes from the Past on Health Care Reform


Last week, The New York Times reported that Senator Ted Kennedy has been holding secret meetings with lobbyists to reach "consensus" on a proposal for national health care reform. Included in the list of participants were America's Health Insurance Plans, the National Federation of Independent Business, and the Pharmaceutical Research and Manufacturers of America -- some of the same players who defeated the Clinton health care reform effort 15 years ago. Notably absent was Physicians for a National Health Program, the California Nurses Association, Healthcare-Now, and other advocacy groups that oppose the private insurance industry and support the creation of a national single-payer program.

According to the Times, lobbyists have discussed increasing health care coverage by subsidizing the purchase of private insurance and expanding public programs. This was the approach taken in Massachusetts following the passage of the Massachusetts Health Reform Law in 2006. Touted as providing universal health care, it expanded and modified Medicaid, subsidized skimpy coverage for those not poor enough to qualify for Medicaid, and imposed financial penalties against those who didn't purchase insurance. This reform has been hailed as a bipartisan success and appears to be favored by both President Obama and Senator Kennedy.

But what has been the result of the Massachusetts reform? A report released last week by Physicians for a National Health Program and Public Citizen documents that as much as 5 percent of the state remains uninsured -- a decrease of only half from the baseline rate of 10 percent and a far cry from universality. New financial barriers, such as co-payments for medications and office visits, have led some of the poorest patients to interrupt care for life-threatening illnesses. The additional cost of the reform has topped $1 billion annually, forcing the state to cut funding to the public hospitals and community clinics that provide a crucial safety net for those who cannot afford health care.

Over the past 20 years, similar reform efforts have been attempted in other states -- Oregon, Minnesota, Tennessee, Vermont, Washington, and Maine. Because these incremental reforms did not address the problems and waste created by private insurers, they all failed to significantly reduce the number of uninsured while costs continued to outpace inflation.

The Times reported that a key feature of the Massachusetts reform that has been embraced in the Kennedy meetings is the requirement that every American have insurance, with financial penalties for those who don't. This mandate is a backwards formula for universality, one that can be arrived at only by starting with the premise that the financial interests of the insurance and pharmaceutical corporations are to be protected. According to James Gelfand of the United States Chamber of Commerce, "Forcing individuals to purchase insurance in the current market would be a disaster. Before we even have that discussion, we need to make health care more affordable and improve its quality."

In other words, we shouldn't force people to buy a flawed and unaffordable product. The only fair way to mandate universal coverage is to automatically enroll everyone in a program that provides a single, high standard of care and allows them to pay based on what they can afford, through progressive taxation. Even Nobel laureate and former Clinton economic advisor Joseph Stiglitz "has reluctantly come to the view that it's the only alternative."

There are troubling parallels between Kennedy's secret meetings and the meetings of the Task Force on National Health Care Reform chaired by Hillary Clinton in 1993. Although special interests were officially excluded from the Clinton task force, documents obtained through a lawsuit filed by the National Legal and Policy Center revealed that more than 300 individuals who participated in task force working groups came from the private sector, and included representatives of the insurance industry and small business groups. In addition, a report from the Center for Public Integrity revealed that around the time of the task force, 80 former government officials -- including 12 former members of Congress -- had gone through the "revolving door" to work for health care interests, many of whom actively lobbied on health care reform.

Fast-forward to 2009 and former-Senator Tom Daschle's failed appointment as Secretary of Health and Human Services. The official story focused on his failure to pay his taxes, but what angered most health care reform activists most was his previously undisclosed work as a health insurance lobbyist.

In post-mortems on the Clinton health care reform effort, pundits concluded that it was overly ambitious and too complicated to garner the necessary public support. They also recognized the impact of the highly successful lobbying effort by the health insurance industry -- the "Harry and Louise" television ads -- and the anemic response from the White House. Perhaps what doomed the Clinton effort to failure at an early stage was the inclusion of the very interests that must be fought to guarantee comprehensive and universal coverage to every American.

Yesterday, President Obama released a budget proposal that includes $634 billion to fund health care reform, days before a White House summit on health care reform begins. Like the Kennedy meetings, this summit currently does not include advocates for single-payer but is well-represented by lobbyists for the insurance industry and other groups who oppose fundamental reform.

President Obama, we urge you not to make the same mistake that the Clintons made. Please don't exclude from the discussion the people who are your grassroots support for real change. Although people in your meetings may be telling you otherwise, there is tremendous support throughout the country for a single-payer system. Give us a seat at the table if you truly want to build consensus around health care reform.

Last week, The New York Times reported that Senator Ted Kennedy has been holding secret meetings with lobbyists to reach "consensus" on a proposal for national health care reform. Included in the list...
Last week, The New York Times reported that Senator Ted Kennedy has been holding secret meetings with lobbyists to reach "consensus" on a proposal for national health care reform. Included in the list...
 
 
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04:50 PM on 03/02/2009
VA benefits.

What image in your mind do those two words conjure? I know what comes up in my mind, substandard care, waiting lists for treatment, ineffective out dated treatment protocols, and vets who would rather have private insurance, and opt to carry private insurance rather then deal with the headaches of navigating that system.

"Free Health Care for All!!" seems to be the battle cry..."Insurance Companies are Bad!!!" seems to be the other. Look around; do you like your house? Car? Goods you purchased with your credit card? Do you not understand that insurance companies reinvest their premiums into our economy to fund such items? They lend to banks and other institutions to so those banks can lend to you. They charge interest for those dollars and then THAT'S HOW THEY MAKE A PROFIT. Not merely for collecting premiums and socking those premiums aside somewhere to pay benefits. So you really want to take billions and billions of dollars out of our economy? You really think a mere 3.3% payroll tax is going to cover that? Not hardly.

Asking my rep to not support HR 676
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James Floyd, M.D.
02:51 PM on 03/05/2009
The VA system you talk about is a relic of the past. Care provided by the VA system in the 80s was substandard, but after a major overhaul the VA leads the country in quality of care provided and patient satisfaction (far outperforming private insurance), at much lower cost. Having cared for hundreds of patients as a physician working in VA hospitals, I can tell you that many veterans continue to get their care within the VA system even when they have private insurance and the option to go elsewhere.

And as far as private insurance companies serving as financial institutions, it is misleading to suggest that their profit derives from investments, rather than by paying for less care than the premiums they collect. It is very well documented that the high administrative costs associated with care in the U.S. (30 cents on every dollar) are due to the overhead of private insurers, as well as the administrative costs foisted on doctors and hospitals who have to deal with hundreds of different insurance plans. The costs of a single-payer system are far lower than the patchwork one we currently have, and the nearly $400 billion in annual savings that would be realized is enough to cover every American.
09:04 PM on 02/27/2009
Martin Luther King said, "Of all the forms of inequality, injustice in healthcare is the most shocking and inhumane."

Congressman John Conyers has introduced HR 676, The United States National Health Insurance Act, to ensure that every American, regardless of income, employment status, or race, has access to quality, affordable health care services.

To end the inhumanity of our failed healthcare insurance system, where profits are more important than patients’ health, ask your Representatives to support John Conyer's HR 676 Bill.

HEALTHCARE SHOULD BE A RIGHT, NOT A BUSINESS. WHY ISN’T SINGLE-PAYER ON THE TABLE?

For more information on HR 676, see:
http://www.pnhp.org/publications/the_national_health_insurance_bill_hr_676.php
09:01 PM on 02/27/2009
If we're all required to buy health insurance, guess who benefits and profits? It's the insurance companies, not us!

Health insurance companies make huge profits and their CEOs make millions, while the rest of us face skyrocketing healthcare costs, impossible bureaucracy, and life-threatening insurance denials.

HEALTH INSURANCE COMPANY PROFITS IN 2007:
1. UnitedHealth Group -- $ 4.654 BILLION. UnitedHealth Group owns Oxford, PacifiCare, IBA, AmeriChoice, Evercare, Ovations, MAMSI and Ingenix, a healthcare data company
2. WellPoint -- $ 3.345 BILLION. Wellpoint owns BLUES across the US, including Anthem Blue Cross Blue Shield, Blue Cross Blue Shield of Georgia, Blue Cross Blue Shield of Wisconsin, Empire HealthChoice Assurance, Healthy Alliance, and many others
3. Aetna Inc. -- $ 1.831 BILLION
4. CIGNA Corp -- $ 1.115 BILLION
5. Humana Inc. -- $ 834 million
6. Coventry Health Care -- $626 million. Coventry owns Altius, Carelink, Group Health Plan, HealthAmerica, OmniCare, WellPath, others
7. Health Net -- $ 194 million

The huge insurance company profits—BILLIONS YEARLY—could provide quality healthcare for millions of people.

Get the insurance companies OUT of healthcare. The only solution is a NON-PROFIT SINGLE-PAYER HEALTHCARE SYSTEM – and the single payer should not be insurance companies.

The solution? The United States National Health Insurance Act, H.R. 676. You can read about it here: http://www.healthcare-now.org/hr-676/
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dustyoh
05:09 PM on 02/27/2009
I voted for Obama over Clinton because frankly, Clinton's plan scared the Bejesus out of me. Please tell me we are not going down this road. This plan is just so bad. While I like Ted Kennedy, can anyone say they are happy with what came down with No Child Left Behind and what a disaster that turned into?
03:53 PM on 02/27/2009
Eactly whose single-payer model are we talking about here?
I came here from Europe - the healthcare system at that time was certainly available, but it was nothing like the standard I encountered when I arrived in this country.
Everything I have read, seen or heard from relatives still there tells me it has actually worsened since then.
Is the burden to be shouldered by the employers ?
09:06 PM on 02/27/2009
Congressman John Conyers has introduced HR 676, The United States National Health Insurance Act, to ensure that every American, regardless of income, employment status, or race, has access to quality, affordable health care services.

To end the inhumanity of our failed healthcare insurance system, where profits are more important than patients’ health, ask your Representatives to support John Conyer's HR 676 Bill.

For more information on HR 676, see:
http://www.pnhp.org/publications/the_national_health_insurance_bill_hr_676.php
03:28 PM on 02/27/2009
You didnt buy insurance because you couldnt afford it, so you have to pay a financial penalty as punishment for not having any money. I missed something here.
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James Floyd, M.D.
04:07 PM on 02/27/2009
Unforunately, you didn't miss anything here. It also does not make sense to me that the most vulnerable people who cannot afford insurance are charged a fine . . . and still not given insurance. You can obtain a waiver from purchasing insurance and avoid the fine in some instances if you really can't afford the premium for the plan offered.

These logical and ethical conundrums will continue unless we stop these patchwork attempts to reach universality and go with a truly universal system.
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HUFFPOST SUPER USER
dustyoh
05:11 PM on 02/27/2009
What happened to the plan to offer us coverage similar to what the representatives and senators in congress get?
11:35 AM on 02/27/2009
First and foremost, give a seat to the people who need health care the most. The disabled and elderly. I'm sick and tired of the talk about Single Payer Health Care system that will inevitably lead to the amputation of entire sections of the population, namely the elderly and disabled, who do not fit into the cost/benefit analysis program that single payer health care will require. Until the needs of the most needy of the people are addressed, there will be no chance of having truly universal health care, let alone that it be affordable AND high quality. Where do you think these cuts in cost will come from? They will come from cuts in quality of research and development of new studies and treatments for the most extreme cases such as stem cell research, umbilical cord blood for bone marrow, and the like. This health care system will do nothing but create a society of super human super healthy Charles Atlases and leave no room for the disabled or elderly. At which point, I hoppe and pray that Death wth Dignity assisted suicide will be legalized, because I for one refuse to live in a society that does not value me because I was born with a disability I have no control over
03:10 PM on 02/27/2009
You are sick and tired of it because you don't know what the hell you are talking about. I don't know if it is misinformation or if you're just that hardheadly clueless, but clearly you are off the rails on your facts and on the results that you imply.
11:17 AM on 02/27/2009
An excellent and needed article by Dr. Floyd.

As I have been asserting for sometime now [and I know many others here have as well], we need to support the HR 676 bill to enact a true single-payer UHC system for ALL Americans.

Our healthcare travesty should shame us to the core, and typical DC political rangling to gut that concept of its primary principles should equally enrage us.