Comment: The conservative policy community has long advocated for an end to employer-sponsored coverage. They believe that insurance should be an individual choice while recognizing that government has to play some role in funding care for low-income individuals.What are we hearing from these voices in the progressive community? They agree that the regressive tax policies are highly inequitable and must be changed.
Andrew Stern goes even further and states that the deterioration in employer-sponsored coverage, declining enrollment, and the financial burden placed on employers leaves no real option other than to replace it with a better system.The progressives acknowledge that the policy issues are well understood. In fact, single payer would certainly accomplish our goals (though Furman conjectures on the well-documented and irrefutable efficiency of single payer).
So what do they say? Let's adopt any better system, except single payer.The policy issues are well understood. Simply changing tax policy (Furman) or adopting a universal, multi-payer system (Stern) perpetuate and expand some of the crucial policy flaws that we face today.Single payer won't fix all of the problems in our health care system, but it will fix all of the problems with the financing of health care. And isn't that what the debate is all about?
QOTD 6/22
Click the title link for transcript and video
6/16/2006
Employment-Based Health Insurance: A Prominent Past, But Does It Have A
Future?
Hosts: Brookings Institution and the New America Foundation
Andrew Stern, president, Service Employees International Union:
...this is not a matter of policy. If we could solve this health care system
by policy it would have been solved every single year. There's more good
policy about health care in America than I can imagine. It is the most
studied, researched, you know, we have commissions and committees publicly
and privately all throughout Washington and the United States. It's really
about politics and leadership.
Our choice is we could keep making incremental changes in the health care
system. And I certainly appreciate that everyone would like to build a
better funding stream for the health care system but the truth is we're way
past incremental change. It's not going to work.
...so the fundamental change for me means one, you have to recognize that
employer based health care is ending, it's dying in front of our very eyes. The
charts say it there. It will not rebound, I believe, in the next economic
upturn in America. It was a good friend. It served America well in the 20th
Century. We love it dearly. Employers, to their credit, lived with it for a
long time despite all of the distortions that it created. But it's
collapsing in front of our eyes. It may still be breathing but anybody who
can look into the future says, "This employer based health care system is
over in America."
I'm here to also say I don't think we need to import Canada or any other
system. We're going to build an American system because we're Americans and
we don't like anybody else's system.
I think the single payer issue is kind of a stalking horse for I'm not sure
what, because we're going to have a multi-payer system or some kind of
system, you know, that it's built into the cost of goods in America.
Thursday, June 22, 2006
Our Unhealthy Tax Code
Democracy: A Journal of Ideas
Issue #1, Summer 2006
Our Unhealthy Tax Code
By Jason Furman
American health care is beset by a well-known litany of problems.If this were a government-run health care system, the voting public and policymakers would be up in arms. Yet, perhaps because health care is largely perceived as a private-sector concern, there is relative quiet: while voters tell pollsters that it is a top priority, there appears not to be comparable political pressure for serious reform or any fundamental change in the government's involvement, either in the provision or funding of health care.
This is in part because much of the federal government's involvement with the health care system is through the hidden backdoor of the tax code. An important principle for modern progressives is that when the government has to intervene in the marketplace, it should not prop up failure. Yet the federal government is, in fact, deeply involved in perpetuating the current "private" health care system and all its flaws, spending approximately $200 billion annually in subsidizing employer-provided insurance. It is the single biggest subsidy in our tax system, more than twice as costly as the mortgage interest deduction.
The only government programs that cost more are Social Security, national defense, and Medicare.The fact that the tax subsidy, which supports the employer-sponsored system, is better than nothing is a feeble excuse for resisting any changes to the status quo. This massive program of tax breaks is ineffective and regressive, wasting money on those who have health insurance while doing little for those who can barely afford it and nothing at all for those without it.A single-payer national health care system would, by definition, remedy the problem, but it is unlikely to happen any time soon, if ever at all. Beyond the political limitations, it is also an open question whether a single-payer system would be the most efficient way to provide quality health care for all Americans.
In the meantime, reforming health care will come down to a set of incremental changes that build on the current system. But that does not mean that change cannot be ambitious. As Massachusetts has shown, achieving a plan for universal health insurance coverage need not wait for the establishment of single-payer government insurance like Medicare or a national health care system like the United Kingdom's.
Wednesday, June 21, 2006
APA President Advocates for Single-Payer
Psychiatr News June 16, 2006
Volume 41, Number 12, page 1
© 2006
American Psychiatric Association
Association News
APA President Urges Support For Single-Payer Insurance System Catherine F. Brown
Steven Sharfstein, M.D., ends his year as president of APA in the same way that he began it: by urging APA members to become or stay involved in advocating for psychiatric patients.
Steven Sharfstein, M.D., presents his presidential address last month in Toronto. David Hathcox
Psychiatrists need to "tirelessly advocate" for a single-payer, universal health care system so every American has access to care as a right, not a privilege.
That was the message that outgoing APA President Steven Sharfstein, M.D., delivered to those attending the Opening Session of APA's 2006 annual meeting last month in Toronto.
"To advocate and to lead, we must say five simple words about the state of our health care system in the U.S. today: the emperor has no clothes," said Sharfstein, president and CEO of the Sheppard Pratt Health System in Maryland.
Sharfstein reminded his audience that in the speech he had delivered at last year's Opening Session, he challenged fellow APA members to become involved in advocating for patients and the profession of psychiatry at the local, state, and national levels.
His challenge did not end with his presidency, however. "We cannot slow down," he said. "Advocacy is not just calling on others to do what we want; it is a shining light for others to follow." ....
Psychiatrists must be vigilant over other core values of the profession as well, he said. After reading in the New England Journal of Medicine that psychiatrists were participating in the interrogation of detainees at the U.S. Naval Station at Guantanamo Bay, Sharfstein expressed his concern in a letter to the assistant secretary for health in the Department of Defense. That letter led to an invitation to tour Guantanamo with the top health leaders in the military and other leaders of medical and psychological organizations. They were briefed on the involvement of "behavioral science consultation teams" and were told that while stress techniques had been used in the past, current techniques focused on building rapport with detainees because the development of positive relationships was found to be more effective. That wasn't an acceptable alternative for Sharfstein, however.
"It is the thinnest of thin lines that separate such consultation from involvement in facilitating deception and cruel and degrading treatment," he said. The detainees, being held as enemy combatants with no legal rights, live in despair, and multiple suicide attempts and hunger strikes are common. "Our profession is lost if we play any role in inflicting these wounds."
Psychologists have taken a position allowing them to provide consultations in interrogations, Sharfstein noted, "and if you ever wondered what makes us different from psychologists, here it is." Earlier that day, he announced, the Assembly, and then the Board of Trustees, voted in favor of a position statement reconfirming that psychiatrists should not participate in prisoner interrogations .
Two other major events during Sharfstein's presidential year demonstrated the Bush administration's failure to take care of the poor and disadvantaged in this country, he said. The first was Hurricane Katrina late last summer, and the second was the launching of the Medicare Part D prescription drug benefit on January 1.
"To advocate and to lead, we must say five simple words about the state of our health care system in the U.S. today: the emperor has no clothes."
Regarding Katrina, he praised the many APA members who helped traumatized survivors—some of whom were survivors themselves—but expressed outrage over the government's failure to follow through on promises to provide health care and other assistance to them. Many survivors were poor and had lost everything to the violence of the storm and flooding.
Four months later, APA had a front-row seat for the train wreck that occurred when Medicare Part D went into effect. APA and other advocacy groups had warned the government about the serious flaws and limitations of Part D, Sharfstein said, but these warnings went largely unheeded. In particular, APA and its partners were concerned about the 6.5 million patients dually eligible for both Medicaid and Medicare; beginning January 1, their drug coverage was moved from Medicaid to Medicare. Within days of the new year, reports proliferated about patients who could not get the medications they needed for a variety of reasons, from confusion over which plan they had been enrolled in to high copays they could not afford, he noted.
The program's unreasonably complex design and rocky start, said Sharfstein, represented "another abandonment of the most poor and vulnerable of our patients, another shocking insight into the failure to care for the less fortunate."
The federal government needs to address Part D's many inadequacies, but more than modest tinkering is required, said Sharfstein. "The solution is for the federal government to establish a basic drug plan that works for those who fail in the private Part D plans," he advised. "This is a concept so obvious that it is easy to be pessimistic that it will ever be adopted."
The events that Sharfstein weathered this past year underscored the importance of the advocacy mission in which he had challenged his fellow APA members to join him. He left them with this simple but weighty message:
"We must tirelessly advocate for [single-payer universal health reform]. As the health care crisis extends and mushrooms, with more and more Americans without adequate coverage, the opportunity for such change will come at national, state, and local levels. And we must be there as advocates for our patients."
Volume 41, Number 12, page 1
© 2006
American Psychiatric Association
Association News
APA President Urges Support For Single-Payer Insurance System Catherine F. Brown
Steven Sharfstein, M.D., ends his year as president of APA in the same way that he began it: by urging APA members to become or stay involved in advocating for psychiatric patients.
Steven Sharfstein, M.D., presents his presidential address last month in Toronto. David Hathcox
Psychiatrists need to "tirelessly advocate" for a single-payer, universal health care system so every American has access to care as a right, not a privilege.
That was the message that outgoing APA President Steven Sharfstein, M.D., delivered to those attending the Opening Session of APA's 2006 annual meeting last month in Toronto.
"To advocate and to lead, we must say five simple words about the state of our health care system in the U.S. today: the emperor has no clothes," said Sharfstein, president and CEO of the Sheppard Pratt Health System in Maryland.
Sharfstein reminded his audience that in the speech he had delivered at last year's Opening Session, he challenged fellow APA members to become involved in advocating for patients and the profession of psychiatry at the local, state, and national levels.
His challenge did not end with his presidency, however. "We cannot slow down," he said. "Advocacy is not just calling on others to do what we want; it is a shining light for others to follow." ....
Psychiatrists must be vigilant over other core values of the profession as well, he said. After reading in the New England Journal of Medicine that psychiatrists were participating in the interrogation of detainees at the U.S. Naval Station at Guantanamo Bay, Sharfstein expressed his concern in a letter to the assistant secretary for health in the Department of Defense. That letter led to an invitation to tour Guantanamo with the top health leaders in the military and other leaders of medical and psychological organizations. They were briefed on the involvement of "behavioral science consultation teams" and were told that while stress techniques had been used in the past, current techniques focused on building rapport with detainees because the development of positive relationships was found to be more effective. That wasn't an acceptable alternative for Sharfstein, however.
"It is the thinnest of thin lines that separate such consultation from involvement in facilitating deception and cruel and degrading treatment," he said. The detainees, being held as enemy combatants with no legal rights, live in despair, and multiple suicide attempts and hunger strikes are common. "Our profession is lost if we play any role in inflicting these wounds."
Psychologists have taken a position allowing them to provide consultations in interrogations, Sharfstein noted, "and if you ever wondered what makes us different from psychologists, here it is." Earlier that day, he announced, the Assembly, and then the Board of Trustees, voted in favor of a position statement reconfirming that psychiatrists should not participate in prisoner interrogations .
Two other major events during Sharfstein's presidential year demonstrated the Bush administration's failure to take care of the poor and disadvantaged in this country, he said. The first was Hurricane Katrina late last summer, and the second was the launching of the Medicare Part D prescription drug benefit on January 1.
"To advocate and to lead, we must say five simple words about the state of our health care system in the U.S. today: the emperor has no clothes."
Regarding Katrina, he praised the many APA members who helped traumatized survivors—some of whom were survivors themselves—but expressed outrage over the government's failure to follow through on promises to provide health care and other assistance to them. Many survivors were poor and had lost everything to the violence of the storm and flooding.
Four months later, APA had a front-row seat for the train wreck that occurred when Medicare Part D went into effect. APA and other advocacy groups had warned the government about the serious flaws and limitations of Part D, Sharfstein said, but these warnings went largely unheeded. In particular, APA and its partners were concerned about the 6.5 million patients dually eligible for both Medicaid and Medicare; beginning January 1, their drug coverage was moved from Medicaid to Medicare. Within days of the new year, reports proliferated about patients who could not get the medications they needed for a variety of reasons, from confusion over which plan they had been enrolled in to high copays they could not afford, he noted.
The program's unreasonably complex design and rocky start, said Sharfstein, represented "another abandonment of the most poor and vulnerable of our patients, another shocking insight into the failure to care for the less fortunate."
The federal government needs to address Part D's many inadequacies, but more than modest tinkering is required, said Sharfstein. "The solution is for the federal government to establish a basic drug plan that works for those who fail in the private Part D plans," he advised. "This is a concept so obvious that it is easy to be pessimistic that it will ever be adopted."
The events that Sharfstein weathered this past year underscored the importance of the advocacy mission in which he had challenged his fellow APA members to join him. He left them with this simple but weighty message:
"We must tirelessly advocate for [single-payer universal health reform]. As the health care crisis extends and mushrooms, with more and more Americans without adequate coverage, the opportunity for such change will come at national, state, and local levels. And we must be there as advocates for our patients."
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