Winning Progressive

For this weekend’s reading list, we have articles on protecting Vermont’s fledgling single payer health insurance system, how progressives can move politics, a debunking of conservative myths about “voter fraud,” how for-profit corporations are making a fortune detaining undocumented immigrants, and the differences in President Obama and Mitt Romney’s plans for the Bush tax cuts.

Can Vermonters Win Single Payer? – a report on how corporate interests are working to undermine support for Green Mountain Care, Vermont’s single payer health insurance system that was passed last year but will not take effect for five or six years.   For our previous coverage of Green Mountain Care, see this post.

Progressive Action Can Move the Candidates – an essay arguing that progressive action both within and outside of the electoral system can and already has moved our politics on issues such as economic inequality and immigration

The Voter Fraud Myth Debunked – A good debunking of some of the most popular false stories about voter fraud being peddled by conservatives across the country.

Private Prisons Profit From Immigration Crackdown – a report on how privately owned prison companies now own nearly half of the cells that immigrant detainees are sent to, which means that the industry is profiting heavily off of the GOP’s misguided objection to immigration.

U.S. Taxpayers and the Bush Tax Cuts – details regarding how various groups would fare under the GOP plan versus Obama’s plan for dealing with the impending expiration of the Bush tax cuts.

(By Joanne Boyer, cross-posted at Wisdom Voices)

Amid all the noise created by the passage of the Affordable Care Act (ACA) and its future now before the U.S. Supreme Court, there are some states who continue to move forward with the only common sense health care solution:  single payer.

First it was Vermont, when Governor Peter Shumlin signed a law in March that sets Vermont on a course to provide health care for all of its citizens through a single payer system called Green Mountain Care. Key components include containing costs by setting reimbursement rates for health care providers and streamlining administration into a single, state-managed system. The ACA reform law would not allow Vermont to enact single payer until 2017; Vermont is asking the administration to grant it a waiver so that it can get there even faster, by 2014.

Could Minnesota be next?

Vermont diligently and patiently worked for years to build the foundation for its law.  So too, is Minnesota under the umbrella of an organization called Health Care for All Minnesota (HCAMn).  Its mission is dedicated to establishing comprehensive single-payer health care for all Minnesotans through advocacy, education, lobbying, and community organizing.  HCAMn, a coalition of member organizations, is an independent, nonpartisan, 501(c)4 non-profit and does not endorse candidates or work on political campaigns.

No matter what the Supreme Court decides, the move to single payer is on in Minnesota.  In 2010, the Minnesota Health Act passed out of both state legislature committees before the November 2010 elections swept in a Republican controlled legislature and a Democratic governor (Mark Dayton). That effectively stalled the legislation even though Dayton is on record as supporting single payer for Minnesota.

“After the 2010 election, we decided our focus would be more to educate people on what single payer is,” said Erin Anderson, Executive Director of HCAMn.  “We are now going state-wide, via forums and meetings, telling people what the benefits are, how it would save money and how everyone would be covered.  We’re focused on education and organizing the general pubic.”

Minnesota is one state actively working to implement a health exchange as part of the ACA.  The governor’s task forces on both health exchanges and health reform offer HCAMn other avenues to turn the conversation toward implementation of single payer.

“We, in an effort spearheaded by the Minnesota chapter of Physicians for a National Health Program, made a commitment to be at task force hearings and to speak during the public forum part of those meetings,” said Lisa Nilles, Vice Chair of HCAMn.  “We’re showing up and making sure the message gets through to the governor.  We’re also present at citizen forums organized by the Citizens League and helping to provide the governor input on what the citizens are saying about health care.  And the message is getting out there that Minnesotans want single payer – that single payer needs to be on the table.”

Some national polls have shown a 2/3 majority in favor of single payer. A 2007 poll of Minnesota physicians indicated a 64 percent approval of single payer.  Also, the majority of physicians (86%) agreed “that it is the responsibility of society, through the government, to ensure that everyone has access to good medical care.”

The HCAMn site provides excellent information on what single payer is and what it is not. It’s a great read for individuals concerned about knowing the facts about single payer.  In summary, single payer provides:

• One system that covers everyone
• A uniform and comprehensive benefit set for everyone
• A single network of health care providers and an end to choice-limiting networks
• A single insurance pool to spread insurance risk
• An outlet to delink health care coverage from employment

“There’s so much misinformation about single payer,” Anderson said.  “People think it’s ‘socialized medicine’ when in fact it’s not that at all.  You still have private clinics and private hospitals, but they are paid by one payer and it doesn’t have to be the government.  And people think it has to be so expensive, when all the studies show single payer saves money.”

Despite making sense and saving money, single payer faces an uphill climb with roadblocks thrown up by big insurance company lobbying. So what keeps HCAMn motivated through this long process?

“We have a fragmented health care system that keeps so many people from getting the care they need,” said Anderson, who herself carries the ‘scarlet letter’ of a pre-existing condition. “I had back surgery when I was 13,” she said.  “I’m a pre-existing condition.

“It’s the stories – that’s what keeps us motivated.  Everyone knows someone who has been affected by debt, who isn’t covered by health insurance, someone who has high deductibles or high prescription drug costs.”

For Nilles, a physician who worked in England in the early 1990s before beginning her practice in the U.S., it’s that first-hand knowledge of working in a system in which “everyone’s covered” that has been her motivating factor.

“I lived in a world where it (universal coverage) was just the norm,” Nilles said.  “And then I came back and saw the crazy and chaotic system here.  People here tend to push back and will cite horror stories about health care delivery in other countries, saying there is rationing and long lines.  And they’re not looking at their own country.  I ask: “what about here?’ We ration health care more than anyone, but people somehow think we have it better. I’ve been active in this for the last seven years, and single payer has become a real contender in the conversation – it seems to be more prevalent. People know what it is – even if they are afraid of it.  And, once they hear it explained in some depth, they are not afraid, but often turn into supporters.”

“In this country it tends to be the states have to do it first,” Anderson said.  “The states are like pilot projects and they have to implement it and then it moves to a national level.”

“For a long term view, everything we are doing is building, and when will it break in favor of single payer? I don’t know, but I do know we are making progress and that is what gives us hope, Nilles said”

Single Payer:  Common Sense & Cost Savings

HCAMn points to the recent Lewin Group report on what single payer would mean for Minnesota.  The report once again states the obvious about single payer – it covers everyone and it saves money.  A complete copy of the report is available by clicking here. Below is an excerpt:

Using health spending data provided by the Minnesota Department of Health (MDH), we estimate with our models that the single payer plan would achieve universal coverage while reducing total health spending for Minnesota by about $4.1 billion, or 8.8 percent, in 2014. This includes added costs due to reductions in utilization management and increased utilization costs resulting from reduced cost sharing. Additional costs and savings estimates under the single payer plan in 2014 include:

• A total savings of $35.7 million to state and local governments;
• An average savings of $1,214 per worker, for employers offering health insurance coverage prior to the ACA;
• An average additional cost of $1,963 per worker, for employers not offering health insurance coverage prior to the ACA;
• An average savings of $1,362 for families, including wage effects;
• A reduction of 42,800 Minnesota jobs for those with insurance-related job functions; and
• A ten year total statewide savings of $189.5 billion, from 2014-2023.

Wendell Potter:  Exposing The Insurance Industry

Perhaps the biggest roadblock to implementation of single payer health care system is the for-profit insurance industry and its lobby.  After all, who stands to lose the most with a health care system designed to take care of individuals rather than line the pockets of executives and shareholder.  The United States remains the only industrialized nation in the world with a for-profit health care system.

HCAMn’s annual single payer summer celebration is Thursday June 21 and will feature Wendell Potter as its guest speaker.  Information on how to purchase tickets can be found by clicking here. Following a 20-year career as a corporate public relations executive, Potter left his position as head of communications for CIGNA, one of the nation’s largest health insurers, to help socially responsible organizations — including those advocating for meaningful health care reform — achieve their goals.

Potter has been a powerful voice in exposing insurance companies and how they put profits before people.  His latest book Deadly Spin provides not just an exposé of health insurers but a stark warning that corporate spin is distorting our democracy.  Visit www.wendellpotter.com for more information on the book and the work Potter does.

For this weekend’s reading list, we have an interview with the author of a new book on how to tackle the deficit without destroying government, a critique of the GOP’s “faith-based” economic theories, a study on conservative media bias that helped destroy ACORN, an accounting of how states have been unable to reform health insurance, an analysis of how computerized voter registration systems would increase voting rolls while saving money, and a critique of Chicago Mayor Rahm Emanuel’s undemocratic governance.

If you have any feedback on any of these articles, or would like to recommend an article for next weekend’s reading list, please let us know in the comments below or at the Winning Progressive Facebook page.

How to Fix the Debt Problem – Without Trashing Government – an interview with Simon Johnson, co-author of the book White House Burning which explains how long term deficit problems can be solved without eviscerating Medicare, Social Security, and other important government programs.

Enough With the GOP’s Faith-Based Economics – an essay explaining how conservative free market economic assumptions are tainted by an assumption of rational informed behavior that does not match reality.

Manipulating the Public Agenda: Why ACORN Was in the News and What the News Got Wrong – an old but interesting evaluation of how the media distorted its coverage of ACORN, thereby enabling a dishonest conservative campaign against the organization to succeed.

Over Stated - an accounting of how the history of state-level health insurance reforms shows that states do not have the market power or ability to achieve the fundamental reforms that are needed in the health insurance market.

Voter Registration in a Digital Age – a report on how computerized voter registration systems could increase voter registration rates, improve accuracy, and save money.

Rahm Emanuel Has A Problem With Democracy – an update on Mayor Rahm Emanuel’s anti-democratic, union busting, white collar patronage creating governance of the City of Chicago.  Winning Progressive raised concerns that this is how Emanuel would govern in a previous post on his mayoralty.

ObamaCare is, of course, under attack, with conservative activists having taken a constitutional challenge to the law all the way to the Supreme Court. That challenge focuses on the individual mandate or shared responsibility provision of ObamaCare, which requires individuals to purchase insurance and which critics claim exceeds the federal government’s power under the Commerce Clause of the Constitution. As we’ve previously explained, leading conservative federal appellate court judges have already rejected that argument, explaining that the “substantial effects” of millions of people not purchasing insurance until they are sick would undermine the health insurance market that Congress indisputably has the authority to regulate. Winning Progressive believes that the Supreme Court will follow suit, either 5-4 or 6-3.

ObamaCare critics, however, have argued that the individual mandate must be reversed because there is no possible limiting principle to a decision upholding the mandate. For example, in the Supreme Court argument yesterday, Justice Roberts asked whether the government could mandate the purchase of cell phones to ensure that people are able to access emergency services when needed, while Justice Alito offered a hypothetical about requiring the purchase of burial plots because everyone will eventually need them. Similarly, in the New York Times, Ross Douthat suggested that if Congress can require the purchase of health insurance, it could also require individuals to obtain food vouchers or join a grocery club presumably to make food more affordable.

The conservative “lack of a limiting principle” argument, however, fails because it ignores the fact that the underlying regulatory goal that the government is attempting to achieve through a mandate must itself be a proper government goal. In the context of health insurance, there is no reasonable dispute that the government can, under the Commerce Clause, require private insurance companies to provide insurance to anyone who can afford it, regardless of pre-existing conditions. But the only way a system free of pre-existing condition exclusions can work is to require individuals to purchase insurance, because otherwise everyone would wait to purchase insurance until they are sick, which is unworkable.

With regards to purchasing groceries or burial plots, however, requiring grocery store owners or burial plot owners to sell their products to anyone who can afford them does not require a mandate to require everyone to purchase those products. And that is because an individual’s refusal to purchase groceries or a burial plot does not threaten a system that requires grocery stores or burial plot owners to sell to anyone who can afford the product. The only way that an individual mandate to purchase groceries or burial plots they can afford could be necessary to achieve a regulatory goal is if that regulatory goal was to require grocery stores or burial plot owners to provide groceries for free to those who cannot afford them. But the government cannot require that (instead, the government would have to provide such products if it wanted to) and, therefore, a grocery mandate or burial plot mandate would never pass muster.

In short, the conservative claim that upholding ObamaCare would open the door to the government requiring individuals to purchase all sorts of products is grounded in fearmongering, not fact.

(By Joanne Boyer, cross posted at Wisdom Voices) 

In the mid 1990s, I worked with an individual in Minnesota who fought hard to enact legislation for universal health care. His passion and desire to see health care reform that included coverage for all was as heartfelt as any I’ve ever seen. In what seemed (at the time) like a never ending legislative battle to change a health care system failing its people, I heard him say that he was going to round-up every three-ring binder report that had been done on the need for health care reform in the last year and just dump them all on the legislators’ desks and claim, “We don’t need another report. We need health care for everyone.” For the first time since I heard that, I feel we may be reaching the point of no more reports and binders. Thanks to Occupy Wall Street, I believe real action for single payer may be within our grasp.

Recently, attention has been focused – and rightly so – on the Occupy Wall Street movement as it continues to shine light on the simple reminder that it was Wall Street who caused the 2008 financial collapse. But lurking not far behind is the natural extension in the discussion for “We are the 99 percent.” The cry heard today from the Wall Street patriots in the streets can easily turn from “people, not profits” to “patients, not profits.” There’s little doubt that the continuing debate on health care will take center stage AGAIN during the 2012 presidential campaign. The Affordable Health Care for America Act will be under assault by many for various reasons. Only this time, the Occupy Wall Street Movement may finally empower people to no longer settle for corporate controlled heath insurance solutions.

Perhaps no one draws the parallels between Occupy Wall Street and the need for an Occupy Health Insurers better than Wendell Potter. The former CIGNA executive-turned-whistleblower remains one of the most vigilant and articulate spokespersons to call the health insurance companies what they are: corporations who value profits over the health of the people of our nation. In a recent column Potter points out but one of the horrific practices of the health insurance companies: the selling of “junk” insurance coverage to millions of Americans in 2014. He concludes that article by saying:

As I write this, the insurance industry and its corporate allies are lobbying the Obama administration to grant limited-benefit plans permanent waivers from that provision. If the White House caves in to their demands, millions of low-wage earners will be forced to buy junk coverage on January 1, 2014. That’s the date all of us will have to buy coverage from a private insurer if we’re not eligible for a public plan like Medicare or Medicaid. If you don’t want to be forced to buy junk, send the White House a message. Now.

As Senator Bernie Sanders (I-VT) always reminds us, the United States remains the only industrialized nation in the world with a for-profit health care system. The need to push the Affordable Health Care Act to do more should remain a primary goal for all of us in 2012. No more three-ring binders…no more studies…no more lobbyists. We need to move to single payer. The Occupy Wall Street movement has unleashed the simple reminder for all of us: We the People have a tremendous amount of power to bring positive change to our financial and social institutions. With Super Committees looking to put Medicare and Medicaid on the cutting block, we simply cannot take our eyes off the real prize: single payer in the United States. To help maintain a focus on this issue, we offer samplings of recent articles or blogs that continue to keep the issue of single payer in the spotlight.

Dave Zweifel, editor emeritus of The Capital Times in Madison, Wisconsin, wrote that the solution to health care is simple: single payer. It’s such an obvious answer staring us all in the face that we have missed the forest through the trees.

This summer, Rochester, Minnesota, physician Mark Liebow, wrote a column for Physicians For A National Health Program urging Minnesota to follow Vermont’s lead and become the second state to pass single payer legislation. With DFL Governor Mark Dayton’s hands tied with a Republican-controlled state house and senate, the task remains a big one. But with the momentum gained from Occupy Wall Street, the old rules may no longer apply.

Health Care-Now is an excellent blog that provides information and resources on what you can do and where activities that promote single payer are planned. Bookmark this wonderful site and keep it handy when you need information on the “who, what, where, when, why and how” of health care reform.

No more reports, no more binders, no more studies. As Jim Wallis, founder of Sojourners Magazine said so eloquently back in 2009:

So let us have the moral dialogue and debate. Let’s take the best of who we are, the greatest parts of our tradition and use that to lead the way. The misinformation, falsehoods and outright lies that many are now circulating obscure the moral and religious core of this debate: that millions of people are suffering in an inequitable and inefficient health care system, and that too many powerful people are profiting from that broken system in defiance of the common good.

Occupy the health care for profit industry now in existence? Impossible you say?  After what we’ve witnessed the last few weeks, I’m no longer so sure.

Republicans point out that Medicare has tried to control costs centrally for decades with terrible results. They argue that a decentralized process of trial and error will work better, as long as the underlying incentives are right. They suggest replacing the fee-for-service with a premium support system. Seniors would select from a menu of insurance plans. Their consumer choices would drive a continual, bottom-up process of innovation. Providers could use local knowledge to meet specific circumstances.

* Medicare has lower overhead costs – approximately 5% for Medicare and 8.9% for private insurance. Once you factor profits, commissions, and premium taxes in, private insurance overhead goes up to 16.7%

* Medicare has controlled costs better than the private system. From 1970 to 2000, annual per enrollee costs went up 9.7% for Medicare and 11.1% for private insurance.

* Medicare Advantage plans, which are Medicare plans run by private insurers, cost the government 14% more than traditional government-provided Medicare

Why is this brilliant? Most ordinary pundits (those without space on the Times op-ed page) use the more common device of citing studies on both sides to show that there is support for both sides. But this is rookie league stuff. Brooks shows how it’s really done: just dismiss the entire attempt at empirical support with a wave of the hand, which lets you get back to “philosophy.” It’s much easier to know nothing than to know something.

But for this question, we don’t even need to go to the academic studies. We already have a health care system where people “select from a menu of insurance plans. Their consumer choices would drive a continual, bottom-up process of innovation. Providers could use local knowledge to meet specific circumstances.” It’s called the individual market, there are tens of millions of people in it, and it’s a complete failure. It leaves tens of millions of people uninsured, and to those who are insured, it delivers mediocre care at high costs. The only way you can ignore this fact is by pretending that facts don’t matter…

Um, David, there’s this country to north of us. It’s called Canada. They have a national health insurance system that covers everybody. And that system . . . Whom am I kidding? When you don’t have respect for facts, a few more aren’t going to change your mind.