Is the public option that some have deemed the sword we should all fall on in the healthcare debate little more than fool’s gold?

In the wake of the now widely touted New York Times poll this weekend that showed 85 percent of Americans believe our health care system should be fundamentally changed or completely rebuilt and that people are even willing to pay more in taxes to get that kind of system,  the next question ought to be why are Democrats and some liberal constituency groups willing to settle for so little?

From the news pages to the blogs, some progressive activists are counting up the votes and what can be done to persuade 12 recalcitrant Senators and a number of insurance industry fans in the House to vote for a “robust” public option.  

But is this really where we should be drawing the line?

One of those not willing to enlist apparently is Robert Kuttner, co-editor of the American Prospect, who wrote Monday

The public option is a not-very-good second best–because our leading liberal politicians lack the nerve to embrace the one reform that simultaneously solves the problem of cost, quality, and universal inclusion. The policy that dare not speak its name is of course comprehensive national health insurance, or Medicare-for-All.

Kuttner also identifies the central problems with the public option that its most passionate advocates have yet to explain how they will avoid:

Basically, it leaves the two worst aspects of the system intact. First, private insurers will continue to dominate. Second, most people will continue to get their insurance through their employers. Given these two bedrock realities, there is no way that the bill can make serious inroads on cost without cutting back on care.

and further:

a mixed system with a public option effectively invites the most expensive and hard-to-treat people to opt for the public plan, while private insurers will seek to insure the young and the healthy. This is a familiar problem known as adverse selection. The private insurers will then smugly point out that the public plan is less “efficient,” when in fact it simply will have a more costly population. The only way to avoid this problem is to have everyone in the same universal plan–what’s otherwise known as a single-payer plan.

Even the “robust” public option, assuming it is not gutted in the heated rush to accommodate the healthcare industry and pass a “bipartisan” bill, will almost certainly be burdened by these shortcomings.

Will the availability of a public plan genuinely stop private insurers from engaging in adverse selection?

Anyone familiar with the marketing techniques the insurers use now will know they have a hundred ways and more to weed out sicker, more costly customers, even with the toughest requirements prohibiting exclusion of patients with pre-existing conditions.

Nothing now proposed in Congress is likely to change these marketing practices.

Will the public option really stop insurance companies from price gouging? The theory we’re told is that the cheaper public plan will force the private companies to lower costs to compete. The reality is likely to be far different.

With the added requirement of an individual mandate, forcing everyone not covered now to buy insurance, many, especially those who are younger, and healthier, will opt for the barebones minimum plans the insurers will be sure to offer as a lure.

But without effective cost controls, the huge out of pocket costs will discourage even the healthiest people from actually using their insurance. And, in the event of an accident or unexpected illness, even greater financial distress looms when they find out all the services their skeletal plans don’t cover or the limitations in the fine print.

Meanwhile, the public plan likely to have a disproportionate number of sicker enrollees and unable to compete in market costs with the multi-billion dollar private corporations could easily face the choice of bankruptcy or, as Kuttner suggests, massive cost cutting in the form of rationing care. To see the future of the public plan, look at what is happening with many public hospitals and clinics today.

Finally, there’s the issue almost no one talks about. Insurance companies denying medical treatment, referrals to specialists, or diagnostic procedures they don’t want to pay for. Will the availability of a public plan prompt the private insurers to start authorizing claims they now deny?

If there’s a message to be drawn from the Times‘ poll, it is that Americans know our system is broken, and they want real change. They want reform that solves the crisis. They want a healthcare system that doesn’t leave them at the mercy of the private insurers, being forced to choose between house payments or going to the doctor. They want to be able to choose their care provider, or keep the one they have. They want coverage they won’t lose if they are unemployed.

And they won’t get that with any of the plans now being touted as politically viable.

One other lesson of the Times‘ poll. If President Obama, who once famously identified himself as an advocate of single payer, and the Democratic leadership were fighting for single payer as hard as they are for limited reform, they would have the overwhelming support of the public.

What’s the alternative for progressives? How about, let’s fight for the reform we need, not just one that might pass, no matter how ineffective the solution it offers.  

The tradition of brave and proud nurse activism for guaranteed healthcare on the single-payer model continued today thanks to Janice Webb, RN, and her nurse intervention at  the convention of the health insurance industry in San Diego, AHIP.  They’re the lobbyists for the insurance giants who make money by denying care to the very patients that Janice cares for at UC-San Diego Medical Center.

As nurses last month shook up the Senate Finance Committee, which led to an important meeting with Senate power broker Max Baucus’ office this week, Nurse Webb took her protest to directly challenge those who are at the main cog in our broken and dysfunctional health care system.  

With thousands of well-paid insurance executives around her waiting to hear from Jeb Bush and Howard Dean, Janice marched up to the stage at the San Diego Convention, where  the moderator was droning on about how hard AHIP is working to find healtcare solutions — meaning legislation that will protect their position at the center of power over our health and the profits they make from the pain and suffering of patients.

Taking the mike, Janice held up a copy of an $11 billion dollar check, Janice then declared, to a mix of cheers and boos, “Nurses have the solution.  You all need to get out of healthcare.  We took up a collection and want to present this check to you to go away so we can finally institute a humane single-payer system for this nation…everybody in, nobody out!”

Of course it did not last long.  Burly security men rushed the stage, grabbed Janice and a companion, and hustled them off.  Hysterical AHIP security guards angrily denounced Janice, and demanded her arrest.  

Instead, the police officers smiled, asked Janice if she had any warrants out, and started to describe the healthcare cutbacks they’re facing due to SDPD’s trouble with affording ever-rising insurance premiums, and escorted her outside  where she was given a raucous welcome from a crowd of nurses, teachers, patients, doctors, and progressive democrats.

Taking the mike again–this time to the cheers of the crowd, Janice said, “They refused my check of course, but they’ll take every bit of money my patients can come up with.  Insurance corporations, nurses and patients want you out of our lives!  How many lives ruined by these corporate executives?  How long will Washington let them deny care, delay care, cancel policies, buy off Washington policies, and masquerade their marketing plans as healthcare reform?  Forcing people to subsidize insurers is NOT healthcare reform.”

Janice was followed by Jeffrey Gordon, a Physicians for a National Health Program member, who brought along a half-dozen of his patients who have been bankrupted or sickened by their insurance companies. You probably saw the report today from PNHP how unpayable medical bills, and income lost as a result of illness, now account for a shocking 62 percent of personal bankruptcies, a number that is rising. Too bad the healthcare reform bills now being framed in the Senate won’t solve that problem — in fact, it will likely make it worse by forcing more people to buy insurance without effective cost controls for ever rising premiums and out of pocket costs.

Gordon told the crowd, “As I was driving here I knew I was in the right place because there’s a whole flock of corporate jets lined up right over there.  We’re here to tell AHIP that it’s time to get rid of their jets.”  He added, “The power of those people across the streets keep the people in Washington from talking about the real problems in healthcare in this nation.  And if you don’t make the right diagnosis there is not cure–which is to get rid of the health insurance industry.”

Jim Gothe, a board member of the California Teachers Association followed Gordon’s point, saying “the bad news is that they’re paying for this conventino with money from students, teachers, retiress.  What sense does that make?  Students are the future of this state!…CTA believes healthcare is a human right for all people.”  The local CTA rep, Kathy Rallings continued his point saying, “My one-year-old son had open heart surgery when he was 3 months old.  You know what that means?  He has a preexisting condition FOREVER.  That means his life will be spent following healthcare…not his dreams.”

It’s not too late.  We will get single-payer in this country because we cannot care for all our patients while also subsidizing AHIP.  Help it along.  Tell Max Baucus that he should still hold a hearing on single-payer, or co-sponsor one with the health committee to provide a real side by side comparison with the plans they are proposing, so the American people can judge for themselves which approach will really produce a reform plan that covers everyone, improves quality of care, and includes genuine cost controls — and gets the hands of AHIP off our necks once and for all.

Single payer activists from coast to coast have done a great job getting the message to Congress, but we have to keep it up. Please Fax Baucus and other committee chairs today.  Healthcare is too important to let Washington get wrong.

Pics  

Today’s meeting of the nation’s leading single payer activists with Sen. Max Baucus was historic, and a recognition of the power of the tens of thousands of nurses, doctors, and grassroots activists across the country who have been turning up the heat on the policy makers in Washington.

Make no mistake – your voices are being heard. And, the protests and pressure will continue.

As Rose Ann DeMoro, executive director of the California Nurses Association/National Nurses Organizing Committee, told Baucus, “there is a groundswell” across the country that will continue to press for single payer reform, and Baucus and other policy makers in Washington “are going to get to know us very well.”  In a later press conference, DeMoro blasted the conventional wisdom that single payer is not politically viable. “Is it politically viable to let people die and suffer from a lack of political will?” Noting the fight for women’s suffrage and the civil rights movement, she emphasized, “we’re going to have to turn up the heat. Women did not get the right to vote by voting on it.”

Today’s gripping meeting was in itself an important part of that campaign, with leaders of the CNA/NNOC, Physicians for a National Health Program, and Sen. Bernie Sanders, author of a single payer bill in the Senate, S 703, making a forceful, unfiltered case to one of the top power brokers in the Senate, Max Baucus, for single payer as the only reform likely to actually fix our broken healthcare system and effectively control costs.  A couple of photos from the press conference afterwards are here.

For the first time, Baucus, who has been deluged with protests inside his Senate Finance Committee which has been in the forefront of drafting legislation and in town hall meetings at home in Montana, was apologetic. “I made a mistake,” he said, “I should have left it (single payer) on the table, front and center with everything else.”

Baucus talked about his own positive experiences in Canada where he inspected the Canadian healthcare system first hand, “I was very impressed,” during the healthcare debate in the early 1990s, noting the contrast between a Montana hospital which has an “entire floor” of people devoted to billing, and other administrative paper work, and a nearby Canadian hospital which does it all “in one room.”

He agreed to use the power of his office to have charges dropped against the Baucus 13, nurses, doctors, and activists arrested for raising their voices in the committee hearings.

While Baucus continued to aver that single payer can not pass the legislature, the nurses and doctors pressed him to:

•              Hold a hearing in which the merits of single payer can be contrasted with the plans now rapidly advancing in the Senate. While Baucus said the tight timeline made that very difficult, Sanders noted that Sen. Chris Dodd is considering a health committee hearing on single payer, which Baucus could co-sponsor. Baucus said, “let me think about it.”

•              Have the Congressional Budget Office score, do a financial analysis, of single payer legislation in addition to other health bills it scores.

•              Support legislation to allow federal waivers for individual states to enact single payer systems as national role models (another Sanders bill).

•              Assist in arranging a similar meeting between single payer leaders and President Obama.

Ultimately, Baucus threw the ball back to the President, citing the demand of the President to Congress to have a bill on his desk by October. “He wants a big win on healthcare reform,” Baucus said.

But the rush to adopt a flawed bill would hardly serve the Senate or the President well, DeMoro noted. “The President would be putting himself in a very bad position. We don’t want that to happen.”

One after one, the other participants made compelling cases for single payer. Dr. Marcia Angell, former editor of the New England Journal of Medicine, noted that only single payer can achieve effective cost controls. The alternatives being considered are “all unaffordable and unsustainable. Why pour more money into a dysfunctional system.”

PNHP co-founder Dr. David Himmelstein said  “the decision should be made on what’s going to work.” He cited the Massachusetts law, where he lives, which is considered a model for both the Baucus proposal and the pending Kennedy bill. The bill is rapidly “fraying,” said Himmelstein. Some 28,000 state residents are about to be cut off of subsidized coverage because the state can’t afford it, and new studies show conditions for many state residents back to where they were before the bill was passed with inadequate or no coverage, and medical bills they can’t pay.

Geri Jenkins, RN, Co-President of CNA/NNOC, said “we need evidence based policy,” and all the evidence shows that single payer is the best way to contain costs, improve quality, and achieve universality.

PNHP President Dr. Oliver Fein cited the study last year reported in the Annals of Internal Medicine that 59 percent of physicians support a single-payer type system, and a new study showing doctors waste three to four weeks a year on paperwork that could be spent caring for patients.

Sanders later praised the efforts of nurses, doctors and activists who have made single payer an inescapable part of the public discourse. “When you have the nurses and physicians saying the current system is not working,” scores of people saying health care is a right  and single payer the most cost effective approach, we’re seeing this grassroots movement growing and gaining momentum.

If you agree, why don’t you fax Max Baucus, maybe a couple times, and let him know that we need real healthcare reform, not lobbyist-driven pablum and nonsense statements.

Follow the national nurses blog and twitter feed!

"It would be nice if something made sense for a change." – Alice, from Alice in Wonderland.

Perhaps we live in an alternative universe.

One in which two thirds of Americans want the government to guarantee healthcare for everyone, while the policy makers in Washington labor to craft a reform plan that caters first to the threats and demands of the insurance industry and the minority voices on Capitol Hill.

One in which the Senate Finance Committee plays congenial host to the insurance industry, the drug companies, and right wing think tanks and it's chairman Max Baucus can proclaim all options are on the table while slamming the door on the nurses and doctors — and arresting them when they speak out.   Why? For advocating the most comprehensive, cost effective reform of all, a single-payer/Medicare for all approach.

One in which single payer is considered off the table inside the rarified airs of Congress, but when President Obama ventures into a town hall meeting with regular folks, the first question he is asked is:

"Why have they taken single-payer off the plate?" asked one woman in the audience to great applause. "And why is Senator Baucus on the Finance Committee discussing health care when he has received so much money from the pharmaceutical companies? Isn't it a conflict of interest?"

Watch here:

http://www.youtube.com/watch?v=Q6d45duX_WU

And one in which Drew Altman, CEO of the Kaiser Family Foundation can ponder today about how baffling it is that the "experts" — presumably people like him who was given a seat at the table by Baucus — sees the world so differently than the vast majority of Americans struggling to survive a cruel, inefficient, and inhumane healthcare system:

"Experts believe the health care system is full of unnecessary care and troubling variations in care, … The public has a very different world view: People think that underservice is a bigger problem than overservice. They want relief from the problems they are having now paying for health care and health insurance in very tough economic times. … And many are worried that they will not be able to afford their health insurance in the future or may lose it altogether."

The "experts" say the problem is too much "unnecessary" care. The public thinks too many people are being denied care they need.

The experts think costs are so high because consumers don't have enough "skin in the game" (i.e., we like to go to the doctor, get invasive tests, and endure long waits for care and high out of pocket costs). The public thinks the reason is "because drug and insurance companies make too much money."

The experts think health care information technology is a panacea to improve quality and cut costs. The public thinks it will probably increase costs (the Congressional Budget Office happens to agree) and are concerned about the privacy of their medical records.

The experts think we must have comparative research to limit future costs. The public thinks "insurers should pay even if their doctor recommends a treatment that has not been proven to be more effective than a cheaper one." (Imagine, getting the care you actually paid your insurance company to provide, what a concept)

Either we need to get more in tune with the self-appointed experts, or they ought to listen to what the people actually think. Or perhaps, as Marcia Angell, former editor of the New England Journal of Medicine told the Great Falls Tribune in Baucus' home state of Montana, "Single-payer is simply considered not realistic for a politician. The medical industrial complex just won't permit it."

But at a price, to our health, to the well being and financial security of American families, and to the cause of health care reform.

Or as Michael Lighty, national policy director for the California Nurses Association/National Nurses Organizing Committee put it:

"Hillary Clinton and President Clinton took single payer off the table much more dramatically than Baucus has, yet everyone draws the lesson that because of 1994 we can't do single-payer. They should draw a different lesson from the Clinton-era struggle. The lesson is we didn't fix the problem. We didn't offer a solution that works and so no one wanted it. That's the risk they run this time going down the road they're currently going. They won't solve the problem, it'll ruin their credibility even if it's enacted, and that's much greater risk."

With Max Baucus’ Senate Finance Committee continuing to shut out the voices of single payer advocates while rolling out the red carpet for the insurance giants and other health care corporations, five more were arrested today and dozens of other nurses stood before the committee in a dramatic silent protest.

Today’s action — the second in a week that led to 8 arrests — coincided with the anniversary of the birth of Nightingale. It also marked the kickoff of two days of actions by nurses from around the country who are pressing for a legislative agenda for quality nursing care and a single standard of quality care for all.

Here’s AP.  Here’s a link to a photo of the nurses being arrested.  The Wash Times covers it here and here’s Patricia Murphy.

Action!  Fax Mad Max and tell him single-payer deserves a voice in the debate!

All told, this is the most media coverage single-payer healthcare has received since SiCKO was released in 2007-ironic given that it comes from an attempt by Washington insiders to keep America’s caregivers out and stifle discussion of their healthcare plan.

“What a disgrace that RNs and physicians are shut out and arrested while the insurance industry is given a seat at the table. We would expect that from the Bush administration, not in the time the Obama administration,” said NNOC/CNA Executive Director Rose Ann DeMoro. “The Baucus Committee can arrest nurses, but they can not silence the voices of RNs who will continue to speak from their hearts on behalf of their patients who want and deserve real reform.”

Standing up in the audience and speaking before she was arrested, Sue Cannon RN, said, “don’t guarantee drug profits, guarantee health care. We’re entrusted to care for our patients, and we can’t do that without single payer, guaranteed healthcare. We need no more Blue Crosses and double crosses.”

“In honor of Florence Nightingale, patients need access to healthcare. We need to protect our patients, we need single payer now,” said NNOC/CNA Board member DeAnn McEwen, RN.

Also raising their voices and accepting arrest were Steve Fenichel and Judy Dasovich, two physician members of the Physicians for a National Health Program, and  Jerry Call of PNHP and Health Care Now.

Some 40 other RNs staged a silent protest — standing before the committee in red nursing scrubs and turning their backs to show signs reading “Nurses and Patients First. Stop AHIP. Pass Single Payer.” AHIP, America’s Health Insurance Plans, is the private insurance industry lobby arm that is given a regular voice by the Baucus Committee, which is in the forefront of discussion on a health plan.

The protests, before a sea of reporters and cameras marked a continuing escalation of voices of protest —  last week eight were arrested — in an ongoing spectacle in which the committee has bent over backwards to accommodate the insurers, the drug companies, the coalitions representing America’s largest corporate interests, even the rightwing Heritage Foundation and conservative think tanks. All while excluding the doctors and nurses who favor single payer and have the most direct, hands on experience with our failed insurance based healthcare system.

Noting the shut out, Call said to the committee, “60 percent of the chairs at the table should be for single payer advocates because 60 percent of the people want single payer” reform.

That’s a system in which choice of doctor and other providers is guaranteed, with comprehensive benefits, real cost controls, and an end to insurance industry denials of care.

And more pix here.

1. Karen Ignani, the president of the insurance industry trade lobby, America's Health Insurance Plans, offers to end the outrageous industry practice of charging women more than men for health coverage, and is widely praised for the concession.

Even though the reprehensible practice of institutionalized gender bias should have been considered out of bounds long ago. The industry was not even shamed by the report last fall by the National Women's Law Center that insurers charged 40-year-old women up to 48 percent more than men of the same age for the same coverage.

And even though the “offer” remains conditional. AHIP continues to demand conditions in health reform proposals now before Congress, including a requirement that all Americans currently without coverage be forced to buy private insurance, and that Congress block any inclusion of a public alternative to private insurance. Now they've increased the ante and want federal pre-emption of state-based public protection regulations on insurers, such as requirements in a number of states that private insurers must cover such critical basics as maternity care or preventive cancer screenings.

Instead of gushing over AHIP for being conciliatory, it's time to demand the insurance industry stop holding our health hostage and end all discriminatory practices, including all higher charges based on age, health status, where you live, or other factors that serve as a financial barrier to access to care.

There can be no more excuses, no more exceptions, no more impediments to care. If anything, the widespread disparities and offensive pricing practices that characterize the private system  are a major reason why so many Americans are fed up with the insurance based system and want real reform, such as a single payer/Medicare for all approach.

Which brings us to Ignani's other remarkable comment yesterday.

2. “We are not asking people to trust us, we are asking people to trust government.”

Yes, Ignani apparently actually said that. And it was presumably not just a Freudian slip. In other words, a tacit admission that the insurance industry has no credibility with the public — and given their legacy of practices such as charging women more because they are of childbearing age they don't deserve it — and have to rely on the government to give them any trust with the public.

Yes, that government. The same government the insurance industry regularly excoriates “government-run” healthcare and is doing its best to provoke fear and loathing of even a public option alternative to private insurance.

3. The very Republicans who the Democratic leadership is bending over backwards to accommodate on the final form of a health plan are making it increasingly clear that they will work to defeat the legislation no matter what it is.

As now reported, GOP strategist Frank Lutz has put together a 26-page memo for the

Republican leadership on how to revive the Harry and Louise ads from 1994 to campaign against the new bill, using almost identical language from that campaign.

So a bill is being crafted to please the Republicans who will oppose it anyway on the assumption that they can use the specter of “government-run” health care, the same government Karen Ignani admits the public trusts more than her insurance industry, to regain political power at the polls.

Which, finally brings us to:

4. The Senate Finance Committee and its chair Sen. Max Baucus held a hearing Tuesday shutting out doctors and nurses and community supporters of single payer while providing a red carpet to AHIP, the Chamber of Commerce, Blue Cross Blue Shield, America's Health Insurance Plans, Business Roundtable, and the rightwing Heritage Foundation.

No wonder that some finally turned to peaceful protest and subjecting themselves to arrest.

The irony or tragedy, if you prefer, is that by trying to silence the voices of doctors, nurses and advocates of broader reform the Democratic leaders have, as the Washington Times put it, “forfeit a crucial bargaining chip with Republicans, meaning that any compromise with Republicans would swing too far toward the center or right” and leave themselves in a position of crafting even more unworkable reform.

“That's why it looks like (Democrats) are moving so far to the Republican position because they're not even considering the advantages” of a single-payer system, said Michael Lighty, national policy director of the California Nurses Association/National Nurses Organizing Committee.

After years of shredding our public health infrastructure and ill advised minimal preparations for the next great global pandemic, the spreading swine flu threat is at last making clear the very real calamity that could be just around the corner. If not today, surely from the next epidemic.

The Obama administration’s call on Congress Tuesday to allocate $1.5 billion for combating the virus is a start, but only a start. The RNs of the National Nurses Organizing Committee and California Nurses Association (NNOC/CNA) believe that far more is needed in federal action, in regulatory crackdown on insurance practices that potentially inhibit those who are infected from seeking help, and in global coordination.

From SARS to avian flu to the swine influenza, the only question has not been if, but when.

Three years ago, during the advent of an avian flu outbreak, in an article by Conn Hallinan and Carl Bloice in the national magazine of the National Nurses Organizing Committee, we warned that the “firewalls for stopping the next great pandemic are getting thinner.”

If the swine flu or the next pandemic has only the fatality of the 1918-1919 global influenza pandemic — 2.7 percent — it would have a catastrophic effect. That pandemic killed 675,000 Americans and anywhere from 50 to 100 million people at a time when the world’s population was less than a third what it is today, and when populations were far more isolated.

Obviously, there have been medical advances in the past 90 years. But on many other levels, conditions remain as precarious as ever.

In the U.S., public health services are often first on the chopping block when budgets are tight — such as the now evidently foolhardy decision of politicians to slash $870 million from the President’s economic stimulus bill that was allotted to fight pandemics.

And many politicians compete to see who can transfer more resources from the public setting into the pockets of private healthcare corporations — often while harvesting hefty campaign contributions from those same companies.

The result is a virtual decimation of many community clinics, especially in rural and medically underserved communities, and a starving of badly needed funds for public hospitals and services.

Over the past eight years especially, we’ve also seen a rash of hospital and emergency room closures, reductions in available hospital beds, and the type of equipment needed to fight pandemics. For example, in 2005, we noted, there were only 105,000 mechanical ventilators, between 75,000 and 80,000 of which are in constant use. Ventilators are particularly important if a pandemic takes on the characteristics of the 1918-1919 flu in which a major killer was acute respiratory distress syndrome.

Hospital and bed closures are all too often driven by the insatiable lust of healthcare industry corporations for greater profit that can be secured by relocating in wealthier communities or re-allocating resources to more profitable services, such as boutique clinics and surgery centers. Such is curse of our absurd reliance on the privatization of healthcare.

An immediate shift in priorities and thinking is needed, if not for swine flu, for the coming plague. Here’s the first call to action by the national nurses movement (link is a .pdf):

• Recruit and mobilize teams of scientists to create the appropriate effective vaccine for the virus.  

• Cease and desist any reductions in public health programs at federal, state and local levels. Lift any freezes on public health funding currently in place.

• Implement a moratorium on any closures of emergency rooms, layoffs of direct healthcare personnel, and reductions of hospital beds.

• Allocate funding for recruitment and retention of school nurses, public health nurses.

• Expand the network of community clinics, especially in medically underserved areas.

• Add thousands of additional ventilators/respirators, which are critically needed in the event of epidemics.

• Assure the availability of protective equipment for all healthcare personnel.

• Require all insurance companies to suspend or waive all out-of-pocket expenses, including co-pays, deductibles, or co-insurance that discourage individuals from seeking preventive care for early signs of infection.

On the international level, it’s apparent that the World Health Organization is overwhelmed. A global infrastructure similar to what is being discussed for the economic crisis should be formed and sanctioned, at least by the G20.  International cooperation and most importantly, transparency of data from all sources, health care facilities, governments, and individuals, is essential to identify the virus and track its patterns.  The global health community must have the authority to require systematic, uniformly collected information to be reported on influenza cases in order to start formulating an effective vaccine.

Within the U.S., we should learn the lessons of the 1918-1919 flu pandemic, one of which was the enormous mitigating effect on mortality of adequate nursing care. We need to rededicate our nation to expanding the supply of nurses and safe patient care in our hospitals and clinics, which is a central component of the healthcare safety net that is especially vital at times of public health crises.

Finally, in order to promote containment and convention, we must eliminate the greed-driven barriers to care based on ability to pay.

Recent reports have emphasized the growing number of Americans who are skipping routine medical screenings, exams, and general preventive care due to the skyrocketing co-pays, deductibles, and other use charges imposed by insurance companies.

Price gouging by the healthcare industry has already put tens of millions of families in healthcare jeopardy, especially in an economic crisis. At a time when untold numbers are already exposed to a dangerous virus, we need to be removing any barriers to medical care that would exacerbate the spread of contagion. We can not afford to wait.

The updated CNA/NNOC swine flu page is here.

In Canada, it took the dogged determination of one province, Saskatchewan, and a visionary leader Tommy Douglas, to pave the path to a national health care system, which they call Medicare.

For all the detractors of the Canadian system in the studios of Fox News and the board rooms of rightwing think tanks, consider this one note: In 2004, the Canadian Broadcasting Corporation conducted a national poll to select the greatest Canadian of all time. The winner in a landslide — Tommy Douglas. 

While the federal window remains open for reform, with two national single payer bills, John Conyers' HR 676 in the House and now Bernie Sanders'  S 703 in the Senate, many nurses, doctors, and health activists are turning to the states to lead as well.

It's worth recalling that Supreme Court Justice Louis Brandeis famously called states “the laboratories of democracy.” As columnist Froma Harrop has suggested, “being closer to the people and more attuned to the local culture, states are better equipped than the federal government to introduce new social policies. Innovations are usually first tried in the places most receptive to them.”

More than a half dozen U.S. states now are considering legislation to establish single payer systems, essentially an expanded and updated form of the U.S. Medicare system to cover everyone in their states.  Here's a roundup of some of the state bills:

California

The latest bill SB 810 passed its first legislative test Wednesday in the Senate Health Committee on a party line 7-4 vote before a room packed with nurses, doctors, medical students, California School Employees Association members, and healthcare activists.

In her lead testimony, Malinda Markowitz, RN, co-president of the California Nurses Association/National Nurses Organizing Committee noted that “nurses know insurance companies don't provide any value whatsoever in the delivery of medicine. Under SB 810, we would be free of their interference, their denial of care, their massive bureaucracy, and their waste of healthcare dollars.”

UC Irvine medical student Parker Duncan said that he did not want to “be in a world not doing what I was trained to do,” referring to the paperwork that is one of the expensive burdens that undermine the ability of the current system to deliver health care.

Twice this decade California's legislature passed earlier versions of SB 810 (SB 840 carried by now retired Sen. Sheila Kuehl), but the bills were vetoed by Gov. Arnold Schwarzenegger. State activists say they will continue to push single payer in California, even if they need to wait until the next governor, who won't be Schwarzenegger, is elected in 2010.

Colorado

House Bill 1273 by Fort Collins Democrat John Kefalas, passed its first vote in the state House April 6. The bill sets up a 23-member commission to design a universal health-insurance system.

“Our current health-care system is not well,” Kefalas said. “Our current health-care system is unsustainable, with the cost of health care and the numbers of the uninsured rising dramatically.”

Press reports note a state Blue Ribbon Commission on Health Care Reform two years ago studied single payer and found it was the only approach that saved money compared to what Coloradans now spent on healthcare.

Illinois

HB 311, the Healthcare for All Illinois Act, sponsored by Rep. Mary Flowers, had its first hearing in March. Though no votes have been taken yet, the new Gov. Pat Quinn is a long time supporter of single payer reform.

At an introductory press conference, Brenda Langford, Cook County RN, said that “Illinois can once again be a symbol of hope and progress for our nation. Nurses are tired of watching our patients suffer from denial of care and lack of access to coverage.  We see far too much of this at Cook County hospitals—and that’s why we support guaranteed healthcare through a single-payer system.”

Maine

LD 1365, sponsored by Brunswick Rep. Charles Priest, and co-sponsored from legislators from all over the state, had its first hearing April 13.

The hearing came just days after both houses of the Maine legislature passed resolutions calling on President Obama and Congress to enact federal single payer legislation. A poll this winter showed 52 percent of Maine physicians also favor single payer.

As Cathy Herlihy of the Maine State Nurses Association put it in a state forum featuring U.S. Senator Olympia Snowe, a single-payer system is the “the only solution,” she said. “We do not have time to wait. Our health should not be sacrificed for limited reforms.”

Pennsylvania

Two single payer bills are alive in the state, House Bill 1660, the “Family and Business Healthcare Security Act of 2009,” and Senate Bill 300.

Gov. Ed Rendell has said that if a single payer bill were to make it to his desk, he will sign it, reports Chuck Pennachio of Health Care for All Pennsylvania.

The state Democratic House Caucus is holding a public forum on the bill Friday, April 17 at 10 a.m. at the University of Pennsylvania campus in Philadelphia, featuring speakers from Physicians for a National Health Program, the Pennsylvania Association of Staff Nurses and Allied Professionals, and other single payer supporters..

The hearing comes on the heels of a resolution passed by the Philadelphia City Council calling for both state and federal lawmakers to establish a single-payer health system. 

Other states

Single payer bills are also on the docket in Minnesota, Missouri, and Washington.

Hundreds of people, nurses, doctors, medical students, grassroots activists, and California School Employees Association members gathered in downtown Los Angeles Monday to deliver an unequivocal message about the nature of the healthcare reform Americans so desperately need.

For those inside the tightly scripted White House Forum or anyone watching the live feed on line, that message was blacked out. Inside the pre-selected speakers kept within the accepted framework: we need reform, costs are out of control, Americans are hurting, and preventive care will solve all our problems ('fraid not). Unfortunately nothing proposed in the forum is likely to cure this crisis.

The “official forum” was so short on content, the Los Angeles Times was moved to note, that “the presentation was light on details. Universal coverage — health insurance for all Americans — was widely touted, but there was no discussion of how to achieve that goal.” 

In other words, the public forums amount to little more than, “window dressing,” as the Times quoted Deborah Burger, co-president of the California Nurses Association/National Nurses Organizing Committee.

Indeed all the real work is being done by a handful of Congress members. Even the White House is largely AWOL, writes Trudy Lieberman in the Columbia Journalism Review:

It looks more like Congress’s overhaul, and the word “overhaul” might be a stretch. The private insurance system looks alive and well; it will just have more people in it. The danger of leaving the details of reform up to Congress is that the special interests cozy with members have a good shot at getting what they want.”

What they want is individual mandate — forcing everyone to buy private insurance, a massive bailout for the insurance industry.

What they don't want is anything that will disrupt their comfortable profit making machine, the real reason why discussion of single payer, as in the Medicare for all bill, HR 676,  has been shut out of the debate.

The failure to include single payer as an option, despite its broad popular support among the American public, majority support among doctors and nurses, and an army of grassroots activists, means that all the pressure inside the hallowed halls of Congress is coming from the right. Not surprisingly, it means all the compromises and concessions will go to appease that crowd — the insurance industry and the right — as well. The result is that even the cherished goal of the liberal establishment, the more limited public plan alternative to private insurance, is greatly imperiled. 

Fortunately, those on the outside are not going away.

“We know there is a conscious attempt to stifle our voices,” said CNA/NNOC co-president Geri Jenkins said at the Los Angeles rally. “As a nurse who still works at the beside I see up front and personal what this fractured and dysfunctional system has done to our patients and the public. We need to get for the for-profit insurance industry out of the delivery of care in this country, so we can have a just and equal system with a single standard of care that everyone is entitled to.”

While California Gov. Arnold Schwarzenegger was inside trying to sell the nation on the type of reform he proposed in California which was rejected because of its call for forced insurance and its failure to rein in the insurance industry, the state's Lieutenant Gov. and former state insurance commissioner John Garamendi was outside with a very different message:

“As a former insurance commissioner, I know the insurance industry very well. They have but one purpose, the bottom line… They will manipulate the system so they do not have to pay” and spend one-third of every health care dollar on administrative costs “so they can deny claims and push people aside. It has to end, and it will end.”

How? “41 years ago we figured out how to solve this problem. Americans created a single payer, universal health care system that covers everyone who is over 65, allows you to choose your doctor and have a comprehensive benefit package. We know how to do it. All we have to do is take the 65, erase it, write in 0, and you send your premium to Medicare. That's change we can believe in and the change America needs.”

“We're here to send a message to the President” and the Congress “to put HR 676 on the table,”, said Reggie Cervantes, a 9/11 rescue worker whose own fight for healthcare was so well chronicled in Michael Moore's “SiCKO“. “I will not go silently into that good night.” Nor should any of us.