(Horray for the nurses… And horray for a health care proposal that actually helps real working people! : ) – promoted by atdleft)

State Senator Sheila Kuehl yesterday re-introduced SB 840, her historic bill to move California to a “Medicare for All” health plan.  These kinds of SinglePayer health systems exist in every other developed nation in the world and are the only solution to the problems of access and cost of healthcare-problems caused by the wasteful private insurance bureaucracy.  Schwarzenegger vetoed the bill last year; this year he has promised to bring about healthcare reform and, when SB 840 lands on his desk again, he will have to consider if he is serious about his promise.

The California Nurses Association is the lead sponsor of SB 840, and a strong advocate of H.R.676, the national bill sponsored by Rep. John Conyers.  Nurses are motivated to fight for SinglePayer healthcare because so much of their time is spent fighting insurance corporations on behalf of their patients.  A nurse explains below….

Brought to you by the National Nurses Organizing Committee/California Nurses Association as we organize to make 2007 the Year of SinglePayer Healthcare.

Deborah Burger, RN, President of the California Nurses Association explains why nurses support SinglePayer in her testimony from the SB840 hearing yesterday, and why nurses will continue to fight for it every way they know how, including in a new advertising campaign.  We are at a historic moment in this movement, and California’s progress should provide hope to people across the country that we can cure this healthcare tragedy that is touching so many of us.

Registered Nurses use what’s called the “nursing process” to assess and treat patients.  We are educated to collect objective and subjective data, synthesize that data, and apply our judgment skills to help patients survive both their health problems and the treatment for those problems.  When we ask a patient how they are doing, what their favorite flower is or if they have children, we are not just being pleasant.  We are noting their skin tone, their speech, their pain level, their emotional response and many other indicators of their overall condition.  We are doing a comprehensive assessment of their health, although it may not be apparent to them.

Applying the nursing process to the ailing patient called California, we note symptoms of less access, increasing costs and a less healthy population leading to a diagnosis of healthcare crisis.

The good news is that there is a cure.  It is called SB 840 authored by Senator Sheila Kuehl.

It is probably no accident that the same legislator who fought to protect patients in hospitals and authored California’s historic nurse-to-patient ratios is also the author of SB 840, a SinglePayer, or “Medicare for All” system, where everyone is in, benefits are better, and costs are controlled.  We are very proud, as the principal sponsor of SB 840, to work again with Senator Kuehl.

The California Nurses Association and nurses around the country have  fought insurance companies, HMO’s, patient-care gatekeepers, hospital corporate chains, and everyone else who wants to put us in the position of letting our patients suffer from inadequate care. 

We know one very important fact: a SinglePayer system is the only cure for the current market-based system that has turned our health into a commodity subjected to “insurance products” that cost more and deliver less every year.

Treating these symptoms with more insurance would be like treating a patient with lung cancer or asthma with cigarette smoke.

A SinglePayer plan is the only way to assure genuinely universal care – not universal insurance with a windfall to health plans.

It is the only way to avoid a multi-tiered system, assure better, more comprehensive benefits, and guarantee patient choice of physician and hospital. 

It is the only effective way to adequately control premium and out-of-pocket costs and to end an insurance bureaucracy that wastes 30% of every healthcare dollar because it quite simply takes the insurance middle man out of the middle.

Therefore, CNA RNs are proud to stand with Senator Kuehl, other advocates and other legislators who will fight for the right cure for California’s health crisis.

If you want to join the fight for SinglePayer healthcare, sign up with SinglePayer.com, a project of the National Nurses Organizing Committee.  You can share your story about surviving the healthcare industry here, and start contacting media here.

(Shiela Kuehl is back, this ought to be interesting. – promoted by dday)

While Schwarzenegger’s healthcare plan languishes, California State Senator Sheila Kuehl will re-introduce her historic SinglePayer bill tomorrow.  It landed on Arnold’s desk last year and it will land there again–except this year he has promised to finally deal with the healthcare crisis.  Elsewhere, Republican and Democratic Governors are fighting Washington for their healthcare dollars, indicative of the national consensus for reform, but the Cook County Board of Supervisors drops the ball by fighting for their patronage jobs instead.  Meanwhile bloggers and editorialists check in on the state of healthcare reform in this country.

Brought to you by the National Nurses Organizing Committee as we organize to make 2007 the Year of SinglePayer Healthcare.

The battle for genuine healthcare reform is shifting now to California, where tomorrow Sen. Sheila Kuehl, hero of the SinglePayer movement, will re-introduce SB840, the nation’s signature SinglePayer bill.  It was vetoed by Arnold Schwarzenegger last year even though, as Senator Kuehl remarks, 

“SB 840 represents the gold standard for healthcare reform-the plan that will move California into healthcare solvency and security, not only for ourselves, but for the generations that will follow.”

The time for this bill is now:

Universal health care is possible.  Polls are showing that 60% of Californians now support a publicly funded universal health care system over the current system.  The conversation is steering away from whether we need to enact such a system in favor of how.  SB 840, the California Universal Healthcare Act, is a very important step forward in this because it answers the how.

Here’s how it works:

SB 840 is the only proposal that establishes universal, affordable, comprehensive health insurance for all Californians and that guarantees the right of each patient to choose his or her own doctor.  SB 840 replaces insurance companies with a state-wide trust fund that collects premiums paid by employers and individuals, sharing the responsibility for funding.  This reduces the administrative portion of California’s healthcare costs from nearly 30% to under 10%.  With everyone in one risk pool, no one is denied coverage for a so-called pre-existing condition. Consumers are free to change jobs; start a business; go to school or start a family without losing the doctors they trust.

So what about Arnold?  He has promised to bring universal, affordable coverage to California.  His mask briefly slipped off this weekend, when he made a slightly different promise in reference to the insurance companies:  “You must let everyone make their profits.”

Nonetheless, he hopes to make his legacy with healthcare reform.  His problem is that his plan won’t work.  Legally, he won’t be able to mandate employers provide their workers with health care.  Practically, he won’t be able to mandate individuals to purchase insurance they can’t afford.  And financially, the numbers don’t add up. 

It’s interesting to note that Mitt Romney’s plan in Massachusetts is also facing severe problem; he over-promised and under-delivered.  Unfortunately for Schwarzenegger, RomneyCare was his inspiration.  Here’s one of many articles detailing the Massachusetts mess, in which a conservative activist notes “RomneyCare is in the intensive care unit, soon to be wheeled into hospice.” 

This kind of uncertainly is leading to legislative trouble for Schwrazenegger.  He has yet to find a sponsor for his bill, much of the state is still sitting on the sidelines watch the drama unfold, and it is entirely unclear that his plan will even get out of committee.  Moreover, the California Nurses Association today unveils a wide-ranging media campaign to shape public opinion about the Governor’s plan, and spread the word that it is an insurance industry giveaway barely pretending to address the problems of cost and access of healthcare.  The San Francisco Chronicle writes:

The ads are strong and striking in a political arena that so far has treated the governor’s health care plan with kid gloves.
Although a lot of interest groups have expressed doubts about parts of the governor’s plan, there’s been little public criticism. Many groups, like the Service Employees International Union and the California Chamber of Commerce, have said that they are withholding judgment until the legislative process takes it course and at least, so far, are willing to work with the administration. The nurses do not appear interested in being part of that effort.
“We will never be a part of any plan that benefits only the big insurance companies,” said Chuck Idelson, association spokesman.

Schwarzenegger will have to choose between affordable, universal coverage under the SinglePayer system proposed by Senator Kuehl or breaking his promise of healthcare reform.  The movement for SinglePayer healthcare runs through the California legislature for the next few months.

Around the country, despite the strong public mood for an increase in healthcare, much of our public health system is in deep peril.  A bi-partisan coalition of Governors is raising a red flag about underfunding of the State Children’s Health Insurance Program, a stop-gap program which helps millions of families.

The program in question, the State Children’s Health Insurance Program, covers more than six million children in families that have too much income to qualify for Medicaid but not enough to buy private insurance.

Karen A. Smigielski, a spokeswoman for the Minnesota Department of Human Services, said her state had a federal allocation of $48.6 million this year, would run out of money in July and would need $15 million to continue the program as it is.

In a separate letter to Congress, the National Governors Association criticized a Bush administration proposal to cut federal Medicaid payments to public hospitals and nursing homes. The White House says the changes are needed to ensure the “fiscal integrity” of Medicaid and to curb “excessive payments.”

It is extraordinary that Republican governors are forcing a confrontation with a Republican President over a healthcare issue.  Are we seeing healthcare emerge as the new third rail of American politics-the issue that no candidate dares to fail on?

If so, Cook County Board President Todd Stroger in Chicago hasn’t gotten the message.  Many of Cook County’s 5.2 million residents rely on their public health system, which is among the best in the nation.  Not for long, if Stroger has his way-his new budget would cut nearly 10% of the system’s nurses and close half the clinics, while maintaing 400 high-paid patronage jobs doled out by the politicians.

The County’s RNs, represented by the National Nurses Organizing Committee, promises a furious fight-back.  Watch this one.

Finally, the Agonist notes why market-based health insurance simply CANNOT work,  USA Today notes that we are approaching a choice: change the employer-based system of healthcare or junk it, and an insurance corporation executive argues that it’s not his bloated industry driving costs in our healthcare system-it’s those darn, sick patients!

If you want to join the fight for single-payer healthcare, sign up with SinglePayer.com, a project of the National Nurses Organizing Committee.  You can share your story about surviving the healthcare industry here, and start contacting media here.

( – promoted by Brian Leubitz)

John Edwards looked a “Medicare for All” health system in the eye, and he blinked.  The tragedy is that there are strong political arguments to be made that a SinglePayer or Medicare for All plan is the smartest politically and will have the most appeal among the public.  Today’s SinglePayer Update will review those arguments, and knock down the claim that SinglePayer healthcare is a political non-starter.  In fact, it seems much more realistic than the incredibly complicated mix-and-match plans that have now been offered by Hillary Clinton, John Edwards, Arnold Schwarzenegger, and Mitt Romney.

Brought to you by the National Nurses Organizing Committee as we organize to make 2007 the Year of SinglePayer Healthcare.

To the data:

1. The public is ready for a significant healthcare reform
Much of my data comes from the Center for American Progress, including this article that suggests that 89% of Americans are looking for fundamental change to the healthcare system.  In this context, the plans we have seen fail woefully.  Edwards, for instance, joins Schwarzenegger in demanding an “employer” mandate and joins Romney in demanding an “individual” mandate.  This is not a fundamental change to our healthcare system–this is much, much more of the same.

2. There is broad public support for significantly expanding Medicare
There is a bunch of date to support this.  The same Center for American Progress article cites an October, 2006 Kaiser Family Foundation/ABC News/USA Today poll finding that, by a 56% to 40% majority, Americans want to replace the current, employer-based system with a universal, governmet-run healthcare plan “like Medicare,” for instance.  It seems that the public is far ahead of our leaders on this-and that the first Presidential candidate, Democratic or Republican, to realize this will have the wind at their backs.

3. People hate the health insurance companies-they will make a wonderful target in explaining a SinglePayer or Medicare for All system.
Much of the evidence I have on this is anecdotal and comes from my bosses, California’s Registered Nurses, telling me about conversation they have with patients and their families in care settings.  I have never heard anyone say anything good  about insurance companies.  Edwards, and Clinton/Romney/Schwrazenegger, all do their darnedest to carve out a role for and protect the profits of private insurance companies, thereby limiting their ability to attack them.  We saw how well this worked for Clinton back in ’93; she couldn’t attack the big insurers, but they attacked her with their Harry & Louise ads.

4. SinglePayer or Medicare for All is the only solution that will work
Look-the U.S. spends the most money of any nation on healthcare, but our healthcare system is only the 37th best in the world.  Every other developed nation uses a system based on SinglePayer, and it has been proven to work time and time again.  You can’t really argue this point, at least not with facts.  For more background, why don’t you check out Physicians for a National Health Program?  Specifically, I don’t think that Edwards’ idea of “regional health markets,” where Medicare would be sold alongside private insurance plans will work, and I turn to Jonathan Cohn:

Still, such an evolution is hardly guaranteed. One big concern is the possibility of adverse selection–the idea that the public program would continually attract sicker beneficiaries, thereby tilting its beneficiary pool in a way that forces it to jack up premiums, thereby scaring away healthier people, further driving up the premiums. If that sort of cycle begins, the public program would eventually lose most of its beneficiaries–not because it was deficient but because, in effect, it was too good. Edwards’s plan theoretically has protections against this: Regulation of private insurers would, supposedly, keep them from selecting out the best risks. But that’s easier said than done and it’s an open question whether the protections would work

5. It is in the interest of businesses to support a move to a SinglePayer system
The healthcare mess is decimating our manufacturing sector and is a major competitive disadvantage for America.  Only a few business leaders are now on the record in favor of SinglePayer, but that will change, as it is in their interest to get themselves OUT of the business of arranging healthcare for their employees.  By contrast, check out this quote on the Edwards plan from a spokeswoman for a small business lobbying group: “Health care mandates are a nonstarter for our members.”

6. Half-hearted reforms hurt progress 
Edwards and his supporters argued that his plan might ultimately pave the way to single-payer by allowing people with his proposals that people “buy in” to Medicare.  I think it is just as likely that the American people will become convinced that our healthcare systems are un-reformable, because his plan won’t work, and we will have missed an opportunity for reform.

7. Rhetorically-which plan will have more effect with voters?

a. “I support an employer mandate, individual mandate, regional health markets with Medicare buy-in, buttressed by tax code changes and tighter insurance regulations.”
b. “It is time to modernize Medicare and extend it to ALL Americans.”

We’re still waiting from Giuliani, Clark, Obama and others-who will be the first Presidential candidate to support SinglePayer?

If you want to join the fight for single-payer healthcare, sign up with SinglePayer.com, a project of the National Nurses Organizing Committee.  You can share your story about surviving the healthcare industry here, and start contacting media here.

Arnold and Bush are going to war over healthcare.  Arnold wants the feds to give him almost $4 billion more to subsidize his insurance industry; Bush wants to cut the money he spends on healthcare.  Any true healthcare reform will have to deal with the cost problem caused by unnecessary private insurance companies.  The other big news in the healthcare cauldron also comes from California, where the state’s top HMO regulator is threatening to investigate insurance thugs who toss sick people off their rolls without cause.  Elsewhere, Massachusetts’ half-hearted reform attempts will force consumers who already have health insurance to buy more plans, New Jersey and New York are coming up with new proposals, New Orleans finally figures out how to get some healthcare, and single-payer activists around the country make their case.

Brought to you by the National Nurses Organizing Committee as we organize to make 2007 the Year of Single-Payer Healthcare.

The Los Angeles Times carries the story of the coming war between Schwarzenegger and Bush over healthcare dollars.  Remember that each is committed to protecting the profits of the private health insurers-and each needs to find more healthcare dollars for their own political purposes.  In Arnold’s case, he’s looking for about $4 billion a year to subsidize the state’s insurance industry.  Not gonna happen:

“That’s a big number on an annual basis,” said Sen. Judd Gregg of New Hampshire, the ranking Republican on the Senate Budget Committee. “California hasn’t yet passed a law [implementing the governor’s plan], but when they do, I would think people are going to take a deep breath.”

The cost of helping states fund their health plans has already attracted the attention of budget cutters because it is complicating President Bush’s stated goal of balancing the federal budget in five years. In his new budget, scheduled to go to Congress on Monday, Bush is expected to call for a substantial slowdown in federal healthcare spending. Some of the cuts Bush proposes could affect programs Schwarzenegger is counting on to help pay for his plan, such as Medicaid.

Yep, this healthcare reform is stuck between Iraq and a hard place.  Remember that a main benefit of single-payer health systems is that they allow for genuine cost savings by rooting out the 34% waste committed by private insurers.

Those private insurers must feel extraordinarily vulnerable right now.  A growing public outcry has targeted, in addition to their profits, their “recissions.”  Recission is industry-speak for revoking the insurance of sick people.  Is California about to crack down on them?

The state’s top HMO regulator said Monday that health plans should be required to get outside review before dropping a policyholder, a dramatic step up in oversight that probably would face stiff challenges from the industry.

Cindy Ehnes, director of the Department of Managed Health Care, said she hadn’t yet developed details on how such a requirement would work. But she said any external input – possibly by the department or some independent panel – could significantly enhance policyholders’ safeguards against the loss of coverage.

“It is clear to me that we have to have some independent oversight,” Ehnes said.

Chris Ohman, president of the California Assn. of Health Plans, contended that regulations to limit rescissions would not be necessary if the governor’s plan were adopted and insurers had to sell to everyone.

“We see pursuing new regulation of rescission as a contradiction of the governor’s overall policy direction,” he said.

Elsewhere, Massachusetts’ plan mandating individuals purchase private insurance is forcing patients to sign up for all sorts of supplemental policies-much to the evil glee of the companies selling the product.

More than 200,000 people with health insurance would have to buy additional coverage to meet proposed minimum standards under the state’s new health insurance law, according to a count completed by insurers yesterday.
Most of the individuals do not have coverage for prescription drugs or have drug coverage that is more restrictive than the minimum proposed by the state board implementing the law. The Commonwealth Health Insurance Connector board is scheduled to vote on the standards in March. Individuals would face a fine of about $200 next year and more in future years, if they do not have insurance that meets the standards.
“It’s very troubling,” said Richard Lord, president of Associated Industries of Massachusetts and a member of the Connector board. “The new law was about expanding access for people without any health insurance. I don’t think we should be forcing people who do have some coverage to spend more.”

Iin California, the state GOP demonstrates that it doesn’t have any idea what to do about health access problems, while New Orleans has figured out that if we can’t have a healthcare system, perhaps we can have a healthcare fair. 

I’m not sure what New York Governor Eliot Spitzer is up to; he says he’ll cut Medicaid to pay for more health insurance.  Sounds like he’s re-shuffling around healthcare dollars.  In New Jersey, the individual mandate-aka, the “forced market” for insurance companies-is coming down the turnpike, at least until everyone realize it doesn’t work. 

Meanwhile, Congressman Pete Stark makes clear that Bush’s healthcare proposals will only make the situation much worse and have no political future, Congresswoman Tammy Baldwin pushes a bill to allow states to use federal money to experiment with single-payer health systems, Connecticut could save $1 billion if it tried a single-payer system, and blogger Terri Emerick at My Left Wing gives us an overview of HR 676, the “Medicare for All” single-payer bill that was recently re-introduced.

( – promoted by Brian Leubitz)

Sadly, we’re reminded again today by Newsweek why we need to fight for single-payer healthcare.  They tell of the struggle of Nathan Wilkes and his very ill son to get medical coverage through his insurer.  Hint: the insurance industry didn’t do the right thing.  But the Wilkes are not alone-today we also learn how Insurance Corporation Gangsters practice unfair, retroactive cancellation of coverage for sick people, and their latest scam for elderly Medicare supplemental insurance patients. Nationally, experts dismiss the Bush plan as a giveaway to insurers, Hillary Clinton tells us why she SHOULD support single-payer, Schwarzencare is running into problems, and more voices around the country call for genuine healthcare reform.

Brought to you by the National Nurses Organizing Committee as we organize to make 2007 the Year of Single-Payer Healthcare.

If you aren’t committed to putting these sociopath insurance corporations out of business and replacing them with the kind of single-payer health plan that works in every other industrialized nation, read this Newsweek profile:

But it wasn’t just folks in Washington who were upset. Nathan J. Wilkes of Greenwood Village, Colo., was so worried about the possible effects of Bush’s proposal on his ability to provide coverage for his chronically ill son that he decided to travel to the capital to make some noise. A computer network security expert who earns over $100,000, Wilkes works for a private firm outside of Denver which fits into the large-group insurance category and is allowed to shop around for different providers each year. But when his son Thomas, born with severe hemophilia, developed a resistance to treatment at age 1, Wilkes’s claims soared; his company’s insurance provider, Wilkes says, soon began hiking premiums 40 to 55 percent each year, and introduced a lifetime cap of $1 million for all employees and their families-including Thomas. Soon, Wilkes says, no other insurance companies would offer to cover the company.

His father will soon have no choice but to go bankrupt.  He had health insurance-and it worked so long as nobody got sick.

A USA Today story suggests that he’s lucky he got what care he did.  The new trend for insurance corporations is to comb the applications of their sick customers and try to retroactively deny them care for mistakes. 

Their stories illustrate a little-recognized fact about insurance purchased by individuals: Even after being approved, policyholders can see their coverage amended to exclude certain medical conditions or revoked entirely, sometimes long after the policies are issued.
“Insurers love to market the promise, ‘We’ll take care of you. Just sign here,’ ” says Karen Pollitz of the Institute for Health Care Research and Policy at Georgetown University. “Then there is all this opportunity for the insurer not to keep the promise, and you don’t find out until it’s too late.”…
Attorney William Shernoff, who represents Wheeler, Seals and some other patients involved in the California legal disputes, says the forms are designed to be unclear, giving insurers cover to cancel almost any policy.
“I would venture to say that anyone who fills one out would make a mistake,” Shernoff says. “They have compound questions, confusing questions, ambiguous questions. There’s no place to answer ‘I don’t remember’ or ‘I don’t know.’ ”

And the San Francisco Chronicle reports one more health insurance abuse-bullying or deceiving elderly customers into buying Medicare supplemental insurance that’s a total rip-off.

So are we any closer to getting rid of them?  The Washington Post tells us that Bush’s plan will only make things work by allowing corporations selling junk insurance to get their hooks deeper into America:

But experts said yesterday that (Bush’s plan) would tilt that field toward a kind of health insurance that Bush has long favored — a high-deductible plan paired with a special tax-exempt health savings account, or HSA.

This is ideological warfare on the everyday consumer.  Patients, like Mr. Wilkes, would have high out-of-pocket expenses and caps that would quickly burn through their HSA’s.  Insurance companies would get more customers, and would find it easier to get rid of those pesky sick ones.  More risk for individuals and more profits for insurers.

Elsewhere, Hillary Clinton tells us why she SHOULD support single-payer healthcare, in an unusual speech making clear that it’s affordable and her supporters like it.

Let’s pick up story.  Campaigning in Iowa, Hillary says she favors universal healthcare, but on the plan:

“I’m not ready to be specific until I hear from people,” she said

Oooookay.  Then:

… Clinton asked at one point for a show of hands from the audience to see how many would prefer employer-based health insurance, how many would prefer a system in which individuals purchased insurance, with help from the government if necessary, and how many would prefer a system modeled on Medicare.
The audience overwhelmingly favored moving toward a Medicare-like system for all Americans. But Clinton, recalling the famous “Harry and Louise” ads run by opponents of her early-’90s health-care plan, warned that until there is greater political consensus, the same kind of attacks could sink any new efforts to provide universal coverage.

Jill Lawrence from USA Today continues the story:

“That really makes a lot of sense, because you could get the costs down,” Clinton said. But she said such a plan, like her 1994 proposal, is vulnerable to attacks that it is “government-run health care.” Clinton said she will work this year to cover all uninsured children and seek input from voters before proposing larger changes. “This time we’re going to build the consensus first,” she said.

So she used to oppose Medicare for All before she supported it?  Or is it the other way around?

Meanwhile, in California, Schwarzenegger’s ineffective, complicated plan is running into political problems and it looks the state will face a referendum of one kind or another in 2008. 

The Minneapolis Star-Tribune has some advice for him: the patchwork plans are too complicated to pass and will never work: 

Yet the closer you look at these ambitious plans, the more you see they are mere patchworks. In Massachusetts, which will require most residents to buy private insurance, policies are coming on the market with higher prices and less coverage than experts hoped. Economist and columnist Paul Krugman points out that the Schwarzenegger plan will require big new state bureaucracies to regulate insurance companies and police individual behavior. As for the president’s plan, even the White House admits it will cover only 5 million of the nation’s 46 million uninsured; that’s because it relies on tax deductions, which aren’t much use to low-income families who represent the bulk of the uninsured population

The biggest argument against a single-payer system is it’s “politically unrealistic” in a free-market society like the United States. We think that gives too little credit to the impatience and common sense of American voters. But then we won’t know until a leader has the courage to find out.

Elsewhere, columnists in New York and California call for single-payer healthcare, Blogger Over My Med Body reminds us it will be cheaper, and the Smirking Chimp asks who’s afraid of SinglePayer.

( – promoted by Brian Leubitz)

Two days after George Bush’s State of the Union healthcare proposals, the bid for reform hits rocky shoals in the states and continues to split America’s business community.  California sees problems with the employer mandate, Massachusetts sees trouble with its individual mandate, and New York sees further threats to its already-declining public health system.  Meanwhile there are rumbles from the national businesses sector over the  broken healthcare system, and editorialists continue to look at Bush’s proposals.

Brought to you by the National Nurses Organizing Committee as we organize to make 2007 the Year of Single-Payer Healthcare.
 

Before we get into the details, go look at the genius cartoon by Tom Tomorrow.

The politics of healthcare remains turbulent in the states.  The Los Angeles Times picks up on two big problems with Schwarzenegger’s proposals. 

Whatever the governor eventually comes up with – and whether he calls it a tax or a fee – could wind up becoming the target of a lawsuit, said Allan Zaremberg, president of the California Chamber of Commerce.

Business groups such as Wal-Mart could challenge any proposed healthcare benefit mandate under the federal law. For their part, Republican lawmakers and anti-tax activists are likely to sue if the payroll levy does not receive what they contend is a constitutionally required two-thirds vote in the (California) state Legislature.

“This is the dilemma that any solution faces in California,”( Chamber of Commerce President Allan) Zaremberg said.

His “employer mandate,” requiring companies to cover workers, might well be illegal thanks to a recent Maryland court ruling, and he also faces trouble from conservatives over its funding.

In Massachusetts, the “individual mandate” (mandating individuals buy insruance) is also running into problems.  When Governor Mitt Romney announced his plans, he predicted state residents could buy basic insurance for about $200 per month.  Whoops!  The insurance industry rolled up their sleeves and came back with a plan to charge residents nearly double that, $380 per month.  The Globe reports:

But yesterday, Eric Linzer, vice president of the Massachusetts Association of Health Plans, said that the board was being “overly prescriptive” and that it would be “a huge challenge” for insurers to meet all requirements and keep costs down.

Which is likely true: there is no way that private insurance companies can keep costs down.  They lose money paying people like Mr. Lizner to dial up the press, and paying politicians like Romney to pass laws favorable to them-all told about one-third of care dollars are lost when insurers get their mitts on them (no pun intended).  And the costs will only rise rapidly once the insurance industry has the market locked up.  That’s why real solutions can’t depend on private insurers.

So we have two main ideas floating around the states to rescue our current insurance-based system: employer or individual mandates, each of which force patients into becoming insurance customers.  Each is running into problems. 

Meanwhile, reports from New York State remind us of how urgently we need to continue pressing for single-payer health insurance.

The New York Times analyses Bush’s State of the Union proposals and finds it would strip New York City public hospitals of 7% of their operating budget, or $350 million a year.  The upshot:

“We would have to do a wholesale dismantling of our ambulatory care system and scale down our emergency departments,” said Alan D. Aviles, president of the Health and Hospitals Corporation.

The poor would even less access to medical services.  This comes on top of recent plans to close public hospitals around the state, which has inspired some very brave healthcare workers to embark on a 320-mile protest march.

Given all this, you would think New York Governor Eliot Spitzer would look into the single-payer solution already working in every other industrialized nation?  Blogger Rick Lippen says no:

Mr Spitzer like these other big state Govs have proposed complex plans that 1) are not fully understood because they are overly complex 2)in some cases require federal and state legislation to implement and 3)take too damn long to achieve desperately needed health care for all in their states now. Mostly however they all seem to buy into continuing their relationships with Big Insurance whose overhead costs and greed are bankrupting the health care system- to put aside Big PhRMA/BIO for the moment.

While the states continue to fumble for answers, the business community is increasingly split over whether it really wants healthcare reform.  If they want really things to change for the better, they could help the drive for single-payer healthcare right along.

News today that Ford Motor Company-possibly the world’s largest health care provider-lost $12.7 Billion dollars this past quarter should force them to think about it. 

The right wing of the business community is increasingly forced into ridiculous positions like this one: our healthcare problem is caused because Americans use too much of it (never mind every indicator shows the quality of healthcare received in this country is scandalously low.)

But there may be signs that the business community is coming around.  Alan Webber argues that if we can truly solve the health care problem, it would unleash a transformative entrepreneurialism like nothing this nation has ever seen.  And Milt Freudenheim of the New York Times tests the wind and finds some businesspeople ready to look for real solutions:

“There is more frustration and less acceptance of the current system among employers than we have ever seen in my 30 years in this field,” said Helen Darling, president of the National Business Group on Health, an organization made up of large companies.

So let’s find a real solution.

Of course many of the biggest stakeholders like things just the way they are:

Jack O. Bovender, chief executive of HCA, the hospital company, said that a patchwork of state plans would not work. For one thing, he said, state regulation of health care financing had often been overturned by lawsuits filed under the federal Employee Retirement Income Security Act, which the courts have said was intended to let big companies set up uniform health benefits across the country, rather than navigate state-by-state requirements.

Finally, the San Jose Mercury News is looking beyond Bush and wants our next crop of Presidential wanna-be’s to lay our their plans:

Since it’s becoming increasingly clear that the president isn’t going to be able to lead a national debate on health care for his remaining years in office, it’s time for the 2008 presidential contenders to start offering ideas.
They can begin by talking about their reaction to what innovative states — including California and Massachusetts — are doing to provide potential national models for health care reform.

( – promoted by Brian Leubitz)

Why’d he do it? Why did George Bush propose a series of initiatives widely acknowledged as “dead on arrival”?  Obviously to distract from his foreign policy woes-but his proposals also serve as an attempt to recast the healthcare debates in terms favorable to the insurance industry while gumming up the drive for genuine healthcare reform that our nation so badly needs.  We’ll take a look at the evidence and the unfriendly reaction this plan received around the nation.

Brought to you by the National Nurses Organizing Committee as we organize to make 2007 the Year of Single-Payer Healthcare.

The Wall St. Journal, long cheerleaders for America’s current healthcare system, give us our first clues to the political thinking behind Bush’s proposals: 

Most Americans can see for themselves that the current employer-based system is breaking down, as more companies pass along the rising cost of their insurance to employees (in higher co-pays and deductibles). Yet the system remains opaque and frustrating because of the underlying tax bias for businesses instead of individuals.

This status quo won’t hold, and the political race is going to be between those who want to move to a more genuine market and consumer-based health care, and those who want to move toward Canada, Europe and more government control. The Bush plan ought to jump start that debate.

And there we have it.  Bush is throwing out rhetorical head feints not as serious policy but in order to shift the debate in ways that encourage a “more of the same” health policy, specifically a “killer” market for health insurance companies.  This is a what the California Nurses Association calls “market-centered” as opposed to “patient-centered” approaches. 

It is cheering, or course, that the Journal (and apparently Bush) fear an imminent move to the patient-centered systems, known as single-payer healthcare, that are working in Canada and Europe.  Single-payer healthcare is cheaper and more effective–just what Americans are looking for in their health reform.

And, by the way, WSJ, it’s not the tax biases that make the system opaque and frustrating; it’s the system that does that.

In a different column in the Journal (reg. req’d.), editorialist Alan Murray lays it right out: “Still, the Bush plan is a big idea that will help frame the health care debate for the future.” 

This PR campaign is apparently coordinated on a wide basis.  Media Matters notes that all the administration’s cheerleaders are reading from the same talking points.

In line with the goals of this re-framing campaign, Ruth Marcus in a widely-discussed Washington Post article attacks healthcare reform advocates for daring to not buy into Bush’s reframing of the healthcare debate.  She writes:

And, yes, it’s fair to argue that a more comprehensive approach — Sen. Ron Wyden (D-Ore.) has proposed one — is needed.
But Democrats — if they care more about addressing health-care needs than scoring political points — ought to be finding ways to improve and build on the Bush proposal, not condemning and mischaracterizing it. Given that nothing’s going to pass without Democratic approval, what’s the risk in engaging in the discussion?

Bloggers Brad Delong and Kevin Sullivan should probably both get stipends this week from the Post for fact-checking the article.

While Bush’s proposals recast the long-term debate, insurance companies are short-term beneficiaries.  According to the AP

President Bush’s State of the Union proposal aimed at increasing health coverage for uninsured Americans might provide a boost to managed care providers such as UnitedHealth Group Inc., Wellpoint Inc. and others looking to increase their enrollment numbers.

At first, it would appear that hospital companies would benefit from Bush’s proposal because fewer uninsured would mean less bad debt. However, Bush is proposing to take money from funds given to hospitals that serve large numbers of Medicare and Medicaid patients and give it to states to bankroll their plans to expand health insurance. Plus, analysts said that if Bush’s proposal pushes people into plans with less generous coverage, more individuals will struggle to pay their hospitals bills.

And Maggie Fox at Reuters notes:

President George W. Bush’s proposed health-insurance plan will raise taxes while helping only a few people, and may eviscerate existing coverage, critics said on Wednesday.

The National Association of Health Underwriters and America’s Health Insurance Plans welcomed Bush’s ideas.

One result of this giveaway to the insurance industry? A possible hospital vs. insurance war? Proof that the coalition propping up our broken healthcare system might be finally breaking down.

Elsewhere, an LA Times reporter calls Bush’s proposal “dead-on arrival,”
a California blogger coins the term “cancer tax,” CNN Money suggests that it’s really a plan to soak the sick, while editorialists across the country took issue with the plan.  I like the article in the Des Moines Register:

The president’s plan represents a piece-meal approach to a national problem demanding a comprehensive solution. What ails this country’s health-care system can’t be fixed by fiddling with the tax code.

This country needs a national approach to health care that offers basic coverage to everyone, perhaps similar to Medicare for seniors.

The Seattle Post Intelligencer chimed in:

There are no guarantees of universal coverage and states are unlikely to receive additional funds to implement this plan, which will likely face opposition in Congress.

Bush would also like to tax employer-based health care plans starting in 2009, and offer a $4,500 tax deduction to individuals who purchase their own insurance plans for $3,000. Assuming, of course, that they earn enough for the tax deduction to matter.

Employer-based health care no longer works for the country, offering fewer options and costing more to employers and employees alike. But taxing those who are happy with their plans hardly seems right.

(ERISA lives – promoted by blogswarm)

All these post-Hillary, post-Arnold health reform plans force people to sign up with big insurance companies, either individually or through their jobs–an “employer mandate” or “individual mandate.”  But a court ruling yesterday in Maryland might kill the employer mandate strategy. 

Meaning that the big solution being offered for our system-wide health disaster?  Forcing individuals to buy some junk health insurance.  All hat, no cattle there–helping along the movement towards single-payer health care.

In other single-payer news, the coalitions for health care reform keep growing, as part of a rapidly evolving health care/political landscape, and even conservative editorialists see single-payer in the offing–despite the best efforts of insurers, certain other corporations, and their allies to block it.  Activists from coast-to-coast are pressing their case, while the rich have a new kind of health care available: the four-star hospital spa.

Brought to you by the National Nurses Organizing Committee as we organize to make 2007 the Year of Single-Payer Healthcare.

Dan Walters in the Sacramento Bee analyses the effect of the Maryland ruling on Schwarzenegger’s new health care plan.  He writes:

A federal appeals court this week struck an indirect but potentially fatal blow to one of the most controversial pieces of Gov. Arnold Schwarzenegger’s comprehensive health insurance plan — requiring employers to either provide coverage to workers or pay 4 percent of their payrolls into a state insurance purchase pool.
By a 2-1 vote, a panel of the 4th District Court of Appeals ruled that Maryland’s play-or-pay health insurance law, specifically aimed at retailing giant Wal-Mart, violates a federal law governing employers’ group health plans. It upheld a lower court’s finding that invalidated “any and all state laws insofar as they may now or hereafter relate to any employee benefit plan.”
If upheld by the U.S. Supreme Court, the ruling bolsters a simmering contention among California employers that Schwarzenegger’s version of the employer mandate also would run afoul of the federal Employee Retirement Income Security Act. ERISA was enacted in 1974 to allow companies to establish health care plans for their workers that applied in multiple states, without having to tailor plans to individual states and to protect the rights of workers under such plans.

In other words, the employer mandate might be completely off the table, unless passed at the federal level, which seems unlikely. 

Wall St. Journal reporters Deborah Solomon and David Wessel have been putting their neandrathal editorial board to shame lately with smart stories about the nation’s on-going health care debate.  Today they look at the pressure for change–much of it coming from the business community:

Thrusting the long-running issue to the fore are political and economic forces that have been building for years but are given new force by political events. Not only have the Democrats taken over Congress, but state political leaders, including Republicans such as California Gov. Arnold Schwarzenegger, are moving on their own to change the system. And U.S. companies increasingly complain that the current employer-paid insurance system puts some of them at a disadvantage — either globally or vis-a-vis firms that won’t provide insurance. …
The heightened political focus on the issue reflects pressure from two sources. One is voters’ anxieties, both about the cost of care and about the risk of losing insurance for reasons such as changing jobs. “A member of Congress goes home and two issues come up every time you get together with folks: One of them is Iraq, and one of them is health care,” says Sen. Wyden, an Oregon Democrat. “A lot of people who have coverage think they’re one rate hike away from losing their coverage.”
The other is an ever-louder complaint from U.S. businesses that they can’t compete in a global economy when companies from other countries don’t have to pay for health care. Deere & Co. Chief Executive Robert Lane told Congress last year that failure to act could result in a “limiting of covered services, loss of employer-provided health care … and even a loss of American jobs, both in the manufacturing and service sectors.”

The key element here is that businesses MUST start cutting the cost of their health care-and only a single-payer system, doing away with insurance company middlemen, can contain costs.

Even the right-wing Washington Times realizes that if the health care problems don’t magically go away in the next two years, then single-payer health care becomes a much more realistic possibility.

A few years down the road, January 2007 could be remembered as a turning point in American health care…. a serious drive for a statist, single-payer universal health-care program for the country could well be unavoidable. 

This is an extraordinary admission for such a right-wing newspaper.

Of course, some groups-such as the national coalition the New York Times describes here-seem pretty happy with today’s health care system, but want a few tweaks here and there.  And the health insurance industry will continue to advocate for tinkering within the current system.  Their take in the Wall St. Journal (reg. req’d)  on Arnoldcare (and other mandated purchases):

“There’s no question (the plan) broadens the opportunity for the industry.”

Meanwhile, Zenei Cortez, RN, Vice President of the California Nurses Association explains why the insurance industry loves both employer and individual mandates-and why patients won’t:

  With no controls on skyrocketing premiums, comprehensive plans will be out of reach for millions of Californians. Most could end up with junk insurance, with up to $10,000 in out-of-pocket payments for any medical care, meaning the average person will likely pay for all his or her medical expenses on top of the premiums. And many may forgo any medical care, risking worse health problems and greater health costs down the road.

Elsewhere, blogger Blake at Critical Condition puts the need for single-payer within a larger public health debate, Jonathon Cohn in the New Republic’s blog Plank finds one possible Presidential candidate calling for single-payer health care, and blogger Anna points out how much better Canadian-style health care is for patients than the US approach.

For a picture of how the other one percent lives, the Chicago Sun-Times writes about the latest trend in high-end hotel spas: medical treatments now available.

(We’ll all be digging into this health care proposal, I’ll have some thoughts later today. Here’s some expert opinion and analysis. – promoted by dday)

This diary brought to you by the National Nurses Organizing Committee as we work to make 2007 the Year of Single-Payer Healthcare.

The fight over nsingle-payer health care in this nation is now being fought in California, which last year passed a single-payer health program only to see Governor Schwarzenegger veto it.

Yesterday, hobbled by his own broken leg, Governor Schwarzenegger presented his own alternative plan via video conference to a packed Sacramento room containing representatives of just about every group that cares about health care reform.  While Washington dithers over “nibbling around the edges” reforms, Schwarzenegger’s proposals instantly become the most-talked about plan for wide-ranging changes in the health care arena since Hillarycare-and like Hillarycare, Schwarzencare is almost too complicated to talk about, with dozens of planks hoping to shore up rather than fundamentally reform our healthcare system.

Also like Hillarycare, Schwarzencare is ambitious;  Schwarzenegger himself said repeatedly, he hopes to build a model, “that can be shared with the rest of the nation,” and finally make himself relevant on a substantive instead of symbolic level.  Unfortunately, his plan will make much worse our already-broken health care system, so patient advocates must watch it closeley.

But first, let’s give Governor Schwarzenegger credit for making a serious effort to pass legislation dealing with the health care crisis.  He said he would, and he did.  He gets an “A” for attendance.  Let’s also give him credit for including illegal immigrants in his plan.  (Does it really require employers of illegal immigrants to get health insurance for them? Wow.)

That said: his plan is terrible. 
• It is a huge boon to insurance companies (his big donors). 
• It is a recipe for financial ruin for most people who get sick.
• It does nothing to address the crushing problem of health care costs.
• It saps an already-underfunded public health system.
• Funding mechanisms seem vague or unrealistic.
• It is a cycnical attempt to derail genuine health care reform-and provide states around the country with a blueprint for also derailing it.

Advocates for a genuine national health care plan should engage with this on an intellectual level, and point out its failings.  Schwarzenegger is arguing for much much more of the same, and if you love our current health care model you’ll love his renovation plans.  Fortunately most people DON’T love our health care system, and this plan provides us the opportunity to advocate for real changes.

Let’s go to the details of the plan, which you might have seen covered everywhere. The New York Times seemed to like it and gives a blow-by-blow account of many of its planks.  The LA Times was not so fond, noting

But many leading consumer advocates, academics and business leaders said they feared that the governor’s proposal was inadequately financed and would shift more responsibility for healthcare to families while unintentionally encouraging businesses to drop or downgrade the coverage they now offer.

The Orange County Register looks at some of the divisions on the right, while the San Jose Mercury News notes a bruising battle in the offing.  Dozens of articles covered it, many of which can be found at Rough & Tumble.

So what exactly does the plan do?  It’s the kitchen sink theory of legislating-everything is in there, in an attempt to placate enough opponents.  The big question is, if a piece or two falls out of the mix, will the whole plan fall apart?

Schwarzenegger included:
1. An individual mandate-meaning every person is required to purchase health insurance.  This is a “forced market” for the insurance industry of 4 to 5 million new consumers.  OF COURSE-the cheapest insurance will be “junk insurance” with high deductible and tough caps, meaning if you get sick you’ll still go bankrupt, but only after the insurance companies have picked some meat off your carcass.
2. An employer mandate–all businesses with more than 10 people must give their employees coverage or pay 4% of revenue into a state pool to help cover them.  Advocates of single-payer have long argued that our illogical employer-based system puts American businesses at a competitive disadvantage with other nations.  See: GM.
3. An end to insurance companies refusing to cover people based on age or occupation.  Of course they can charge still them exorbitant rates based on age or occupation, so this feel-good plank is largely irrelevant.
4. A requirement that insurance companies put 85% of their dollars into patient care.  So a) they are guaranteed a profit of 15% and b) it is very easy to manipulate what a patient care expense is, so we have another largely irrelevant plank–but one that hints at the big problem with our “market-based medicine,” which is huge profits for an unnecessary middleman, the insurance industry.
5. Some shell games moving money around among hospitals, doctors, and Medi-cal.
6. Partially funded by cutting the public health budget by $2 billion.  So we’re taking patient care dollars and running them through an insurance industry machine that will lop off between 15% and 30%?
7. Coverage for illegal immigrants.

Much more to discuss as this behemoth sails towards the legislature.

(Two in One: Support clean money AND protest Doolittle! Edited slightly for space – promoted by SFBrianCL)

Does the culture of corruption have a cure? California’s nurses think so. 

This week, nurses are in the process of turning in 600,000 signatures to registrars around the state to qualify an initiative for “Clean Money Elections,” also known as public financing of elections.  Think of it as the Jack Abramoff anti-dote, or as the comprehensive campaign finance reform that voters are desperately looking for.  You can read about it here and here. More in the extended…

Why nurses?  For years nurses have watched patients suffer while the deep-pocketed healthcare corporations convince the legislature to block reform of our broken healthcare system.  Nurses are patient advocates, from the bedside to the ballot box.

Why Clean Money Elections?  The system is working well already in Arizona, Maine, and Connecticut.  It enjoys bi-partisan support, has stood up to multiple court challenges, and has allowed everyday Americans—nurses, teachers, firefighters, women, ethnic minorities, healthcare activists—to run for office and win, instead of the parade of millionaires we’ve become used to. 

It’s a simple cure: if candidates don’t beg corporations for money, they can’t be bought.  Simple, but powerful, as we believe it has the potential to remake the political landscape in the Golden State, and reverberate across the nation.

Make no mistake, this will be a tough election.  Our Clean Money Elections initiative sharply reduces the influence of lobbyists and corporations on our political system, and they will fight back to protect what they view as theirs.

You can help two ways.  One, visit our online home and let us know what you think.  Sign up to help!

Or, if you’re in Sacramento, come to our first public protest of the campaign next Monday.  Dick Cheney will be in town to raise money for John Doolittle.  You may have heard of this Congressman?  He’s taken money from both Jack Abramoff, and from Brent Wilkes, the un-indicted co-conspirator in Duke Cunningham case.  Oh, and John’s fundraiser is his wife Julie, meaning that 15% of everything he raises goes straight into the family checking account.  Nice work if you can get it. 

Come join us at the Sacramento Hyatt (1209 L Street) at 10:30 am.  Questions, email [email protected]

Full disclosure: I am, clearly, a political organizer with the California Nurses Association…