It's time to lay to rest the myth that spending billions on more high tech is the salvation for rising healthcare costs. Some people will peddle any notion to avoid addressing the best way to rein in costs, pushing the insurance companies out of the way with a single payer system.

It's become an article of faith that a national system of electronic medical records would produce huge savings.  President Obama made it a centerpiece of his healthcare plan during the campaign (as did Sen. John McCain), and has emphasized it repeatedly in legislation and speeches.

As a first step, the stimulus bill allotted $17 billion in incentives to prod doctors and hospitals to get on board during a five year period beginning in 2011, along with financial penalties if they don't.

The administration has relied in large part on a RAND study claiming savings of $80 billion a year through the nirvana of what Wall Street Journal reporter Anna Wilde Mathews caustically referred to as “whizbang computer systems.” The President cited the $80 billion figure again during the White House health-care summit last week. Or, as White House press secretary Robert Gibbs asserted, “The health IT in the economic recovery plan will make health care more affordable, will save patients' lives, and increase the quality and the outcome of the health care that millions of people are provided.” He might want to take a mulligan. As a series of reports this week make clear, the bloom is coming off the rose. Writing in the Wall Street Journal, Harvard Medical School faculty Jerome Groopman and Pamela Hartzband debunk the received wisdom, noting:

Following his announcement, we spoke with fellow physicians at the Harvard teaching hospitals, where electronic medical records have been in use for years. All of us were dumbfounded, wondering how such dramatic claims of cost-saving and quality improvement could be true.

It's not, they conclude. And they are not alone. The RAND study has been sliced and diced fairly regularly now by, among others, one Peter Orszag, now the White House budget director.

Last May, when Orzag was director of the Congressional Budget Office, CBO examined the Rand report and a parallel study concluding they “appear to significantly overstate the savings for the health care system as a whole — and, by extension, for the federal budget.” Summing it the CBO findings, Orzag concluded that while the technology, in combination with other moves, may help reduce expenses, “by itself it typically does not produce a reduction in costs.”

Another report from Avalere Health, quoted by the Associated Press this week, concludes it will cost providers far more to implement the golden goose systems than they will get back in return.

Using government cost estimates, Avalere researchers found that it would cost about $124,000 for a single doctor or small practice to upgrade to electronic health records over the five year period from 2011-2015 when the stimulus bill offers incentives to do so.

But the total incentive payments a doctor could get over that time period only add up to $44,000. In 2015, penalties start to kick in for doctors who haven't switched to electronic record-keeping. But in one scenario mapped by Avalere, the starting penalty would be $5,100 a year — far less than how much it would cost to install and maintain an electronic health system.

In other words, a pig in a poke. And, that's just the supposed financial benefits. Registered nurses have long raised alarms that some of the technology may be intended to displace staff or an RN's professional judgment, which is especially critical with the complex medical conditions seen in the patients who get through the hospital doors these days, and said those billions could be better spent on actual care delivery. Many doctors, like those in the Journal report, are speaking out now as well. Groopman and Hartzband note “there is no evidence that electronic medical records lower the chances of diagnostic error.” And they point to studies that raise further doubts. For example:

A 2008 study published in Circulation, a premier cardiology journal, assessed the influence of electronic medical records on the quality of care of more than 15,000 patients with heart failure. It concluded that “current use of electronic health records results in little improvement in the quality of heart failure care compared with paper-based systems.”

Another such warning came from MD Scott Haig this week in Time who describes the frustrations of doctors who are forced to use such systems “or risk losing our hospital privileges” if they don't. Yet some big hospital chains are spending billions of dollars for the high tech hype with despite the lack of evidence it will produce either cost savings or improved healthcare. Haig wonders who is really behind it and concludes:

Not surprisingly, nationwide adoption of Electronic Medical Records is being pushed hardest by those who would profit financially from it. The slightly embarrassing financial reality of EMR is that large, mechanized medical operations like hospitals, clinics and big multi-doctor practices stand to make quite a bit of money by adopting them — given our current convoluted system of paying for health care. Two clear factors make EMR a money-winner: improved billing and internal cost control.

And, there's another hook for the insurers here, Haig notes:

Computerized medicine means both more information — and less medicine. Less therapy, less surgery and less testing too. That's how it saves money. A variety of promising terms describe it — terms like targeted treatment, algorithmic patient-care, fiscally responsible medicine and evidence-based practice — but for doctors treating patients, one word describes how computerized records save money. Denial. EMR has the potential to greatly increase insurance company denials of the tests and treatments that doctors order.

Big profits, for the tech corporations that manufacture them, and the software companies that design them. Better bill collection for the hospitals. Improved billing, and fewer nettlesome claims for the insurers whose first priority is always receiving payment, not actually paying for care. Who would have guessed? A boondoggle for some, it looks like, and misplaced priorities for the rest of us.

While thousands of activists step up efforts to make single payer a part of the national debate on healthcare reform, similar efforts are underway in many state capitals as well.

With a dual purpose. Single payer might end up enacted in a few states first, then spread like a prairie fire across the nation — the approach that worked for Canada. And the grassroots campaigns in states should reinforce the national push.  

California is a case in point. Twice in the last few years, a single payer, Medicare for all style bill has passed the state legislature, only to be vetoed by the insurance companies’ ever loyal Gov. Arnold Schwarzenegger.  

But the campaign to pass the bills has brought together dozens of healthcare, labor, and community organizations across California who have subsequently become a central component of national coalitions for single payer, and an impressive army of activists who have made their voices heard on healthcare.

Just ask the insurance trade lobby association which hosted a national convention in San Francisco last June, only to be greeted by 3,000 people surrounding the conference center and resonating it with chants that were heard throughout the conference hall.

Fast forward to today, and the re-introduction of a single payer bill in Sacramento in a press conference jammed with dozens of nurses, health care activists, doctors, medical students, union members, seniors, and many others.

As bill author State Sen. Mark Leno of San Francisco, put it, the new bill, SB 810, “is not just legislation. It’s one of the fastest growing social movements in California.”

California State Sen. Mark Leno with California Nurses Association/NNOC Executive Director Rose Ann DeMoro to his right and community activists at Sacramento press conference.

Despite the political pragmatists or cynical policy wonks or legislators who have tried to shut single payer out of the healthcare reform debate, the movement itself has taken on a life of its own.

“We’re not going away — and our ranks are building,” said Rose Ann DeMoro, executive director of the California Nurses Association/National Nurses Organizing Committee, principal sponsor of the bill, said at the press conference.  

Among the many others represented were the California School Employees Association, One Care Now (a coalition of many other community and senior groups), Los Angeles Unified School District, California Physicians Alliance, medical students, and about a dozen other legislators.

“What we are doing here will influence and impact the debate nationally,” Leno pointed out, adding that it just might be passed in California — or any number of other states — first.

And he used a national example, the banking meltdown, to emphasize part of the argument for the single payer. “In health care, it is the industry who decides who they will insure and who takes the profit, and we the public who take all the risk. Just as in the banking system, the private banks took the profits, and now we the public are taking the risk.

Anticipating the expected opposition of Schwarzenegger again, Leno noted, “we intend to keep the debate alive through the facts” of the bill, place it on the governor’s desk again, said Leno, and, if needed, “work hard to elect a governor in 2010 who will sign our bill.”

SB 810 is an successor to SB 840, the single payer valiantly carried for years by now retired State Sen. Sheila Kuehl.  From both a health care policy and economic perspective the bill is more critical than ever.

As if any more reminders were needed, one came with a Gallup-Healthways Well-Being Index survey reported today in USA Today which found that 21 percent of Americans have difficulty paying for needed medical care or medications, with great disparities based on race and class. And the numbers facing that financial stress grew rapidly in 2008. http://www.usatoday.com/news/h…

Single payer remains the most cost-effective, comprehensive way to fix the broken system.

Cost effective by removing the bloated private insurers with their high administrative costs and financial incentives to continually raise premiums, co-pays, deductibles, and other fees that are the primary cause of rising costs.

Comprehensive in guaranteeing choice of provider, all you lose is your claims adjustor and utilization review team blocking care recommended by your doctor.

And, as a CNA/NNOC study has demonstrated, DeMoro added,  single payer “not only saves lives and people’s health, it is also an economic stimulus.”

Nationally, the study found, implementation of a single payer system would create 2.6 million new jobs, infuse $317 billion in new business and public revenues, and inject another $100 billion in wages into the U.S. economy. The jobs, through increased spending on health care delivery, ripple through the economy, creating employment in retail, manufacturing, and other sectors in addition to healthcare. But in healthcare alone, DeMoro noted, the impact would be especially great in California where an estimated 15 percent of the new jobs would be generated. http://www.calnurses.org/resea…

A large part of the task of the coalition, several emphasized, is public education. The campaign has begun.  

In this effort, every voice must be heard. Every idea must be considered. Every option must be on the table.” — President Obama, opening the White House health care summit.

Except one idea, apparently. The one reform that will actually contain health care costs, cited by the President as his main goal, and, as a bonus, solve the healthcare crisis —  single payer, or expanding and upgrading Medicare to cover everyone.

In the weeks leading up to the summit, the White House made sure all the people it wanted in the room were there. The insurers, drug companies, corporate lobbyists, and those consumer and advocacy groups willing to play by the script.

One segment, however, was conspicuously absent, advocates of single payer reform. Who happen to include, nurses and doctors, the people who have the most daily experience with the collapsing health care system and who by large margins support single payer.

Why were they excluded? When the dean of the press corps, Helen Thomas, asked White House Press Secretary Robert Gibbs that question yesterday, he came up with this charmer:

MR. GIBBS:  I will certainly check on — I told Chip we rented a big room, but we didn’t get the Nationals’ baseball stadium.  

So despite their years of experience in fighting for real reform, the single payer proponents had to take to the streets (again), to pound their way in. Just a few hours before the meeting, and apparently hoping to head off the announced protest at the gates of the White House, invitations were hurriedly and belatedly extended to Rep. John Conyers, author of HR 676, the Medicare for all bill in Congress, and Oliver Fein, MD, president of the Physicians for a National Health Program.

Two seats out of some 120, not exactly a message of inclusion. And there was no space for their voices in the tightly scripted sessions.

As The Nation’s John Nichols wrote afterwards:

while the doctor was not included on any of the lists of breakout session speakers, the CEOs were, along with representatives of the U.S. Chamber of Commerce, America’s Health Insurance Plans, the Blue Cross Blue Shield Association and the Business Roundtable.

In other words, the overwhelming weight of opinion at what was supposed to be a wide-ranging discussion of health reform was — at best — on the side of tinkering with the existing for-profit system. Change we can believe in was not on the agenda.

http://www.thenation.com/blogs…

Maybe the redoubtable Mr. Gibbs can explain:



Helen Thomas:    Why is the President against single-payer?

MR. GIBBS:  The President doesn’t believe that’s the best way to achieve the goal of cutting costs and increasing access.  

Or perhaps there’s the reason suggested by Harper’s Magazine editor Luke Mitchell on Democracy Now this morning:

it’s a threat to a great deal of people who are making a lot of money right now, which is to say the insurance companies. A single-payer system would take a lot of money out of the insurance system, the private insurance system. And it’s also something that a lot of people in Washington understand as ideologically threatening,

http://www.democracynow.org/20…

And, as Democracy Now host Amy Goodman noted, the silence in the summit is largely echoed in the exclusion of single payer voices in the major media:

A new study being released today by FAIR, Fairness and Accuracy in Reporting, found the views of advocates of single payer have only been aired five times in the hundreds of major newspaper, broadcasts and cable stories about healthcare reform over the past week. No single-payer advocate has appeared on a major TV broadcast or cable network to talk about the policy during that period.  

It’s not single payer advocates who are harmed by this wall of exclusion, it’s all the American families and patients who yearn for real reform and will almost surely be disillusioned by proposals that fail to achieve it.

Because you can’t genuinely rein in costs without tackling them at the source — the insurance companies and their built in incentive to perennially jack up premiums, co-pays, deductibles and all the other ATM fees that are bankrupting families and crushing businesses. Nor can you begin to address the callous and routine denial of care for those already insured by the claims adjustors and bean counters who don’t want to pay for it.

There’s another potential casualty here as well, President Obama who himself famously said in 2003 that he was a proponent of single payer and must surely know it is the best approach. A lot of political capital will be expended to pass reform this year, it ought to be devoted to a reform that will actually work.

“In this effort, every voice must be heard. Every idea must be considered. Every option must be on the table.” — President Obama, opening the White House health care summit.

Except one idea, apparently. The one reform that will actually contain health care costs, cited by the President as his main goal, and, as a bonus, solve the healthcare crisis —  single payer, or expanding and upgrading Medicare to cover everyone.

In the weeks leading up to the summit, the White House made sure all the people it wanted in the room were there. The insurers, drug companies, corporate lobbyists, and those consumer and advocacy groups willing to play by the script.

One group, however, was conspicuously absent, advocates of single payer reform. Who happen to include, nurses and doctors, the people who have the most daily experience with the collapsing health care system and who by large margins support single payer.

Why were they excluded? When the dean of the press core, Helen Thomas, asked White House Press Secretary Robert Gibbs that question yesterday, he came up with this charmer:

MR. GIBBS:  I will certainly check on — I told Chip we rented a big room, but we didn’t get the Nationals’ baseball stadium.

http://www.whitehouse.gov/the_…

 

So despite their years of experience in fighting for real reform, the single payer proponents had to take to the streets (again), to pound their way in. Just a few hours before the meeting, and apparently hoping to head off the announced protest at the gates of the White House, invitations were hurriedly and belatedly extended to Rep. John Conyers, author of HR 676, the Medicare for all bill in Congress, and Oliver Fein, MD, president of the Physicians for a National Health Program.

Two seats out of some 120, not exactly a message of inclusion. And there was no space for their voices in the tightly scripted sessions.

As John Nichols wrote on the Nation website afterwards:

while the doctor was not included on any of the lists of breakout session speakers, the CEOs were, along with representatives of the U.S. Chamber of Commerce, America’s Health Insurance Plans, the Blue Cross Blue Shield Association and the Business Roundtable.

In other words, the overwhelming weight of opinion at what was supposed to be a wide-ranging discussion of health reform was — at best — on the side of tinkering with the existing for-profit system. Change we can believe in was not on the agenda.

http://www.thenation.com/blogs…

Maybe the redoubtable Mr. Gibbs can explain:

Helen Thomas:    Why is the President against single-payer?

MR. GIBBS:  The President doesn’t believe that’s the best way to achieve the goal of cutting costs and increasing access.

Or perhaps there’s the reason suggested by Harper’s Magazine editor Luke Mitchell on Democracy Now this morning:

it’s a threat to a great deal of people who are making a lot of money right now, which is to say the insurance companies. A single-payer system would take a lot of money out of the insurance system, the private insurance system. And it’s also something that a lot of people in Washington understand as ideologically threatening,

http://www.democracynow.org/20…

And, as Democracy Now host Amy Goodman noted, the silence in the summit is largely echoed in the exclusion of single payer voices in the major media:

A new study being released today by FAIR, Fairness and Accuracy in Reporting, found the views of advocates of single payer have only been aired five times in the hundreds of major newspaper, broadcasts and cable stories about healthcare reform over the past week. No single-payer advocate has appeared on a major TV broadcast or cable network to talk about the policy during that period.

It’s not single payer advocates who are harmed by this wall of exclusion, it’s all the American families and patients who yearn for real reform and will almost surely be disillusioned by proposals that fail to achieve it.

Because you can’t genuinely rein in costs without tackling them at the source — the insurance companies and their built in incentive to perennially jack up premiums, co-pays, deductibles and all the other ATM-type fees that are bankrupting families and crushing businesses. Nor can you begin to address the callous and routine denial of care for those already insured by the claims adjustors and bean counters who don’t want to pay for it.

There’s another potential casualty here as well, President Obama who himself famously said in 2003 that he was a proponent of single payer and must surely know it is best approach. A lot of political capital will be expended to pass reform this year, it ought to be devoted to a reform that will actually work.

Nurses from Nevada and around the country  continued rolling through Western Nevada today as part of the “Drive for Healthcare Voters” tour, visiting the small towns of Gardnerville and  Fallon.  The tour is being put on by the National Nurses Organizing Committee, which is America’s largest RN union, and is complemented by a campaign including mail pieces, phonebanking, and advertising.  Our goal is to make sure that voters have the information they need to be healthcare voters.

Day 2 of the tour was intense and emotional, as our healthcare outreach led to many conversations with voters about what is going on in their lives.

Our first stop was at Woodett’s diner, the main joint in Gardnerville.  15 nurses, one gigantic wrapped bus with our “Healthcare Report Cards” on the presidential candidates printed in 10-foot high letters, and a newspaper photographer.  Yep, we were a scene.  Nurses in scrubs fanned out in pairs and spoke to about 50 voters in our visit.

The themes we heard in Gardnerville are similar to what we’re hearing throughout Nevada:  people are hurting economically, deeply, today.  They told us stories of losing their jobs, and losing their healthcare.  Many of the older voters talked about their childhood, in harder economic times, that seem to have returned today.  We passed shuttered stores and houses for sale.

Some of the people we talked to were angry about the direction of our country–and some were scared.   Some people pointed fingers at immigrants, but many more talked about a feeling of helplessness in the face of Washington D.C. and Wall Street, of politicians and businessmen on the take.

Wherever they were coming from, almost every single person was receptive to our message, thanking us and blessing us, bonding with the nurses they knew were on their side.  People hugged the nurses, and encouraged us in our work, even those who did not agree with us.

Only a few were rude.  One physician and his wife, who deigned to speak with nurses, informed us that health care reform would only lead to waiting lines-and that we have to “draw the line somewhere” on who gets healthcare.  A couple of young punks told us that they were working with the McCain campaign…and were made obviously uncomfortable when our nurse  Jill thanked them for their civic service and made them pose for a photograph with the nurses.  

From Gardnerville we rolled through the sagebrush and the high plains to another press event and another meeting with voters.

This one, though, was different.  

This was Fallon, Nevada…a symbol of our broken healthcare system and how it wastes innocent American lives.  About a decade ago, a pediatric cancer cluster began to grow in Fallon, eventually striking 17 young children with a deadly form of leukemia.

Maybe it was the nearby Navy Air base, or maybe the nearby chemical plant.  Either way, we put these kids in harm’s way…and then abandoned them when harm struck.  At least one of the youngsters died a few years ago, due to insurance company denials of care…the very denials that would end with HR 676 and guaranteed healthcare.

The mood in Fallon was somber.  Our conversations with voters outside the hospital were shorter.  We were on hallowed ground there and we knew it.  We were fortunate and honored to be able to film an interview with one of the grassroots activists who had worked to bring justice to the children stricken by the cancer cluster.

We went to a nearby Wal-Mart afterwards to do more public outreach.  Management kicked us out of course…but not before whispering that they agreed with our report cards and asking for a spare to share with family.

As we left the parking lot, one man came up to us and thanked us for giving him hope.  He said that while lots of groups go to Reno or Vegas to do outreach, they rarely take the time to go out into the small towns and rural areas.  But we were there, and he took it as a sign that good news was right around the corner.

Tomorrow we head east to the towns of Lovelock and Elko, where we will gather with nursing students to watch the final Presidential debate.  Eventually, by November we will have hit 11 Nevada cities…and headed east to Ohio, Pennsylvania, New Hampshire, and Maine.

The National Nurses Organizing Committee (NNOC) today kicked off a national road show and outreach campaign designed to inform voters about the healthcare proposals of both leading Presidential candidates.  5 swing states will be targeted before the election for this healthcare outreach.

As one nurse from St. Mary’s Medical Center Reno put it, “Our patients are voters too, and we’re here to get them the information they need.”

The road show hits 11 different Nevada cities stops this week-everywhere from Reno to Elko to the Shoshone Reservation-with a striking wrapped bus featuring the nurses’ report cards on Obama and McCain.  Next week, the bus turns left and heads to Ohio, Pennsylvania, Manchester NH and Bangor ME (along with a visit to healthcare hero Eric Massa, running for Congress in New York.)

The RNs will hand out a version of the report card at stops along the way, and mail a different version to both RNs and voters around the state.  Nurses and labor activists from across the country will follow the mail with phone calls to a targeted list largely composed of nurses and voters who are likely to want healthcare information, particularly non-partisan women.   The campaign will be supported by advertising in the local areas the bus is visiting.  The report cards gives Obama a B+, McCain an F, and calls on all candidates to support HR 676, and which guarantees healthcare with a  single-payer system like Medicare for All.

Donna Smith, a star of the movie SiCKO and now a healthcare organizer for NNOC (and their sister union, the California Nurses Association), commented on the first day:

Nurses shared their report card for the candidates where they rate Sen. Obama’s plan better thatn Sen. McCain’s plan because Obama improves access to care while McCain’s plans to tax employer-based healthcare benefits and may cause as many as 20 million more people to lose access to coverage and care.

Out on the sidewalks, citizens welcomed the chance to talk with the nurses on a cool fall day.  One young man became angry when he thought the nurses were representing the health care industry — “No, I don’t want to talk to you.  i owe the healthcare industry thousands…”  

But he stopped and listened when told the nurses are advocating HR676, the National Health Insurance Act — single payer healthcare for all.

The road show will undoubtedly bring some surprises — as the nurses take their message far and wide.  But the trust patients feel for nurses clearly softened even the most campaign-message-weary.  Citizens know who speaks the truth and who has a hidden agenda.  

And during these last weeks of what has been a two-year long presidential campaign cycle, nurses break through the din of attack ads and economic shell shock with a clear, clean message:  healthcare is a basic human right that we can and should provide one another.  It’s in the nation’s best interests.

Like the young man Donna talked to, many many Nevadans are hurting economically-which makes this the right message for the right time.  Rose Ann DeMoro, executive director of NNOC and CNA was thinking of patients like that one when she asked “If We Can Nationalize Banks, Why Not Health Care?”:

Through the simple, cost effective approach of improving and expanding Medicare to cover everyone, the U.S. could effectively nationalize the financing of healthcare delivery, a single-payer system, while leaving intact the most private system of hospitals and doctors. … If it’s good enough for every other industrialized country, if it’s good enough for the speculators and CEOs who have mortgaged our financial security, it ought to be good enough for the rest of America.

Indeed.

Dissent magazine has a fascinating article by Marie Gottschalk on current efforts to achieve healthcare reform in the United States http://dissentmagazine.org/article/?article=1166. SEIU President Andy Stern and the business-friendly approach that failed here in California gets some well-deserved criticism:

“So far, Stern has garnered a disproportionate amount of media and popular attention. His business-friendly stance on health care reform, which stresses how the U.S. health care system is fundamentally hurting the country’s economic competitiveness, helps explain why. But his economic competitiveness argument is not convincing and could undermine efforts to forge a successful coalition or movement on behalf of affordable, high-quality care for all.”

The author argues that wooing business leaders in order to build momentum for healthcare reform is a backwards-thinking approach, and one that has failed before. For example, the labor movement tried to bring business leaders to the table in the early 1990s. The Clinton healthcare plan fell apart not only due to a lack of grassroots support, but also after multimillion-dollar attacks came from those same business leaders. The author also shows that healthcare costs are not hurting the U.S. business community’s ability to compete with overseas companies.

One example: European and Japanese firms bear higher indirect costs, because of higher corporate taxes. Those extra costs generally exceed what even the most generous American businesses spend on coverage for their employees. Another example: corporate spending on healthcare, as a percentage of after-tax corporate profits, declined steadily in the U.S. between 1986 and 2004 (except for the three years from 1998 to 2001).

Gottschalk’s bottom line: “The economic competitiveness framework obscures the fact that employers and insurers have been remarkably successful at shifting health care costs onto employees, their families, and other individuals through higher co-pays, higher deductibles, restrictions on coverage, and other measures,” and the focus needs to be placed squarely on the damaging economic consequences for individuals and households who are bearing the greatest burden of rising healthcare costs, not on employers.

The reality is that only by building a bottom-up movement will we win healthcare reform—and only after we make it clear that change is important because it’s the right thing to do for everyone. Arguing that we need reform in order to protect corporate profits is the wrong way to go. It is the right of every person in this country to have access to quality, affordable healthcare. This moral rationale for reform must maintain center stage, linked to an economic rationale focused on reducing costs for working families, and delivering higher-quality healthcare more efficiently—by providing better integrated, more appropriate services, and reducing insurance company administrative overhead, marketing costs, and profit.

My union, United Healthcare Workers-West, fights for real healthcare reform based on these principles and our personal experiences with this perverted system. We oppose phony reform, like what Arnold Schwarzenegger proposed for California last year. Badly misreading the situation here in the state, Andy Stern supported a reform package that yielded far too much ground to Schwarzenegger’s proposals. That plan proved unacceptable to the rest of the labor movement and the State Senate, and would have been rejected by voters had it gone to the ballot.

This year’s extended primary just might be great for healthcare reform as the Clinton campaign’s failure may have killed off the terrible idea of insurance mandates.  She ran on it, and lost–just like Arnold did in California last year.

If so, great news all around.  Working people, already struggling, will not face the prospects of having their wages garnished to pay off Blue Cross’ inflated premiums, overhead, and denials.  Healthcare reformers can focus their work towards enacting genuine solutions, rather than fighting off this insurance marketing scheme masquerading as health care policy.  And all of us can debate the real issues at hand here, like the new report finding the number of underinsured is spiking as our healthcare system continues its death-by-insurer spiral.

We’ll take a look at this and updates from single-payer movement below!

The big political advantage of health insurance mandates (laws forcing people to buy private insurance, no matter the cost or quality) is that insurance companies love them, and can create big coalitions of business-friendly groups that seem safely centrist but also reasonably effective.  They seem so dang politically viable.

But the Wall St. Journal points out they’re not and argues that Clinton’s Exit Deals Setback to the Push for Health-Care Mandates

Sen. Hillary Clinton’s exit from the presidential race will deal a blow to supporters of a key element in the tussle over universal health coverage: the idea that all Americans be required to buy or have health insurance.

After gaining considerable political ground, especially at the state level, the concept has suffered other setbacks lately, too. Despite years of entrenched political opposition to the idea of a mandate, it was a key part of the 2006 universal health care legislation enacted in Massachusetts and of California Gov. Arnold Schwarzenegger’s plan to overhaul health care in that state….

The Schwarzenegger plan, though, failed this year, in part because unions and business groups objected to its individual and employer mandates. In Massachusetts, results have been mixed. While the overall plan has cut the number of uninsured adults in that state by roughly half, the state authority responsible for overseeing the program has exempted nearly 20% of uninsured residents because it has deemed they can’t afford the policy premiums on offer.

The California plan died when the public and legislators learned that nurses and labor unions were strongly opposed to the idea-and that their wages could have been garnished or a lien put on their home.  This same strategy will kill similar proposals nationally.  It is generous to call Massachusetts’ experiment mixed; check out Dr. Steve B’s more informed comments.

There are a number of problems with mandates.  On a macro level, they make genuine healthcare reforms-single-payer-impossible by showering for-profit insurers with millions of new customers and billions in new revenues and subsidies.  On a micro level, they trap patients into this broken system and saddle them with junk insurance that will drain their bank accounts only to offer them no protection in the case of a health crisis.

A new study today elaborates on this very problem of underinsurance:

About 25 million Americans – or approximately one of every five adults younger than age 65 with health insurance – did not have sufficient coverage last year to shield them from financial hardship if they ended up in the emergency room or were seriously ill, according to a new study to be released on Tuesday by the Commonwealth Fund.

I actually think that number is really low, but at least it focuses our attention on this:

As the nation debates how best to improve its health care system, including how to insure the increasing number of Americans without coverage, policy makers also need to discuss the quality of available coverage, said Karen Davis, the president of the Commonwealth Fund.  “Lack of insurance is only part of the problem, as even the insured have serious gaps in coverage,” she said.

Meanwhile, hilarity ensues as The head of Blue Shield of California begs health reformers: “Stop demonizing health plans.”  I don’t think so.

Chellie Pingree is about to become a great Congresswoman from Maine, and she is running on a single-payer platform.  Rose Ann DeMoro from the California Nurses Association/National Nurses Organizing Committee,  finds a gold rush town that symbolized our healthcare crisis.

Elsewhere, a writer in the Tennessean reminds us why we don’t have single-payer healthcare…the war…and the trend of getting married for health insurance continues.

Finally, Elizabeth Edwards, well, um, eviscerates John McCain’s so-called health care plan.  Snap!

In an extraordinary convention just concluding in Puerto Rico, here’s what you didn’t hear from Andy Stern’s paid PR blitz.  SEIU was under siege throughout by protest encampments of the popular Puerto Rican Teachers’ Union, responding to SEIU’s raid of the island’s largest  union– during a strike to improve horrific educational conditions.  

Inside the convention, to the detriment of the overall labor movement,  Stern successfully squashed  the internal dissent by SEIU’s democracy activists, thereby further concentrating power in himself.  The CEO model.

And in an extraordinary development, Stern announced that  SEIU is basically doing away with labor reps in favor of outsourced call centers…which makes sense, in that if you sign no-strike promises to your employer, why would you need to mobilize your members?  

There’s more!  SEIU is continuing its war against state and national RN unions by now picking up John McCain’s frame of attacking “government-run healthcare” as their latest salvo against the California Nurses Association/National Nurses Organizing Committee (AFL-CIO).  If anyone doubted SEIU’s willingness to sell out genuine healthcare reform in a second, there it is.

Details below…

Juan Gonzalez and Democracy Now note that SEIU is trying to colonize the independent Puerto Rican teachers’ union in the midst of a historic  strike-and hope to do the same to other Latin American unions.  Solidardad no mas?  Read the background here or watch the video here about why SEIU was facing a protest encampment by Puerto Rican teachers .  Gonzalez:

I think that the key thing here is that the teachers’ union is the largest and most militant union in Puerto Rico and has always been, and the efforts of SEIU earlier this year when the teachers were in the middle of a major battle and a strike with the government to step in, in essence, and to try to take over or raid the leadership of the union, has created enormous reverberations throughout the labor movement in the United States, as well as in Latin America. I think, in fact, one of the most interesting things was that Stern and Dennis Rivera announced before the convention started that they are going to begin a new effort from Puerto Rico throughout Latin America to build ties between the SEIU to build global unions. So, in essence, what SEIU is trying to do by gaining control of the teachers’ union and, in effect, the Puerto Rican labor movement is to then branch out into the rest of Latin America. Now, they insist that they’re not going to do it in a way that will hurt the autonomy or the democracy of those unions, but the record has so far-has not been too good in that way. …. But the fact that SEIU would have such a demonstration at its national convention shows that the contradictions are growing there.

Gonzalez also notes the irony of SEIU pretending to carry the banner of labor reform, while consolidating power in one problematic leader.  

And the reality is that SEIU has increasingly become a more centralized union in the way it operates, and it is increasingly, in terms of some critics, doing anything it can to grow, in terms of making arrangements or deals with political leaders to be able to expand membership in different parts of the country. So I think that this is an important or watershed moment, because the SEIU is leading the supposed reform movement within organized labor, when now the leaders of the reform movement are being challenged over the nature of their reform. And I think that this is the opening salvo in what’s going to continue to be an ongoing battle.

Labor journalist Steve Early also covers the contradiction of Andy Stern holding a convention in Puerto Rico-exactly while trying to bust the Island’s largest and most-beloved union!

Using the “mobile picketing” skills well honed during a ten-day strike by thousands of teachers in February, the FMPR delegation marched right up to a police check-point–two hundred yards from the meeting hall-and burst right through. The flying wedge took  several casualties along the way, from flailing  police clubs and attempted collars. They then made a successful dash for the front door of the building, which is bigger than an airline terminal.

The ensuing picket-line-composed of fleet-footed survivors of the race to get in-had a feisty David vs. Goliath feel to it. For more than two hours, the teachers walked, chanted, sang union songs, distributed leaflets, and displayed a big FMPR banner under the soaring arches of the! convention center entrance. The FMPR message was “Stop Union Raids” — one that SEIU has fervently embraced back home but only when the California Nurses Association is “raiding” SEIU, in which case it should stop immediately….

Apparently the reform and democracy activists within SEIU were squashed by Andy Stern.  One reports:

While obviously they wanted to go out on a high note, this convention will always have a cloud hanging over it, memorable for its unparalleled security, its level of doublespeak, its stomping on free speech, and now its marred election process.

Meanwhile, SEIU actually told the New York Times that they are doing away with labor reps, the people who walk the halls of facilities and organize workers.  Instead?  Call centers.  “Please hold if you want to stand up to the boss.”  This is an extraordinary development, and one that undermines genuine worker power.

As 2,000 convention delegates gather in Puerto Rico, the Service Employees International Union is about to jettison a time-honored union tradition – having members go to their union representatives with their questions and grievances.  The delegates are expected to vote to have union members rely on call centers instead to handle their problems.

But some union leaders and members complain that the call centers would hurt the union and its members.  Sometimes you can’t get through to these centers,” said Eva Lozada, a home-care worker from Oakland, Calif. “It’s like talking to an A.T.M. This will be bad for the union.”

Hilariously, SEIU’s latest attack on the California Nurses Association/National Nurses Organizing Committee is the same one John McCain launches at Barack Obama: supporting “government-run healthcare”.

In a mailing to CNA/NNOC members this week, SEIU blasts CNA/NNOC for supporting a “government-run health care system.” McCain has used almost identical language to disparage Obama’s proposals for healthcare reform on an issue that will be a major focus of the fall campaign.

“By carelessly and cynically adopting the McCain language, SEIU is not only showing its contempt for the majority of Americans who have told pollsters that the government should guarantee healthcare for everyone as a solution to the healthcare crisis that has put so many of our families at risk.

“They are also giving aid, comfort, and ammunition to Sen. McCain whose own healthcare plan would be a disastrous continuation of the dismal and failed status quo,” said CNA/NNOC co-president Malinda Markowitz, RN….

To obtain sweetheart deals with employers, SEIU has “routinely sacrificed patients,” CNA/NNOC Executive Director Rose Ann DeMoro noted. She cited, for example, an agreement with California nursing home operators under which SEIU agreed to back legislation impeding patients’ rights to sue over nursing home abuses and oppose reforms to require better staffing for patient safety. SEIU also joined with the New York hospital industry to endorse the closure of hospitals and nursing homes.

Another independent nurses union-New York Professional Nurses Union-calls on all RNs to resist SEIU, due to their terrible track record of representing RN issues.  They write in an open letter about their experiences with SEIU:

1199/SEIU has a top-down leadership structure with very few RNs in top leadership positions.

We negotiated strong contract language only after we left 1199, including minimum nurse/patient ratios and a prohibition against all mandatory overtime.  

We became an independent union in order to gain control over our own bargaining and our own professional lives.  No union can represent the interest of registered professional nurses better than a nurses union.  Nurses need a union of nurse, by nurses and for nurses.  

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