I’ve been in our nation’s capital this week meeting with Obama Administration officials and Congressional leaders about national health care reform. Everywhere I go, from the White House to the Department of Labor to the U.S. Senate, I get the same question: can San Francisco’s universal health care program, Healthy San Francisco, be scaled?

The answer is yes.  

Truly, one of the strongest aspects of Healthy San Francisco (HSF) is its simplicity. The program allows participants to select their primary care provider from among dozens of local hospitals and clinics, both public and private. Our local system does not require lengthy HMO paperwork and there is no denial of treatment based on pre-existing medical conditions.

A recent study showed that Healthy San Francisco is dramatically less expensive than traditional insurance. And our experience in San Francisco is proving what most American’s already know – it is much less expensive to keep people well than it is to treat their sickness, particularly when so much treatment for uninsured Americans is provided in costly emergency rooms.

There are currently more than 40,000 participants in HSF. We are enrolling approximately 600 new participants every week. We have already enrolled more than half of the previously uninsured San Franciscans and the vast majority will have access to health care by the end of next year.

I believe that administration and congressional leaders understand that we cannot wait for health care reform. Our health care crisis affects every aspect of our society – from making sure every child receives the health care they need to succeed in school, to decreasing the financial burden on business, both large and small, so our economy can get back on track.

I know there is pressure in Washington to wait until the economy improves before we act on health care reform. I faced many of the same pressures when I was working with allies in San Francisco to forge our universal health care delivery system.

But “waiting” in politics usually means never – and we simply cannot afford to wait any longer. The lessons we are learning in San Francisco shows that investing in health and wellness is its own kind of economic stimulus.

The time is now to tackle this problem and I applaud President Obama for promising to sign a national health care reform bill by October. We cannot wait for change – the President needs your help. Sign the petition to support President Obama’s call for health care reform.

One of the key figures leading the charge in Congress is Iowa Senator Tom Harkin. I spoke with Sen. Harkin on my Green 960 radio show this week about the challenges Congress and the administration face and the possibility of using HSF as a model for a national program. You can listen to the show online or via iTunes.

For my part, I was recently made Chair of the U.S. Conference of Mayors Task Force on Health Care Reform. Cities often have the most pressing health care needs and have had to adapt and innovate in lieu of national health care reform. I am looking forward to working with my fellow Mayor’s to hear what they have learned in their cities and share what we’ve learned in my hometown through Healthy San Francisco.

In the end, the task force will identify urban health care priorities and advise the work of Congress and the Administration to help solve this crucial challenge we all share. As always, please feel free to give me your input and feedback in the comments section below.

Listen to Mayor Newsom’s Green 960 radio show online or subscribe to his weekly policy discussions on iTunes.  Join Mayor Newsom on Facebook. You can also follow him on Twitter.

With the final White House Forum on healthcare scheduled Monday, April 6 in downtown Los Angeles, advocates of single payer/guaranteed healthcare have one more opportunity to shake up what has become a dreary conventional wisdom about the presumed acceptable parameters of the debate.

Hundreds of nurses, doctors, healthcare and labor activists will rally at 9 a.m. outside the California Endowment, 1000 North Alameda St., Los Angeles.

It will mark the fifth time, at all five White House regional forums, that the single payer/Medicare for all message will come to the stage, outside and inside the forum.  You can extend that to the town hall meeting at the White House last week where the President was asked why we can't have a national healthcare system like they have in other industrialized nations.

But the scene is very different in the committee rooms where the top legislators, with their handpicked insiders, either from the healthcare industry or conventional players who won't upset the status quo, have determined the general framework of a legislative approach they deem acceptable — and dismissed as out of bounds the one reform most likely to work, a single payer approach.

While single payer is not on the table, accommodating the insurance industry and healthcare proposals by the party that was trounced in the polls in November apparently is.

That's why two of the biggest debates now are not over whether to adopt a national healthcare system, that has guaranteed access to care in every other industrialized nation, but whether to force people to buy private insurance and to tax their employer-funded health benefits.

Start with requiring everyone not covered to buy insurance, which amounts to a massive bailout for the insurance industry. The Democratic chairs of the key committees that are running the show on healthcare have all agreed that individual mandate, putting us all in hock to the insurance giants, will be part of the bill, the New York Times' Robert Pear reported this morning.

Their alleged premise, says Pear, “that if everyone had health insurance, it would be easier to control health costs.” 

Not to mention that it is the top priority for the insurance industry, which is salivating at the prospect of tens of millions of new customers marched into their offices under threat of federal penalties.

But it's not so popular with everyone else — a major reason why the individual mandate plan by Gov. Arnold Schwarzenegger, host of the LA forum, crashed and burned last year. And it hasn't worked so well in its prime model, Massachusetts, either.

Listen to the comments of Massachusetts State Sen. Jamie Eldridge, who voted for the law, but recently gave this assessment to a Congressional committee, as reported by healthcare writer extraordinaire, Trudy Lieberman at the Columbia Journalism Review:

The assumption was that, as more people—and, in particular, more young and relatively healthy people—joined the system, premiums would go down across the board. There was also the assumption that as more people became insured, the number of people going to the emergency room would drop dramatically, saving the Commonwealth money. Neither of those things have happened—at least not enough to produce the cost savings we were told we would see. In fact, health care reform has cost the Commonwealth much more than expected—-up to a record $1.3 billion this year. It is maddening that so many of our public health care dollars are diverted to HMOs and health insurance companies, under the current employer-based Massachusetts health care system.

As to taxing benefits, turn the page back to the fall campaign when that idea, the centerpiece of Sen. John McCain's healthcare plan, was widely denounced by soon-to-be President Obama and virtually every other Democrat running for office in stump speeches, election mail, and numerous TV ads.

It was considered so distasteful Sen. Joe Biden even found it to be a handy zinger to Gov. Palin in the vice-presidential debate, saying: “Taxing your healthcare benefit. I call that the ultimate Bridge to Nowhere.”

But, apparently that was then and this is now, as the Los Angeles Times affirmed this week:

Democrats and Republicans on Capitol Hill are expressing increasing openness to an idea that once seemed unthinkable: putting taxes on some healthcare benefits.

And Peter Orzag, the Obama administration's budget director, told the Washington Post that taxing benefits “should most definitely remain on the table.” Unlike real reform, apparently.

What changed? Lieberman has one idea:

What happened to Obama’s budget proposal of a $634 billion down payment (for health care reform) that was to be funded in part by making wealthier people pay higher income taxes? Or the $175 billion that was to be saved by cutting the excess payments to Medicare Advantage plans over ten years? … The Senate draft budget doesn’t contain any actual money for health care. Instead…there will be “space” for a health reform reserve fund. No taxing the rich—members of Congress beat up on that one. No trimming Medicare Advantage plans—insurers don’t like that.

The $634 billion figure was always too small to provide all the subsidies people will need if they are required to buy health insurance, which seems to be the direction the pols are going. But if Obama’s revenue source doesn’t survive the budget process, then where does the money come from? …  Bingo! The money might just come from taxing the health insurance benefits of …  everyone else who gets insurance from their boss.

Ironically, the main reason President Obama says single payer reform is not under consideration is because it would “scrap (the employer based system) everybody is accustomed to,” as he said in the town hall meeting last week in response to the question of why we can't have the system that works for everyone else:

But demolishing what we have now is almost exactly what would happen when you tax health care benefits.

Many if not most of the youngest and healthiest employees, especially in a recession, would drop their employer coverage to shop for cheaper, barebones plans in the private individual market.

Employers, left with the more expensive employees to cover and an unsustainable risk pool, would see their premium costs skyrocket even more, prompting many to sharply reduce coverage or eliminate benefits entirely.

As Texas employers and healthcare analysis succinctly told the Dallas Morning News' Jason Roberson during the campaign, “this could eventually lead to the death of company-provided health plans.”

Some seem to have forgotten that consequence. On April 6, come help us remind them.

Haven't we heard this song before? It sure looks like the people who already control our healthcare system are framing the biggest issues of the present healthcare reform debate.

From the back rooms to the committee hearings to the White House summits to the front pages of the newspapers, the demands of the insurance industry are given enormous deference and accommodation.

Is it fear of Harry and Louise, the insurance campaign that some believe torpedoed the muddled Clinton health proposal? Is it the considerable influence of insurance industry contributions in the pockets of many legislators?

Or perhaps it's the caution or lack of will of some liberal groups to press for more fundamental reform–such as a single payer/expanded Medicare for all approach–that permits the industry and its conservative champions in Congress to dominate the terrain.

There's two major indications of this trend.

First, who is in the room where the key decisions are being made. As Consumer Watchdog put it:

First we heard that consumer advocates had been left out of closed-door negotiations orchestrated by senate staffers to formulate health care reform legislation. Then, consumer advocates were left off the invite list to the White House summit on health care reform.  The third strike came when no consumer voices were heard at a U.S. Senate Heath, Education, Labor and Pensions committee round table discussion about insurance reforms in the forthcoming national health care reform effort.  Three of the seven panel members were from the insurance industry.  A forth panelist represents an insurer-friendly think tank.

The second key sign is what the chattering class defines as the contours of the debate.

In a telling piece earlier this week, the Washington Post's Ruth Marcus called the present moment “crunch time” in which only five major pieces remain to be resolved.

Piece One: Should there be a public insurance option?
Piece Two: How to pay for the program? Specifically, should employer-provided health insurance, no matter how generous, continue to be treated as tax-free income?
Piece Three: Should individuals be required to purchase insurance?
Piece Four: What mechanism should there be to control costs?
Piece Five: How much muscle should Democrats use to get health-care reform done? The temptation is to use special budget procedures known as reconciliation that would allow Senate Democrats to approve health reform with just 51 votes. House leaders, fed up with being held hostage by Senate gridlock, are pushing this approach.

On each of the policy points here, the insurance industry and its defenders are on the offensive. And on every point, major concessions that will appease the insurers, but do little to rein in skyrocketing costs or protect families, lurk.  

Imagine a scenario in which the bill that finally emerges includes a mandate that all individuals must buy private insurance, but there are no uniform standards, widely varying prices for coverage depending on where you live or your age, no real controls on what the insurance companies can charge in premiums, co-pays, deductibles and other out of pocket costs. If that sounds a lot like the badly flawed Massachusetts model, it should.

If you get health coverage at work, your benefits are now taxed, a clear incentive for your employer to reduce or drop coverage, pushing more people into the still poorly regulated cutthroat private market.

And even if proponents win on the much debated public plan option, don't expect it to solve the problem, as Physicians for a National Health Program leaders David Himmelstein and Steffi Woolhandler point out :

1. It forgoes at least 84 percent of the administrative savings available through single payer. The public plan option would do nothing to streamline the administrative tasks (and costs) of hospitals, physicians offices, and nursing homes, which would still contend with multiple payers, and hence still need the complex cost tracking and billing apparatus that drives administrative costs. These unnecessary provider administrative costs account for the vast majority of bureaucratic waste. Hence, even if 95 percent of Americans who are currently privately insured were to join the public plan (and it had overhead costs at current Medicare levels), the savings on insurance overhead would amount to only 16 percent of the roughly $400 billion annually achievable through single payer — not enough to make reform affordable.

2. A quarter century of experience with public/private competition in the Medicare program demonstrates that the private plans will not allow a level playing field. Despite strict regulation, private insurers have successfully cherry picked healthier seniors, and have exploited regional health spending differences to their advantage. They have progressively undermined the public plan — which started as the single payer for seniors and has now become a funding mechanism for HMOs — and a place to dump the unprofitably ill. A public plan option does not lead toward single payer, but toward the segregation of patients, with profitable ones in private plans and unprofitable ones in the public plan.

Yet only on the final piece identified by the Post's Marcus, process, does it look like the insurers and the right are being aggressively challenged. Perhaps what may be most telling is the gushing this week over the non-concession by the insurance industry that it will be willing to end its immoral practice of denying coverage to people with pre-existing conditions if it gets everything else it wants. 

In his town meeting yesterday in which the public got to ask the questions, President Obama was asked about single payer, and while demurring that we have “a legacy, a set of institutions that aren't that easily transformed” showed that he understands a central tenet of what is clearly right about single payer.

“A lot of people think that in order to get universal health care, it means that you have to have what's called a single-payer system of some sort. And so Canada is the classic example: Basically, everybody pays a lot of taxes into the health care system, but if you're a Canadian, you're automatically covered. And so you go in — England has a similar — a variation on this same type of system. You go in and you just say, “I'm sick,” and somebody treats you, and that's it.”

The challenge to the rest of us is to show that legacy has collapsed and no longer works for the uninsured or the insured, and move the debate beyond what the insurers want to what the rest of us need.

Hector De La Torre’s bill, AB 1945, which would have forced health plans to seek approval from a third party before rescinding health insurance – a VERY common practice, unfortunately – was vetoed by Arnold today. Interestingly, Arnold was for it before he was against it as De La Torre noted:

Having the governor not engage in any discussions or negotiations for months, and then just veto the bill is astonishing,” he said. “The issue was good enough to use as an applause line in his State of the State Address in January, but not to sign a good piece of legislation that would protect insured people in the individual market.

It’s another sop to the HMOs, whose business model relies on preventing people from getting the health care they need. This is especially true on the individual health insurance market (the one John McCain wants you to rely on) – if you get sick, the insurance company is going to comb over your application, your policy, and your life with a fine toothed comb to find a reason to cut you off and watch you suffer.

Arnold has vetoed a lot of bills this session, but few vetoes will hurt more Californians than this one.  

It’s been just three months since Nataline Sarkisyan was killed by her health insurance company, CIGNA. Today the California Nurses Association and Eve Gittelson, aka “nyceve” at Daily Kos, bring us the story of another Southern California teen whose lifesaving treatment is being denied by an insurer – in this case, PacifiCare/United Health.

It’s unconscionable that in the United States in 2008, one has to organize protests in order to save a life. But here we are. From the CNA’s Guaranteed Healthcare website, where there are dozens of similar stories:

This is Nick’s older brother, Ricky, and I want to ask all of you for a huge favor. Our insurance company, PacifiCare, denied Nick to go to Kansas City for a special treatment of radiation for his cancer (this could save his life). Nick has suffered with cancer for 4 years of his life and he has exhausted every avenue to get better, but nothing worked. This is our last effort and this procedure has worked before with people in Nick’s situation. I think it is our duty to stand up for Nick and tell PacifiCare that what they are doing is wrong.

I am putting together a demonstration in front of the PacifiCare building at 5701 Katella Ave Cypress, CA 90630. Tuesday, March 25th, at 10:00 a.m. We are getting the media to step in and put pressure on (kcal9 and newspapers).

If we can at least get 300 people there I know they will have to say something about it. I know that my brother isn’t the only one suffering because of America’s poor healthcare system.

If you guys know anyone else that is suffering because of this, have him or her come out too. We need to let not only PacifiCare but America know that what they are doing is wrong and we need change.

Thank all of you so much.  

Ricky Colombo

From Eve’s diary at dKos:

Here are the emails I received from the California Nurses Association.

Just received a call from Ricky Columbo.  His brother Nick has cancer, and the treatments thus far have been ineffective.  The docs recommend cyberknife. Insurance won’t pay.

   He is organizing a protest outside the Pacifica Care building in Cypress, CA next Tuesday at 10.  He heard CNA did this kind of thing, and would like CNA to come and support the effort.  He says he has already rallied a bunch of people to come to it, thinks there is going to be a big crowd.

   He has also spoken with Dave Lopez at Channel 9, who is supposedly covering it.

Here’s another just received:

Just spoke to the young man, Ricky, 19.  Nick, this boy with Ewing’s Sarcoma (bone cancer) is only 17 – The mother works long hours preparing taxes for people and cares for the son before she leaves; the father then comes home earlier in the day to care for his son.

   They have had a local TV reporter to their home to interview Nick and are hoping to get more attention to push PacifiCare.

   Donna Smith

   Communications Specialist

   California Nurses Association

The contact information is PacifiCare at 714-828-1821 or Tyler Mason, the UnitedHealth/Pacificare spokesperson at 714-226-3530.

More info and background below.

At issue is a procedure known as “cyberknife.” I’m not a doctor, so I won’t pretend to know what exactly this involves. But the treatment is not considered surefire, although it is believed that it’s Nick’s best hope for survival. There is some dispute about whether or not the treatment is “experimental” and one Kossack who called PacifiCare was told this:

Just called and talked to Tyler Mason, the spokesguy…

He said that Nick Colombo’s claims were reviewed by USC and Stanford (which developed cyberknife).  Both hospitals said that Nick was not a good candidate for the procedure.  He also said that California regulators reviewed the request.  He said that the family found a doctor in Oklahoma who holds out some hope for cyberknife and they are pinning their hopes on this.

Poor Msson was upset at the 100s of calls he was getting and didn’t know where they were coming from or why.  🙂

I don’t doubt that Mason is spinning the facts and that there is more to the story.   I also think that Pacifica should pay for the procedure even if only one doctor says that it could help.   But I thought I should post Mason’s response.

And California Nurses Shum had this to say about the dispute between Nick’s doctors and PacifiCare:

For now, we have a compelling case with an important point: the medical decisions of this youth have been compromised by the system we have let him fall into.  For now, we can save one person shortchanged by the industry–and hope that his story will inspire the changes that all of us need.

At the end of the day, none of us can truly unwind the medical disagreement here: Nick’s doctors vs. PacifiCare’s.  But we can all see that Nick’s care decisions are taking place in an environment where PacifiCare’s profits are valued as much as his life, and we can never trust the results.

I think that’s an excellent response to PacifiCare’s attempt to muddy the waters. Many doctors dislike the insurance system partly because it limits their ability to provide care to their patients in this way (and it doesn’t help that insurers routinely stiff doctors on reimbursements).

Ultimately this is another example of why it is such a bad idea to have insurance involved in the delivery of basic health care at all. That’s not to say that government-run single-payer care would not have limits on what it could provide. But it would also not have the profit motive that leads insurers like Cigna and PacifiCare to coldly allow a young patient, who is insured, to die.

In Canada, for example, when there aren’t enough beds in town for a patient, the provincial health care authority will fly a patient to a place where there ARE enough beds, at no cost to that patient. In France the government health provider ensures that a sick child gets the full range of treatment he needs to live.

In America, however, we have this:

Hospitals Rank UnitedHealth/PacifiCare “Worst” Insurance Company in Nation

The Minnetonka, Minn.-based insurer received an “unfavorable” opinion from 91% of the hospital executives who responded, while 8% gave it a “favorable” rating. United owns PacifiCare of California.

California investigates 100,000 claims processing problems by Pacificare

UnitedHealth/Pacificare Looking at 13% Growth

   UnitedHealth Group Inc., the largest U.S. health insurer, is poised to reach its forecasts of 13 percent profit growth this year and next, even after being accused of cheating customers by New York’s attorney general.

Former CEO of UnitedHealth had to surrender ***$620***million in pay for options backdating scandal

And PacifiCare was fined for its claims denial problems…a paltry $3.5 million:

Pacificare fined $3.5 million

“This is off the scales in terms of severity. We rarely see so many complaints,” said state Insurance Commissioner Steve Poizner. “I simply will not tolerate shoddy claims practices.”

Stories like Nick Colombo’s and Nataline Sarkisyan’s show us just how dire the state of health care in America has become, just how much we need root and branch reform – single-payer reform. With the failure of the pro-insurance industry mandate plan back in January, the initiative now seems to be with the advocates of single-payer care. Protest actions such as this will not only help save the life of a SoCal teen, but will help save many more lives as they hopefully become the basis of a broader single-payer movement.

It’s horrific that it takes a teenager facing death for us to see just how deeply flawed the health insurance concept has become in America. But, here we are. Let’s hope that PacifiCare does the right thing for Nick Colombo, and that WE can do the right thing and start working to ensure that all Americans have guaranteed access to affordable health care whenever and wherever they need it.

A full list of contact info, from nyceve:

You can also call this guy:

UnitedHealthcare

Tyler Mason, 714-226-3530–spokesperson

[email protected]

Main #: 714-952-1121

Then, you can move on to investor relations:

UnitedHealth Group

P.O. Box 1459

Minneapolis, MN 55440-1459

Ph. (800) 328-5979

Investor Relations Contact:

Cheryl Mamer

UnitedHealth Group

MN008-T930

9900 Bren Road East

Minnetonka, MN 55343

Ph. (800) 328-5979

Fax (952) 936-1819

[email protected]

Here’s contact information for Pacificare:

Contact Information

Telephone Numbers

Main Telephone Number: 1-800-624-8822

Hearing Impaired (TTY): 1-800-442-8833

“I Am Not A Health Reform” appears in today’s New York Times, an op-ed by two Harvard professors of medicine and members of Physicians for a National Health Program, a group of doctors working for single-payer health care. In it, they explain that the “individual mandate” approach that Speaker Núñez has now caved to is by no means a new or untested idea – that it has failed everywhere it has been tried. And it’s been tried many places:

IN 1971, President Nixon sought to forestall single-payer national health insurance by proposing an alternative. He wanted to combine a mandate, which would require that employers cover their workers, with a Medicaid-like program for poor families, which all Americans would be able to join by paying sliding-scale premiums based on their income….

In 1988, Massachusetts became the first state to pass a version of Nixon’s employer mandate – and it added an individual mandate for students and the self-employed….In 1988, 494,000 people were uninsured in Massachusetts. The number had increased to 657,000 by 2006.

Oregon, in 1989, combined an employer mandate with an expansion of Medicaid and the rationing of expensive care….The number of uninsured Oregonians did not budge.

They go on to describe how Minnesota, Vermont, Tennessee, and Washington all passed various forms of mandated insurance in the early 1990s, only to see the number of uninsured fail to decline and in many cases continue to rise. They then turn to Massachusetts’ reform, which is failing:

As governor, Mitt Romney tweaked the Nixon formula in 2006 when he helped devise a second round of Massachusetts health care reform: employers in the state that do not offer health coverage face only paltry fines, but fines on uninsured individuals will escalate to about $2,000 in 2008….Yet even under threat of fines, only 7 percent of the 244,000 uninsured people in the state who are required to buy unsubsidized coverage had signed up by Dec. 1. Few can afford the sky-high premiums.

Why has this failed?

Each of these reform efforts promised cost savings, but none included real cost controls. As the cost of health care soared, legislators backed off from enforcing the mandates or from financing new coverage for the poor. Just last month, Massachusetts projected that its costs for subsidized coverage may run $147 million over budget.

Hmmm…no cost controls, rising costs of care, and a deficit that limits the availability of subsidized coverage. Sound familiar?

The Núñez-Schwarzenegger plan does not appear to have ANY firm cost controls in place. The 5% out-of-pocket maximum, which previously applied to families up to 300% of FPL, now only applies to 250% of FPL, which for 2007 was $34,225 for a family of two (my fiancee and I make twice that) and $51,625 for a family of four. The California median income as of 2004 was $54,385 – meaning over half the population would have NO statutory protection from crippling out of pocket costs. Their only recourse would be to plead their case to the MRMIB, which would be a daunting and discouraging challenge for most Californians, who have no idea how to go through such a process.

Further, the minimum “creditable” coverage for the mandated plans will NOT be guaranteed in law. As Sal Roselli pointed out, this is a bad approach. Similarly, SEIU’s Jeanine Meyer Rodriguez, quoted by Matt Lockshin, agreed that having MRMIB determine the minimums was bad policy:

As a matter of policy, the bill must be amended to require that a specific and appropriate minimum benefit package, such as a standard HMO package plus prescription drugs, be available to an individual for less than 6.5% of their income in order for them to be mandated to carry coverage.  Allowing MRMIB to define this minimum benefit package rather than specifying it in statute could result in middle income Californians being compelled to buy coverage that they can’t afford to use if the deductibles and out of pocket costs are too high.

So we have a plan without firm cost controls for over half the population, no reliable guarantee of a minimum, useful coverage for these mandated plans (as I read the text of the amended bill, “health insurance plan” is specifically defined to exclude vision and dental). Further, it’s by no means clear that federal courts will uphold the employer mandates, or that if they did, that CA’s fate would be any different than the six states that already tried this. Finally, MA is already running deficits in the funding of their subsidized coverage, which suggests that CA’s $14 billion deficit is even more relevant to this issue than we had previously realized.

The PNHP op-ed’s conclusion about these kinds of plans seems appropriate in our context:

The “mandate model” for reform rests on impeccable political logic: avoid challenging insurance firms’ stranglehold on health care. But it is economic nonsense. The reliance on private insurers makes universal coverage unaffordable.

We’ve seen this train wreck before. This time, maybe we should think about not letting this train even leave the station.

The Employee Retiree Income Securtity Act of of 1974 means that only Hawaii can legislate employer mandates (10 steps down from Single Payer). Hawaii is unique for a whole bunch of reasons, but they have done better for decades than the rest of the states due to their excemption.

When the Fed didn’t step up, Hawaii did. Now that the California has yet to step, San Francisco is trying (can’t wait to see the author — Tom Ammiano — in the Assembly). Yet the same old ERISA complaint.

And the Consolidated Omnibus Income Security Act of 1985 pretty much means health care will suck (despite out of the best intentions) until we get real primary care.

ERISA did a lot of great things, but it should be amended. Of minimum, common sense revision would still not bring about single payer, but it would give local governments some parlay room.