CHAPTER ONE. WHY DEMOCRACY FOR AMERICA SHOULD NOT SUPPORT OBAMA’S PUBLIC OPTION PLAN

Written by: Rick Staggenborg, MD on May 10, 2009 6:10 AM PDT

Congress is reportedly considering a variety of universal health plan options that involve using multiple payer sources including a Medicare-like plan and traditional insurance offered by for-profit corporations. These plans are all supposed to offer similar benefits, but there is a huge debate as to whether the public option will have to be handicapped by regulations to decrease its efficiency to match the poor performance of private plans. 

We do not know the details of the negotiations because Max Baucus, chairman of the Senate Finance Committee, has closed the hearings after supporters of a single payer, Medicare for All plan tried to speak from the audience in the opening committee hearing.  Instead of being invited to join the negotiations, 13  patriots including doctors, nurses and lawyers were arrested and charged with trespassing for refusing to be silent in the face of this betrayal of the American taxpayer, including most of the millions of workers who were denied access to health care.

The Baucus 13 were forced to speak out  when Baucus refused to invite any single payer supporter to the hearing, which was dominated by representatives of the for-profit health care, insurance and pharmacy industries. 

The ostensible purpose of  the hearings is to come up with a plan that will provide health care to the millions of low and middle income wage earners whose taxes would disproportionately fund the resulting plan. Instead, experts in the economics of  single payer health care were excluded from the process of coming up with a plan. Predictably, this  will ultimately prove to be a bailout of the medical insurance industry that has caused the crisis. Perhaps it is not coincidental that these same industries gave a combined total of over 1.6 million dollars to Baucus during the previous Congress.

The public option will not work because Baucus and these lobbyists are not about to endorse a plan that will let the Medicare option outperform the private plans, as it would if it were operated as efficiently as possible. How could Medicare, with its three percent overhead not outcompete private insurance, which consumes 30 per cent of its revenue in administration, advertising, marketing and profits? 

The only reasons Medicare is so expensive is that 1) It covers the at-risk elderly and the much sicker patients who cannot get private insurance and 2) Since the passage of the Medicare Modernization Act, it has been burdened by partial privatization and the unsustainably expensive Part D medication plan that specifically bars the government from negotiating for favorable drug prices using its huge purchasing power. These problems can be corrected by incorporating what amounts to repeal of this law in the reform legislation. 

As an Oregonian, I cannot fail to note that our own Senator Wyden cast the final and deciding vote for this bill, despite strong Democratic opposition to this blatant gift to the private medical insurance and pharmaceutical industries.

The Medicare Modernization Act is a perfect example of what a Senate brought to us by corporate sponsors will produce when it is not watched closely by citizens. This is the reason we must educate ourselves about the options being considered by Congress and more importantly, the one that is being explicitly not considered, the single payer system. 

Polls show that this is the option favored by over 60% of the American public and 60% of physicians. These numbers are growing rapidly as universal insurance approaches reality and people are educating themselves about the costs and benefits of various proposals. The percentage of doctors favoring a single payer plan has increased by ten percentage points in just five years.

The public option plans are estimated to sacrifice over 80% of the savings achievable through a single payer plan in order to satisfy the corporate medical care industries that dictate policy to many of our Senators. Single payer achieves its efficiencies through a variety of means. 

It streamlines paperwork and would dramatically cut administrative costs to providers that currently consume 10 % of the health care dollar. It eliminates excessive insurance industry profits and all of their advertising and marketing expenses. It would lower administrative costs because government employees do not demand excessive salaries to serve the public. A single payer plan can monitor abuses of fee-for-service providers and administrators will have the mission of ensuring prompt payment to providers, rather than to repeatedly review claims to find loopholes to deny payment.


Most people do not realize that government is only expensive because we keep re-electing pork-loving politicians who reward their corporate masters with lavish contracts paid for by the taxpayer. If we paid more attention to what our Congressional representatives were doing and routinely got rid of those not serving the public interest, corporate money would be less influential. In other words, most of the blame for the exorbitant cost of government is ours.

We are not powerless. President Obama has told us that we must “be the change.” If we let our Congress know that we want single payer now through letters to newspapers, magazines and especially calls, emails and faxes to members of Congress, we can change minds by empowering more responsible members of Congress to resist lobbyist pressure. 

As for those who put corporate interests over those of citizens, we can send them an even stronger message in 2010 and 2012, when 2/3 of the senate will stand for re-election. While there are compelling reasons to oppose single-issue voting, the establishment of a single payer system is the defining civil rights issue that will tell us which members of Congress understand and believe in democracy and which do not.

Please learn more about the advantages of a single payer system of universal health care at the website of Physicians for a National Health Program.

Rick Staggenborg, MD


Physicians for a National Health Care Plan


Coos Bay, OR

CHAPTER THREE. WHY THE PUBLIC OPTION WON’T WORK: HOW SINGLE PAYER WILL SAVE DEMOCRACY IN AMERICA

Written by: Rick Staggenborg, MD on May 21, 2009 7:40 AM PDT

This essay is dedicated to James Madison, chief architect of the American Constitution.

Americans need to know that Congress is refusing to consider the single payer approach to universal health care for a reason: Max Baucus and other key committee members writing the legislation refuse to betray the interests of medical insurance industry lobbyists. Go to opensecrets.com and see for yourself how Baucus received 1.65 million from these corporate interests to come up with an expensive taxpayer bailout of the failing private insurance industry.

Democratic senator Charles Schumer  has announced his intention to refuse to vote for any public option plan that does not force the public option to be handicapped in such a way that it will not compete with private insurance plans using its inherent cost advantages. The result is that tens of millions of Americans will continue to suffer from lack of insurance or underinsurance.

The whole point of health care reform is not just to provide universal access to health care, but to do so in a sustainable way. We cannot afford to continue to sacrifice our children's future for the sake of the profits of these soulless corporate entities. It was a group of particularly fallible men on a previous Supreme Court that erroneously or deliberately decided that corporations have all the rights of citizens. 

Some of us find convincing Jeffrey Toobin's argument that the current court has so little respect for precedent that the rule of law itself is threatened. Fortunately, more recent decisions suggest that they have begun to take their responsibilities more seriously. (Note to reader: This was written prior to the Citizens United decision).

Thank God that erroneously decided opinions can be reversed by a more enlightened Court. The legal argument that corporations are persons as referred to in the Fourteenth amendment and thus possess the rights of natural persons was not based on precedent and is incontrovertibly erroneous. The due process clause of the Fourteenth amendment clearly states that "All persons born or naturalized" in the United States are guaranteed all the rights of the Constitution. If corporations are born, then it seems that the government should be able to execute them for crimes against humanity, but this does not seem to be the case in the Incorporated States of America.


Corporate personhood has resulted in formerly illegal lobbying practices corrupting Congress and the Senate in particular. This Court must recognize the danger of discarding stare decisis, or We the People may have to call for a constitutional convention to restore the meaning of "person" under the Fourteenth amendment to its original, intuitively obvious meaning. The only other alternative is for Congress to pass such an amendment itself, which is clearly beyond the realm of the possible with this Congress.

It is not that all politicians are working against the public interest. Many understand the problem and want to stand up for single payer but are afraid to make themselves the target of smear campaigns by these ruthless advocates of naked greed. President Obama himself has repeatedly stated that the single payer plan is optimal but that he believes it is politically impossible. This may simply represent a failure of imagination. He is said to be a political chess grandmaster and I do not rule out the possibility that he foresees the results of this blatant antidemocratic process and is waiting for the American people to rise up in righteous anger and "Be the change."

It makes little sense to me to hold the President responsible for failing to expect more out of this Congress, when he sees passage of some form of reform as critical to his ability to advance the rest of his domestic agenda. Whether or not he is considered sufficiently progressive by Democrats, the consequences of his being replaced by an even more neoconservative President with a veto pen would be disastrous, as recent history has demonstrated. 

Failure to recognize the culpability of a bought and paid for plurality in Congress would be a grave tactical error if progressives want to ever advance our cause. The only recourse is to follow the lead of Republicans and organize together to elect those Senators and Representatives who would best represent what we consider to be American principles. 

While some believe that the Democratic Party can be reformed just as the Republican Party was transformed into a blatant arm of the corporatocracy, human nature suggests that true change will only come from outside the Party. It is clear that its leadership feels that cooperation with the corporate interests that now control the political process is in their own best interests. I am sure that they believe that this is the only way to represent the People against corporate power, but their actions belie their stated intentions.

I believe that President Obama will withhold his support of single payer until the public stands up as one and demands it. This is our chance to prove that despite a dysfunctional Congress, we still have the power to take back the American government and demand that it serves the interest of the people it is supposed to represent.

Will we have a government of the people, by the people and for the people or will we simply continue to shrug and drop out of the political process in despair of the prospect of taking back our government from corporate rule? Our task is to build a movement that will take to the streets and demand that the interests of the People be given precedence to those of the corporate sponsors of campaigns for our Congressional representatives. Failure to do this would be to surrender the fight to restore democracy in America.

We need to write, call, fax and email our Congressmen and demand single payer now. If a complicated and expensive substitute is created now, we will eventually have to borrow more money from China to finance it, since there is no constituency willing to bear the burden of paying the ever-increasing cost of a multipayer system accessible to all and there is no way to prevent cost inflation in such a system. China has already indicated its hesitancy to continue financing our profligate ways. Wake up, America! We have no real choice. When the average income is projected to equal the average individual insurance premium by 2025 at current rates of growth, we must have single payer and no other form of health care reform.

It is ironic that the birthplace of modern democracy has ceded its leadership role to the former monarchies of Europe who have been able to achieve this obvious means of providing what the UN has declared is a human right. We have to stand up to the fundamentalists of the cult of Ayn Rand and prove to them that they are wrong. The pursuit of individual self interest is ultimately destructive. Just look at what it has done to the world economy if you still need proof.

Get off your knees and join the fight to preserve democracy in America. There is no use  praying that our President expend some of his enormous political capital to give us real health reform or that he would find the Senate receptive if he tried.

To paraphrase the immortal words of Jack Crabb in the classic movie "Little Big Man" as he simply used the truth to set up his revenge against the arrogant and cocksure General Custer: "You go, General. You go into the streets of America with your army of corrupt and cowardly Congressman armed only with corporate blood money. You are going to be facing millions of angry Americans. These ain’t helpless men, women and children. Them are American warriors, brave and true. They are going to fight to the death to protect their children's future. So you go, general. You go out there and see what happens."

Rick Staggenborg, MD


Physicians for a National Health Plan


Coos Bay, OR

CHAPTER TEN. THEOLOGY 101: WHY DESPAIR IS A SIN

Written by: Rick Staggenborg, MD on Jun 26, 2009 7:07 AM PDT

This essay is dedicated to Eric Shinseki, a soldier's soldier who stood up to Rumseld in telling Congress that the projected fighting strength Rummy was preparing to deploy to invade Iraq was grossly inadequate. 

Unlike political generals, the men and women who served under him were not mere cannon fodder for the politicians working for the international corporate terrorists who started that war and planned the occupations of Afghanistan, Iraq and Iran. As a military man, he knew better than the chicken hawks in the White House what would have been necessary to give our military a fighting chance of success at carrying their mission out. 



It has been customary for centuries to pray to God when preparing for battle, hoping that God will favor our cause. We inevitably believe that our forces fight for justice, and we pray that God agrees. The battle for a single payer health care system and the larger war against the corporate assault on democracy is one cause whose righteousness no one can doubt. Therefore, it is a moral imperative that as we engage in this battle, our confidence must not falter. When the fate of our children depends on our success, we cannot worry about our chances of success, because failure is not an option.

Human progress depends on the vision of those who dream of a better world and have faith in their own ability to create it. To lose hope in the sight of difficulties is to abandon that faith and to risk  leaving future generations to the vagaries of fate. 

According to the second law of thermodynamics, the natural tendency of things is to decay. Humanity must continue to resist entropy in order to survive and to thrive in the Universe. We must learn from our mistakes and constantly devise new strategies to ensure human progress, even as threats to our survival and vitality multiply in number and dangerousness.

As we stand at the edge of the opportunity to bring a single payer health care system to America, we also have an opportunity to strike a blow at the heart of one of the most dangerous enemies of freedom. The insurance industry is one of the corporate forces which have thwarted the democratic will in America since 1889, when the Supreme Court granted corporations human rights under the Fourteenth amendment clause assuring that the Bill of Rights applies to all “persons.” 

In a blatant reactionary response to Teddy Roosevelt’s attempts to rein in the dangerous power of corporate monopolists, these counter-Revolutionary “justices” used this precedent to systematically grant human rights to these legally fictitious “persons.” Ignoring the fact that a corporate “person” cannot be imprisoned or executed for the crimes it commits in the name of free enterprise and the pursuit of profit over human need, the court gave them the same constitutional protections that you and I enjoyed until they began to be stripped from us under the guise of a “war” on terror.

Belief in progress is not naïve. Self styled “realists” will tell you that human nature is such that moral compromise is always necessary and will inevitably lead us to accommodate individual self interest in any personal or governmental decision. This assumes that men and women are not capable of governing themselves either individually or collectively. Thus, those who hold this view essentially reject the core assumption necessary to believe that democracy can work.  Why do these people hate America so much?

Religious conservatives take it as an article of faith that we are all “sinners.” While it may be true that we all fall short of the Christian ideal, this should not stop us from making every effort to follow Christ’s example, rather than allowing this to become an excuse for our willful moral failings. Abraham Lincoln pointed out that we must strive to become a "more perfect" union so that the American experiment in democracy would not fail and the hope for freedom in the world would be ended for generations, if not forever.

Just as striving for perfection is a moral issue on a personal level, so does the manner in which a nation addresses social justice issues determine the character of its soul. The fight to assure that medical care is available to all when needed is one of the great social justice issues of our time.

If the United States is truly a nation whose people believe in the principle that all humans have inalienable rights to life, liberty and the pursuit of happiness then we must ensure that all citizens have the right to physical and emotional health. We must preserve life in order to use our liberty to pursue the means of happiness.  

It is a sick society in which the murder of those who regretfully terminate potential lives is condoned and even encouraged by men and women who call themselves "Christians." The majority of the morally twisted individuals who approve of this form of murder in the name of God are typically willing to callously abandon children once born, in the delusional belief that individual responsibility is the defining feature of the American character. Those who reject the idea of social responsibilty ignore the fact thar our collective well being is also the responsibility of each of us. Those who choose to be willfully ignorant of this truth commit the gravest sin of all.

As Reverend Martin Luther King observed, injustice anywhere is a threat to justice everywhere. When we allow injustice to be done to one of us, democracy is endangered. Those who care only about accumulating wealth and power would use our divisions to conquer us all. We have to recognize that the  well being of each of us is intimately dependent on assuring the well being of all of us.

A society that does not care for the least among it is a dying society. Strong citizens build strong governments and will fight any attempt to undermine the foundations of democracy through the authoritarian rhetoric of self-interested power-mongers. They believe they have a divine right to rule over the rest of us. This is the greatest threat to our democratic Republic, which is founded on the principle that every citizen has the right and duty to help make decisions that affect all of us.

Rick Staggenborg, MD


Ketchikan, Alaska

APPENDIX I. THE ECONOMIC CASE FOR A SINGLE PAYER SYSTEM

 

The following is the bullet point outline of the economic benefits of a universal single payer health care system. As noted in the introduction, this paper was presented to representatives of Congressman DeFazio's in his Eugene, Oregon office to the great skepticism of his chief aide in that office (and to the delight of the secretary taking notes). 

It was only with great difficulty that the PNHP delegation of which I was a part persuaded the staffer who dismissed our presentation to send a request for DeFazio to meet with Washington PNHP representatives. He agreed to let them meet with staffers, who presented as bored and skeptical as well. 

When I later questioned DeFazio about his position on a single payer system at a town hall in Coos Bay, Oregon he dismissed the idea as foolish because "Medicare is in serious financial trouble," neglecting to mention that the reason it was so expensive was because his Democratic colleague Ron Wyden in crossing party lines to cast the deciding vote in favor of the Republican-sponsored budget busting Medicare Modernization Act. 

This was a major factor in my decision to run against Wyden for the US senate in 2010.

1.     EFFICIENCIES

-Eliminates cost of subsidizing insurance company profits.

-Eliminates overhead from marketing, sales and inefficient review process designed to delay or avoid payment.

-Uses simplified and standardized claim forms and payment schedules or capitated formulae.

-Uses rational utilization guidelines derived from best practices, a benefit which cannot be imposed without government intervention. Such practices will save billions and produce health benefits, not just more medical care.

-Can impose reasonable formulary restrictions, like the VA.

-Maximizes benefits of electronic records to create single database and avoid duplication or delays in treatment decisions that could adversely affect outcomes (and thereby costs).

-The same unified records system has been used in Taiwan to virtually eliminate fraud and overutilization by tracking patterns of provider claims and patient utilization.

-POOLED RISKS CUTS AVERAGE COSTS OF GOVERNMENT FUNDED CARE-THIS WILL BE AMPLIFIED BY ELLIMINATING UNNECESSARY EMERGENCY CARE OF THE UNINSURED WHICH IS COVERED AT LEAST 85% BY THE GOVERNMENT

-In general, emphasis on primary care will decrease demand for secondary and tertiary care services.

2.     OTHER ECONOMIC BENEFITS

-Cut bankruptcies by 60%

      -Spinoff benefits include minimizing macroeconomic effects of recessions, encouraging entrepreneurship and career mobility.  This is not just health insurance, but bankruptcy insurance.

-Removes a major incentive to get and stay on disability. This will cut cost in Social Security, VA compensation payments and state accident insurance funds and other disability funds.

-Other insurance costs will be slashed, since they are largely driven by the cost of insuring against medical loss. Automobile, homeowner, business and other insurance will suddenly become affordable. The dollars saved will reduce the cost of extending health care to the currently uninsured and underinsured.

-Cushions effects of job loss on the individual, giving breathing room to recover without losing home, etc.

-Encourages the retirement of older workers who hold on to jobs unwillingly because they must keep their insurance until they get Medicare. Their retirements free up jobs for willing younger workers.

-Reduces burden on business, increasing competitiveness and not rewarding the shirking of benefits for profits.

-Frees insurance industry employees to find productive employment, so that they add to real US productivity.  HR 676 does not prevent their employers from reorganizing as nonprofits and competing to manage provision of a defined benefit package.This has been done effectively in Germany.

OTHER BENEFITS

-Increased access-true universal care

-Increased provider choice-no PPOs

-Fairer cost sharing. Insured individuals already pay all health care costs way already through taxes, copayments, deductibles and foregone wages yet are still unprotected from catastrophic illness and preventable disease.

-More complete, more rational and consistently defined benefits.

-Virtually eliminates malpractice claims.  Clark Newhall, a physician now practicing malpractice law, has stated that almost all tort claims are filed out of fear of bankruptcy. Taking out medical costs removes most of the profit for the sharks in this field of law and will put people like Clark out of the business of having to sue companies to protect his clients.  

COSTS

-Taxpayer contribution may increase from a present 60% of total costs. However, efficiencies may result in net savings. Canada’s per capita spending is approximately 50% lower and produces a comparable benefit package with high customer satisfaction, better health outcomes in general, and excellent access for most services. We may be able to do better.

-To function with maximum effectiveness, government will have to eventually increase subsidies for medical and nursing education.  This can be used to create loan or grant programs for those agreeing to serve underserved populations, advancing the President’s goal of promoting public service.

-Capital costs.  These could be substantial, depending on the model adopted. However, these would not be ongoing other than basic infrastructure maintenance, which is a fraction of what we would pay private insurers to provide the infrastructure at a profit.

-Retraining/unemployment benefits for insurance workers (and eventually, pharmaceutical industry employees). These could be avoided by any insurer that chooses to convert to nonprofit status.

These companies could then compete to provide a defined benefit package, a system that has worked well in Germany. To be competitive, they will probably have to reduce the multimillion dollar salaries enjoyed by medical insurance corporate CEOs.

We seem to have forgotten that there was a time when insurers were expected to be nonprofit and to utilize a shared risk pool, so that everyone was covered and we all shared the risks. For the conservative in us, we should regard that as an idea worth conserving.

Richard K Staggenborg, MD

stagmd@hotmail.com

3/12/09  (modified 7/30/09)

APPENDIX IV. HELPING GET SINGLE PAYER ON THE TABLE

      
     1.      Continue to educate yourself about single payer and alternatives.
First convince yourself that SP is the only workable, sustainable of creating  a  system of universal health care.  Check out PNHP.org for more information.

2.     Educate your friends, family, neighbors, coworkers and community about the economic and social responsibility to join the effort to demand such a system.

3.     If you know people out of state, contact them.  Each of us can reach out across the country if we are not afraid to talk to those who may disagree. This is an issue that all Americans need to understand and pressure their Congressional representatives to support.

4.     Write your senator and representative. Letters are best, they get the most attention.  Direct these letters to offices in your home state, not to Washington.

5.     Call your senator and representative in their state or D.C. offices.

6.     Write or call other politicians who will be important in the debate.

7.     Join PNHP, Healthcare Now! and other groups supporting single payer. Register for automatic email notifications about new campaigns and important news concerning the single payer movement.

8.      Write letters to the editor and editorials to your local newspaper.

9.      Call talk shows to make the case. The corporate media has been an obstacle but we can use it to make our case in this way.

10.    Attend rallies in support of single payer or other genuine health care reforms to help re-open the debate on reform.

11.   Volunteer to help at events.

12.     Have house parties showing Health Care Around the World to teach others that single payer works and that there are many models.

13.     Talk to your union reps about how to get your union endorse HR 676, the SP concept, or just putting it “on the table” for discussion in Washington.

14.      If you can, contribute to any of the groups fighting to bring us SP, the only truly sustainable universal health care plan.

15.     Help organize events with speakers who are experts on the topic.  These can be found at the PNHP website or perhaps in your communities.

MOST IMPORTANTLY, PLEASE JOIN THE EFFORT TO AMEND THE CONSTITUTION TO ABOLISH CORPORATE PERSONHOOD AND GET CORPORATIONS OUT OF THE BUSINESS OF BUYING CONGRESS:

http://movetoamend.org/