Massachusetts Health Reform Bill: A False Promise of Universal Coverage By Steffie Woolhandler, M.D., M.P.H. and David U. Himmelstein, M.D.
April 6, 2006 by CommonDreams.org http://www.commondreams.org/views06/0406-35.htm It's a stirring scene. The Governor, legislative leaders and leaders of Health Care For All standing in the State House Rotunda declaring victory in the fight for universal health coverage. Unfortunately, this week's tableau merely repeats one from 20 years ago when Governor Dukakis was celebrating passage of his universal healthcare bill. That plan imploded within two years, and today about 250,000 more people are uninsured in Massachusetts than the day it was signed. Unfortunately, Massachusetts' new health reform legislation looks set to repeat that disaster. What's in the New Bill? The new bill includes three key provisions meant to expand coverage. First, it would modestly expand Medicaid eligibility. Second, it would offer subsidies for the purchase of private coverage to low-income individuals and families, though the size of the subsidies has yet to be determined. Finally, those making more than three times the poverty income (about $30,000 for a single person) would have to buy their own coverage or pay a fine. To help make coverage more affordable, a new state agency will connect people with the private insurance plans that sell the coverage, and allow people to use pre-tax dollars to purchase coverage (a tax break that mostly helps affluent tax payers who are in high tax brackets). This new agency is also supposed to help design affordable plans. Businesses that employ more than 10 people and fail to provide health insurance will be assessed a fee (not more than $295) to help subsidize care. Additionally, hospitals won a rate hike assuring them better payments from state programs, and several provisions were included that are meant to attract additional Federal funding to help pay for the Medicaid expansion. What's Wrong With This Picture? First, the politicians assumed that only about 500,000 people in Massachusetts are uninsured. The Census Bureau says that 748,000 are uninsured. Why the difference? The 500,000 figure comes from a phone survey conducted in English and Spanish. Anyone without a phone or who speaks another language is counted as insured. The 748,000 figure comes from a door-to- door survey carried out in many languages (including Portuguese and Haitian Creole, common languages in Massachusetts). In sum, the reform plan wishes away 248,000 uninsured people who don't have phones or don't speak English or Spanish. It provides no funding or means to get them coverage. Second, the linchpin of the plan is the false assumption that uninsured people will be able to find affordable health plans. A typical group policy in Massachusetts costs about $4500 annually for an individual and more than $11,000 for family coverage. A wealthy uninsured person could afford that - but few of the uninsured are wealthy. A 25 year old fitness instructor can find a cheaper plan. But few of the uninsured are young and healthy. According to Census Bureau figures, only 12.4% of the 748,000 uninsured in Massachusetts are both young enough to qualify for low-premium plans (under age 35) and affluent enough (incomes greater than 499% of poverty) to readily afford them. Yet even this 12.4% figure may be too high if insurers are allowed to charge higher premiums for persons with health problems; only half of uninsured persons in those age and income categories report that they are in 'excellent health'. The legislation promises that the uninsured will be offered comprehensive, affordable private health plans. But that's like promising chocolate chip cookies with no fat, sugar or calories. The only way to get cheaper plans is to strip down the coverage - boost copayments, deductibles, uncovered services etc. Hence, the requirement that most of the uninsured purchase coverage will either require them to pay money they don't have, or buy nearly worthless stripped down policies that represent coverage in name only. Third, the legislation will do nothing to contain the skyrocketing costs of care in Massachusetts - already the highest in the world. Indeed, it gives new infusions of cash to hospitals and private insurers. Predictably, rising costs will force more and more employers to drop coverage, while state coffers will be drained by the continuing cost increases in Medicaid. Moreover, when the next recession hits, tax revenues will fall just as a flood of newly unemployed people join the Medicaid program or apply for the insurance subsidies promised in the reform legislation. The program is simply not sustainable over the long - or even medium - term. What Are the Alternatives? The legislation offers empty promises and ignores real - and popular - solutions. A single payer universal coverage plan could cut costs by streamlining health care paperwork, making health care affordable. Massachusetts Blue Cross spends only 86% of premiums paying for care. It spends the rest - more than $700 million last year - on billing, marketing and other administrative costs. Harvard Pilgrim and Tufts Health Plan - our other big insurers - are little better; each took in about $300 million more than it paid out. That's ten times as much overhead per enrollee as Canada's national health insurance program. And our hospitals and doctors spent billions more fighting with insurers over payments for each bandaid and aspirin tablet. Overall, Massachusetts residents will spend $13.3 billion on health care bureaucracy this year - nearly one third of our total health bill. If we cut bureaucracy to Canada's levels we could save $9.4 billion annually, enough to cover all of the 748,000 uninsured in Massachusetts and to improve coverage for the rest of us. Study after study - by the Congressional Budget Office, the General Accounting Office and even the Massachusetts Medical Society - have confirmed that single payer is the only route to affordable universal coverage. And single payer is popular. The Massachusetts Nurses Association supports it along with dozens of other labor, seniors and consumer groups; so do 62% of Massachusetts physicians according to a recent survey. National polls find that almost two-thirds of Americans favor a tax-funded plan like Medicare that would cover all Americans. But single payer national health insurance threatens the multi-million dollar paychecks of insurance executives, and the outrageous profits of drug companies and medical entrepreneurs. It's time for politicians to stand up to the insurance and drug industries and pass health reform that can work. [Steffie Woolhandler and David Himmelstein are primary care physicians at Cambridge Hospital and Associate Professors at Harvard Medical School. They co-founded Physicians for a National Health Program. They can be reached via [EMAIL PROTECTED] portside (the left side in nautical parlance) is a news, discussion and debate service of the Committees of Correspondence for Democracy and Socialism. It aims to provide varied material of interest to people on the left. To subscribe: http://lists.portside.org/mailman/listinfo/portside *** KATIE COURIC VERSUS AMY GOODMAN By Russell Mokhiber and Robert Weissman We haven't done the poll, but our guess is that most Americans recognize the name Katie Couric. And they wouldn't know Amy Goodman from a hole in the wall. NBC Today Show co-anchor Katie Couric said this morning that she is leaving the show to become the anchor for the CBS Evening News. Amy Goodman is the anchor of the award winning one-hour television and radio news program, Democracy Now. Couric gets more ink than Goodman in the mainstream press. That's because Couric plays by the rules of the game. Goodman doesn't. Couric has been with the Today Show for 15 years. She has also been a contributing anchor for Dateline NBC. For most of her professional life, Couric has been a celebrity interviewer and stenographer to power. According to the Today Show web site, she has interviewed "a panoply of world leaders, national political figures, writers, actors and pop culture icons." Some of her groundbreaking political interviews have been fawning sycophantic things with: George Bush Sr., George Bush Jr., Barbara Bush, Laura Bush, Hillary Clinton, Bill Clinton, Kofi Annan, Tony Blair, Jennifer Wilbanks ("whose disappearance just before her wedding day created a nationwide sensation, earning her the moniker "runaway bride"), Tricia Meili -- the Central Park Jogger, John F. Kennedy, Jr. John and Patsy Ramsey about the death of their daughter, JonBenet, Amy Goodman has reported more substantive news in one year than Couric has reported on in a lifetime. Just last week, Democracy Now ran a two part interview with Noam Chomskyabout his new book, Failed States: The Abuse of Power and the Assault on Democracy. Would Couric run a debate on the Israeli/Palestinian issue between Noam Chomsky and Alan Dershowitz, as Goodman did this year? Would Couric interview Norman Finkelstein on the same? Would she know who Norman Finkelstein is? Would Couric know Al Lewis as more than Grandpa on the Munsters? Or would she dare interview him on his radical political philosophy, as Goodman did before Grandpa Al died earlier this year? Would Couric know about the 1991 massacre of 271 peaceful protesters in Dili, East Timor by Indonesia forces? Goodman was there with the protesters, was beaten, but survived. If Katie Couric were interviewing Vanessa Redgrave, would the conversation be dominated by the death by Israeli bulldozer of peace activist Rachel Corrie -- as was Goodman's interview last month of Redgrave? Would Couric dare interview the now untouchable Harry Belafonte -- after he called the war criminal a war criminal? Would Couric travel to Nigeria -- as Goodman did -- to document Chevron's complicity with the Nigerian military in putting down an indigenous revolt? Couric is going to CBS News, the old stomping ground of Edward R. Murrow. The recently released movie of Murrow -- Good Night and Good Luck -- purports to be how Murrow stood up to Senator Joseph McCarthy and his communist witch hunts. But the movie is actually about the sacrifice of television news at the altar of corporate commercialism. Murrow had slim hopes for television. He could see the writing on the wall. As movie reviewer John Powers put it, the movie's real theme is "the inherent debasement of mass news in a commercial culture, a process so powerful that even brave individuals can't stop it." "You see, news is a product that must be able to pay for itself," Powers said on NPR's Fresh Air. "In practice, that means getting ratings, finding corporate sponsors and newsmen becoming purveyors of fluff, and that's precisely what we see happening in the film. Murrow's show 'See It Now' has to fret about alienating its sponsor, Alcoa, when it goes after McCarthy, and Murrow himself must placate CBS by hosting the celebrity interview show 'Person to Person.'" Powers says that "like it or not, the age of infotainment was in the cards from the very beginning." "And for all his highfalutin speeches about how television can educate, illuminate and inspire, Murrow could do nothing to slow it down," Power said. "Seeing it now, his famed anti-McCarthy broadcast looks less like the flowering of a golden age than a blip on the radar of packaged commercial news, rather like Shepard Smith and Anderson Cooper unexpectedly exploding with anger during Hurricane Katrina before returning to their usual sleek selves." Amy Goodman and Democracy Now are what Edward Murrow professed television could become. Katie Couric and the CBS Evening News represent what he feared it would become. Good night. Good luck to Amy Goodman and Democracy Now. Russell Mokhiber is editor of the Washington, D.C.-based Corporate Crime Reporter, <http://www.corporatecrimereporter.com>. Robert Weissman is editor of the Washington, D.C.-based Multinational Monitor, <http://www.multinationalmonitor.org>. Mokhiber and Weissman are co-authors of On the Rampage: Corporate Predators and the Destruction of Democracy (Monroe, Maine: Common Courage Press). (c) Russell Mokhiber and Robert Weissman This article is posted at: http://lists.essential.org/pipermail/corp-focus/2006/000235.html --------------------------------------------------------------------------- LAAMN: Los Angeles Alternative Media Network --------------------------------------------------------------------------- Unsubscribe: <mailto:[EMAIL PROTECTED]> --------------------------------------------------------------------------- Subscribe: <mailto:[EMAIL PROTECTED]> --------------------------------------------------------------------------- Digest: <mailto:[EMAIL PROTECTED]> --------------------------------------------------------------------------- Help: <mailto:[EMAIL PROTECTED]> --------------------------------------------------------------------------- Post: <mailto:[EMAIL PROTECTED]> --------------------------------------------------------------------------- Archive1: <http://www.egroups.com/messages/laamn> --------------------------------------------------------------------------- Archive2: <http://www.mail-archive.com/[EMAIL PROTECTED]> --------------------------------------------------------------------------- Yahoo! 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