UNIVERSAL HEALTH CARE EDUCATION FUND ~ VOLUME 5, NUMBER 1 ~ SPRING 2011 CommonHealth Filing Our Bill National Action“An Act for Improved Medicare for All In Massachusetts:Providing Guaranteed Affordable Health Care” was ﬁled by co-sponsors Senator Jamie Eldridge and Representative Jason Lewis,and has been referred to the Joint Committee on Health CareFinancing. About forty-ﬁve other legislators have signed on asco-sponsors. Thanks to the analysis provided by GeraldFriedman, U-Mass Amherst economist (see page 3), we knowthat our current single-payer bill, when passed andimplemented, will save the Commonwealth of Massachusetts, itsbusinesses, families and individuals at least $9 billion per year!You can read the bill and Friedman’s analysis on the Mass-Careweb site.Like our previous bills, this one will provide quality health care Ben Day welcomed James Haslam from the Vermontfor all Massachusetts residents, eliminate the large amount of Workers Center to our Ben Gill gala. He brought us upinsurance overhead (including huge CEO compensation and to date on the exciting grassroots movement formarketing) taken out of each of our health insurance premium single payer in the Green Mountain State. On May 1st,dollars, eliminate the high cost to medical providers for dealing as the bill moved forward but remained vulnerable towith the voluminous paperwork and varying regulations required crippling amendments, supporters rallied in Mont-by individual insurers, eliminate price gouging by setting prices pelier to make sure health care would become afor manufacturers and service providers, and encourage early human right, no longer a commodity or privilege.intervention and prevention of diseases, and set reasonable Among the Massachusetts folks who joined the rallylimits on administrators’ compensation.Unlike our previous bills, it has a new name. It’s no longer called“An Act to Establish a Health Care Trust,” even though it would -and it speciﬁes how Medicare for All would be ﬁnanced.1) An employer payroll tax of 7.5 percent will be assessed,exempting the ﬁrst $30,000 of payroll per establishment,replacing previous spending by employers on health premiums.An additional employer payroll tax of 0.44% will be assessed onestablishments with 100 or more employees;2) An employee payroll tax of 2.5 percent will be assessed,replacing previous spending by employees on health premiumsand out-of-pocket expenses;3) A payroll tax on the self-employed of 10 percent will beassessed, exempting the ﬁrst $30,000 of payroll per self- were Sue & Abe Chipman from Brookline and Peteremployed resident; and Knowlton from Taunton, heading a strong presence4) A tax on unearned income of 12.5 percent will be assessed to by the United Electrical Workers. The California singlefairly distribute the costs of health care across various sources of payer bill was recently reported out favorably by theincome. (Social Security and welfare and disability payments will Senate healthcare committee. On Capitol Hill,not be considered unearned income.) Representative John Conyers reﬁled his Medicare for All bill, HR.676. Senator Bernie Sanders of VermontA private or public employer may agree to pay all or part of an and Representative Jim McDermott of Washingtonemployee’s payroll tax obligation. Such payment shall not be have just ﬁled a bill endorsed by the AFL-CIO thatconsidered income for Massachusetts income tax purposes. would move the country forward to single payer through partnership with the states, requiring a highYou can help to get the bill passed by informing your legislators standard of care nationally. - Sandy Eaton, RNabout it and asking them to sign on as supporters if they havenot already done so. You can also help by asking current co- Universal Health Care Education Fund c/o Mass-Caresponsors (listed on the Mass-Care web site) to actively work to 33 Harrison Avenue, Fifth Floor, Boston, MA 02111get the bill moved out of committee, acted on and passed on the P: 617-723-7001, F: 617-723-7002ﬂoor of both houses of our legislature. - Judy Deutsch email@example.com http://www.masscare.org
UNIVERSAL HEALTH CARE EDUCATION FUND ~ VOLUME 5, NUMBER 1 ~ SPRING 2011 Health Care Costs & the Needless Mass-Care Single Payer Gala Fills Attack on Public Sector Employees Ryles Jazz Club in CambridgeIn order to rein in a massive budget deﬁcit - a deﬁcit It was standing room only at the 13th Annual Gala incaused more by health care costs than any other factor - Memory of Benjamin Gill on March 26th! While enjoying athe Massachusetts House of Representatives recently spread of tasty snacks from S&S Deli, attendees socializedpassed a proposal that would allow cities and towns to and listened to music by Bo Winiker (trumpet) and Jamiestrip public employees of their right to bargain health Saltman (piano).care beneﬁts, and both the Senate and Governors officeare contemplating compromise versions of this proposal. Mass-Care co-chair Jackie Wolf welcomed everyone andThis is tragic for three reasons: introduced the ﬁrst keynote speaker, UMass economist Gerald Friedman. Professor Friedman’s engaging styleFirst, it is not true that public employees enjoy better kept everyone’s attention as he explained the impact ofwages and beneﬁts than the rest of us. Compared with single payer reform in Massachusetts and options forprivate employees with the same education level, public ﬁnancing it.workers have better beneﬁts but lower wages. This trade-off turns out to apply to all of us: the economics literature During a break for dessert, everyone had a ﬁnal chance tohas found that employers do not pay for any health care buy raffle tickets and Mass-Care items such as hats andcosts, but rather pass these costs on to employees in the Pat Berger’s posters before Katie Murphy conducted theform of lower wages. When the country goes through raffle drawing. Joseph Lillyman’s piano solos provided theperiods of rapidly climbing health care costs, real wages perfect background music, which even stimulated some ofstagnate or decline - in fact, almost all of the stagnation the attendees to dance.in lower- and middle-class wages is due to our healthcare system producing out-of-control costs. Unionized The 2011 Dr. Benjamin F. Gill Memorial Awards wereworkers just have the luxury, if you can call it that, of presented to three honorees for their consistent work intrading better health coverage for their families in support of Universal, Single Payer Health Care inexchange for lower wages than private sector workers Massachusetts:receive for the same work. If the House budget were tobecome a reality, it is likely that municipal employees who • Reverend Judy Deutsch, for her tireless efforts on behalfhave been sacriﬁcing wages for years to retain health care of single payer since 1945.coverage, will lose both and fall behind their private- • Matthew Patrick, State Representative from the 3rdsector counterparts. Barnstable district for ﬁve terms, who was the lead sponsor of the single-payer bill in 2009-2010 and aSecond, none of this is necessary. We are the only country leading advocate for progressive energy reform andin the world with costs as high, and growing as rapidly, as democratization of the legislature.ours. In exchange for our high and rapidly rising costs, we • Walpole Peace and Justice, who put a single–payeractually get worse health outcomes and extraordinarily question on the ballot in Walpole and Norwood and wonpoor access to needed care. Health care is now about half majority support in that district, as well as for a ballotof the state budget, consumes almost all of municipalities question in Walpole and Dedham.new revenue each year, and we are getting literallynothing for our new spending each year. A single payer The second keynote speaker, direct from Vermont, wasplan for Massachusetts, which is not experimental and James Haslam, Executive Director of the Vermont Workershas been tried and proven around the globe, would save Center. His group has carried out a well-organized, highlystate and local governments in Massachusetts between successful grassroots campaign that has resulted in$1.5 and $2 billion, according to estimates from UMass Vermont possibly becoming the ﬁrst state in the nation toeconomist Gerald Friedman. This would close our budget enact single payer health care legislation. Mr. Haslam’sdeﬁcit. Municipalities, like all other employers, would pay energy and enthusiasm were inspiring to all as he detaileda 7.5% payroll tax, and would not have to face rising the steps involved in organizing the campaign.health care premiums ever again. Almost all municipalitiescurrently spend upwards of 15% of payroll on health care The program ended with remarks from Ben Day.costs - the city of Boston, for example, spends about20%. This event was a success thanks to the leadership of Mass-Care co-chair Pat Berger. The Gala Program BookletLastly, although you have all heard a lot of rhetoric about was attractive and fun to read(!), thanks to Ben Day andpublic employees having lavish beneﬁts paid for by intern Claudia Chauca. Volunteers who helped producetaxpayers (which we have just disproved - public the event included: Carol Caro, Asha Cesar, Martyemployees are paying for their own beneﬁts with lower Downes, John Blanchard, Vic Bloomberg, Joseph Lillyman,wages), remember who pays for most tax revenue: rich Bea Mikulecky, Nivedita Poola, Leo Stolbach and Mariapeople! Massachusetts has a ﬂat income tax, which means Termini. - Bea Mikuleckyit is not as progressive as the federal income tax, but still- because income inequality is so high in Massachusetts - Logo of the Health Care is a Humana very large share of our total tax revenue comes from Right Campaign of the Vermonthigh income households paying their share. When we shift Workers Centercosts from tax revenues onto patients, which is what thestate is proposing by cutting coverage for public workers,we are also making our health care ﬁnancing much moreregressive, and letting high-income earners off the hook.
UNIVERSAL HEALTH CARE EDUCATION FUND ~ VOLUME 5, NUMBER 1 ~ SPRING 2011 Can we afford universal coverage? Can we afford anything else?American health care is afflicted by two unsustainable conditions, rising costs and declining coverage. While critics chargethat a single-payer health insurance system would exacerbate the cost problem by expanding coverage, such criticism isfounded on a mistaken model of health care and is inconsistent with the experience of other countries with public healthcare systems providing universal access. Indeed, it appears that the only way that the United States can control health carecosts and avoid ﬁscal and economic catastrophe would be by establishing a system of universal health insurance with asingle payer.Advocates of single-payer health insurance recognize that therising cost of health care threatens the American economy. Fordecades, the cost of health insurance has been rising at over twicethe general rate of inﬂation; the share of American income goingto pay for health care has more than doubled since 1970 from 7%to nearly 17% even while more Americans are doing without healthinsurance or have inadequate coverage.If health insurance were like other commodities, like shoes or bowties, then reducing access would lower costs. But health insuranceis different because insurers can increase proﬁts by reducingaccess to insurance even when this drives up total expenditures.The health insurance and health care economy are different frommost other markets because private companies selling insurance do not want to sell to everyone but only to these unlikelyto need health insurance. Insurers proﬁt by screening subscribers to identify those likely to submit claims and to harassthem so that they will drop their coverage and go elsewhere. The collection of insurance related information has become amajor source of waste in the American economy because it is not organized to improve patient care but to harass and todrive away needy subscribers and their health-care providers. Because driving away the sick is so enormously proﬁtable forhealth insurers, they are doing it more often, creating the enormous bureaucratic waste that characterizes the process ofbilling and insurance handling. Rising by over 10% a year for the past 25 years, health insurers’ administrative costs areamong the fastest rising costs in the American health care sector. Doctors in private practice now spend as much as 25% oftheir revenue on administration, nearly $70,000 per physician for billing and insurance costs.Not only are health-insurance administrative costs wasteful, they create waste by driving the sick into more expensive caresettings. Inadequate health insurance turns small conditions into major problems, and drives the sick from doctor’sofficers into expensive emergency room and hospital settings.The great waste in our current private insurance system is an opportunity for policy because it makes it possible toeconomize on spending by replacing our current system with one providing universal access. I have estimated that inMassachusetts, a state with a relatively efficient health insurance system, it would be possible to lower the cost ofproviding health care by 17% (as much as $10 billion a year) largely by reducing the cost of administering the privateinsurance system with most of the savings coming within providers’ offices by reducing the costs of billing and processinginsurance claims. In a report prepared for the State of Vermont, Professors Hsiao (Harvard) and Gruber (MIT) estimate thatshifting to a single-payer could lead to savings of around 25% through reduced administrative cost and improved deliveryof care (saving $600 million in little Vermont).A comparison of health care in the United States with health care in other countries also demonstrates how a single-payersystem leads to cost savings by improving care. When Canada ﬁrst adopted its current health-care ﬁnancing systemaround 1970, the health-care share of the national gross domestic product was similar in the United States (7.1%) as inCanada (6.9%). Since then, however, health care has become dramatically more expensive in the United States where healthcare spending has risen by over $6,900, nearly double the increase in Canada. Had Americans experienced better healthoutcomes, then we might accept these higher costs. Instead, however, we have gone from a relatively healthy country tothe country with the shortest life expectancy of these advanced economies. Our gain in life expectancy since 1971 (5.4years for women) is impressive except when put beside other advanced economies (where the average increase is 7.3years). Had the United States increased life expectancy at the same dollar cost as in other countries, we would have savednearly $4,500 per person; had we increased life expectancy at the same pace per dollar spent as in other countries, wewould have bought an extra 10 years of life expectancy.The international comparison also provides another perspective on any supposed trade-off between cost containment andcoverage expansion. In other countries than the United States, almost all of the increase in health care spending out ofnational income is due to better quality health care as measured by improvements in life expectancy. The problem of risinghealth care costs is almost unique to the United States, the only country without universal coverage and without anyeffective national health plan. - Professor Gerald Friedman
UNIVERSAL HEALTH CARE EDUCATION FUND ~ VOLUME 5, NUMBER 1 ~ SPRING 2011 Coffee with Susanna Reaching Out to CongregationsWe were gossiping, talking about almost everything, A few months ago, I started working as an outreachthen our mood changed as Susanna dropped a bomb volunteer with Mass-Care. I have been very busy contactinginto our other wise comfortable conversation. churches and congregations to offer them a presentation on the promise of single payer health care. I am also writingLast month she had a suspicious mammogram, letters to the editor. I decided to take on this task when Iher doctor ordered a second set of x rays, realized how clearly health care is a justice issue. It is crucialbut her insurance company won’t pay for them. and natural for faith communities to work for justice in health care. I sense a lot of confusion from people aboutSusanna is a single mother, a job by itself, single payer health care and believe that education on thisand she works another full-time job, issue is the place to start.barely gets by and can’t afford home repairs. I have developed, with expert help from Dr. Pat Berger, a short presentation that explains the crisis in health care, theMy friend’s voice shakes with worry, qualities of sustainable health care reform, what single payerwe both know her mother died of cancer. health care is, and how it represents justice in health whichSomething is very wrong with this picture, is most truly a human right.even though my friend has insurance I also talk about how past health care reforms have failedshe can’t get the care she needs, and how the single payer bill currently in the Massachusettsbecause corporate profits and greed legislature, the Medicare for all Massachusetts Bill, can givecontrol our health care industry. everyone affordable, comprehensive and sustainable healthHow long will this injustice continue? care. I would like to make single payer health care a household word in Massachusetts and believe that peopleMaria Termini will support single payer health care to the degree that they know about it and understand it. Ellen in Medicaland I have focused on contacting congregations near Boston, butEllen Kagan has reached many thousands over the last we need to expand this outreach to the entire state. I have aﬁfteen years through her health education TV and radio background in this kind of work because of my experienceseries, Your Health Care: Choice or Chance? Her tales with Habitat for Humanity, which involved coordinatingfrom the healthcare twilight zone will now continue to hundreds of volunteers from many congregations whobring compassion and hope to wider audiences through worked to build houses with poor families. I believe people print, now avail- of faith are ready to work for justice in health care. Please able on Kindle. A contact me if you know a congregation or group that would study published like a presentation or if you would like to be on our recently reveals committee. that hospital care injures almost one - Maria Termini, 617-928-1544, firstname.lastname@example.org in ﬁve patients. Bureaucratic efforts have failed to improve patient safety after a de- cade of trying. Only an enlight-ened, engaged and outraged population will establishand enforce high standards of care. Ellen has workedon the cutting edge of the movement for that standard.We continue this ﬁght for high standards as a right ofeveryone encountering our proﬁt-driven healthcarenon-system. - Sandy Eaton, RNPicture at right: Peter Knowlton and his grandson Travis celebrateMay Day and enjoy the good weather in Vermont whilecampaigning for a just healthcare system. CommonHealth, Volume 5, Number 1: Director: Benjamin Day Editor & Photographer: Sandy Eaton Production: Erin Servaes Printing compliments of the Massachusetts Nurses Association