muddying up the waters

Do we in the Working Class have any supporters left in congress?

Here's an article well worth reading and thinking about.
Carl Jarvis
***

A Proposal Designed to Confuse Public and Prevent 'Medicare for All'
Michael Fleshman / CC 2.0

The Center for American Progress (CAP), a Washington-based Democratic Party
think tank funded by Wall Street, including private health insurers and
their lobbying group, unveiled a new healthcare proposal designed to confuse
supporters of "Medicare for All" and protect private health insurance
profits. It is receiving widespread coverage in 'progressive' media outlets.
We must be aware of what is happening so that we are not fooled into another
'public option' dead end.*

The fact that CAP is using Medicare for All language is both a blessing and
a curse. It means Medicare for All is so popular that they feel a need to
co-opt it, and it means that they are trying to co-opt it, which will give
Democrats an opportunity to use it to confuse people.

This effort could be preparation for the possibility that Democrats win a
majority in Congress in 2018 or 2020. It is normal for the pendulum to swing
to the party opposite the President's party during the first term in office.
If Democrats win a majority, they will be expected to deliver on health
care, but they face a dilemma of having to please their campaign donors,
which includes the health insurance industry, or pleasing their voters,
where 75% support single payer health care.

The public is aware that the Affordable Care Act (ACA) protects the profits
of the medical-industrial complex (private health insurers, Big Pharma and
for-profit providers) and not the healthcare needs of the public. "Fixing
the ACA" is not popular. Last year during repeal attempts, people made it
clear at town halls and rallies that they want a single payer healthcare
system such as National Improved Medicare for All (NIMA). By offering a
solution that sounds good to the uninformed, "Medicare Extra for All," but
continues to benefit their Wall Street donors, Democrats hope to fool people
or buy enough support to undermine efforts for NIMA.

This is an expected development. If we look at the phases of stage six of
successful social movements by Bill Moyers (see slide 8), we see that as a
movement nears victory, the power holders appear to get in line with the
public's solution while actually attacking it. If the movement recognizes
what is happening, that this is a false solution and not what the movement
is demanding, then we have a chance to win NIMA. If the movement falls for
the false solution, it loses.

Our tasks at this moment are to understand what the power holders are
offering, recognize why it is a false solution and reject it.

"Medicare Extra for All" versus National Improved Medicare for All

The basic outline for the new proposal is that people would be able to buy a
Medicare plan, a form of 'public option,' including the Medicare Advantage
plans offered by private health insurers. People who choose to buy a
Medicare plan would pay premiums and co-pays, as they do now for private
health insurance. The new Medicare system would replace Medicaid for people
with low incomes.

Private health insurance would still exist for employers, who currently
cover the largest number of people, federal employees and the military.
While workers would have the option to buy a Medicare plan, it is unclear
how many would do so given that most employers who provide health insurance
have their own plans and that private health insurers are experts at
marketing their plans to the public.

NIMA, as embodied in HR 676: "The Expanded and Improved Medicare for All
Act," would create a single national healthcare system, paid for up front
through taxes, that covers every person from birth to death and covers all
medically-necessary care. NIMA relegates private insurance to the sidelines
where it could potentially provide supplemental coverage for those who want
extras, but it would no longer serve as a barrier for people who need care.

Here are the flaws in the CAP proposal:
1.CAP's plan will continue to leave people without health insurance.Instead
of being a universal system of national coverage like NIMA, coverage under
the CAP plan relies on people's ability to afford health insurance. Only
people with low incomes would not pay, as they do now under Medicaid. Just
as it is today, those who do not qualify as low income, but still can't
afford health insurance premiums, would be left out. Almost 30 million are
without coverage today. There is no guarantee that health insurance premiums
will be affordable.
2.CAPS's plan will continue to leave people with inadequate coverage. Under
NIMA, all people have the same comprehensive coverage without financial
barriers to care. The CAP plan allows private health insurers to do what
they do best - restrict where people can seek health care, shift the cost of
care onto patients and deny payment for care. This is the business model of
private health insurers because they are financial instruments designed to
make profits for their investors. People with health insurance will face the
same bureaucratic nightmare of our current system and out-of-pocket costs
that force them to delay or avoid health care or risk bankruptcy when they
have high health care needs.
3.CAP's plan will continue the high costs of health care. NIMA has been
proven over and over to have the best cost efficiency because it is one plan
with one set of rules. It is estimated that NIMA will save $500 billion each
year on administrative costs and over $100 billion each year on reduced
prices for pharmaceuticals. As a single purchaser of care, NIMA has powerful
leverage to lower the costs of goods and services. The CAP plan maintains
the complicated multi-payer system that we have today. At best, it will only
achieve 16% of the administrative savings of a single payer system and it
will have less power to reign in the high costs of care.
4.CAP's plan will allow private health insurers to continue to rip off the
government. NIMA is a publicly-financed program without the requirement of
creating profits for investors. With a low overhead, most of the dollars are
used to pay for health care. The CAP plan maintains the same problems that
exist with Medicare today. Private Medicare providers cherry pick the
healthiest patients and those who have or develop healthcare needs wind up
in the public Medicare plan. This places a financial burden on the public
Medicare plan, which has to pay for the most care, while private health
insurers rake in huge profits from covering the healthy with a guaranteed
payor, the government.
5.CAP's plan will continue to perpetuate health disparities. NIMA provides a
single standard of care to all people. Because all people, rich and poor
(and lawmakers), are in the same system, there are strong incentives to make
it a high quality program. CAP's plan maintains the current tiered system in
which some people have private health insurance, those with the greatest
needs have public health insurance, some people will have inadequate
coverage and others will have no coverage at all.
6.CAP's plan will continue to restrict patients' choices. NIMA creates a
nationwide network of coverage and consistent coverage from year-to-year so
that patients choose where they seek care and have the freedom to stay with
a health professional or leave if they are dissatisfied. CAP's plan
continues private health insurers and their restricted networks that dictate
where patients can seek care. Private plans change from year-to-year and
employers change the plans they offer, so patients will still face the risk
of losing access to a health professional due to changes in their plan.
7.CAP's plan does not guarantee portability. NIMA creates a health system
that covers everyone no matter where they are in the United States and its
territories. CAP's plan maintains the link between employment and health
coverage. When people who have private health insurance lose their job or
move, they risk losing their health insurance.
8.CAP's plan will perpetuate physician burn-out. NIMA creates a healthcare
system that is simple for both patients and health professionals to use.
Under the current system, which the CAP plan will perpetuate, health
professionals spend more time on paperwork than they do with patients and
physician offices spend hours fighting with health insurers for
authorization for care and for payment for their services. This is driving
high rates of physician burnout. Suicides among physicians and
physicians-in-training are higher than the general population.

The new proposal is a 'public option' wrapped in a "Medicare for All" cloak.
It is a far cry from National Improved Medicare for All. And, contrary to
what CAP and its allies will tell you, the CAP plan will delay and prevent
the achievement of NIMA.

Co-founders of Physicians for a National Health Program**, Drs. Steffie
Woolhandler and David Himmelstein, explained why the public option would not
work in the last health reform effort:

"
"The 'public plan option' won't work to fix the health care system for two
reasons.

"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."

What we must do

The movement for National Improved Medicare for All experienced tremendous
growth in the past few years. All of the flaws of the Affordable Care Act
are becoming reality as people are forced to pay high health insurance
premiums, face high out-of-pocket costs before they can receive care and
have their access to health professionals or services denied. There is a
strong demand for NIMA that has resulted in more than half of the Democrats
in the House of Representatives signing on to HR 676 and a third of the
Democratic Senators endorsing the Senate Medicare for All bill. Medicare for
All is becoming a litmus test for the 2018 elections and 2020 Democratic
presidential nomination.

Power holders are feeling threatened by support for NIMA. They are looking
for ways to throw the movement off track and allow lawmakers who don't
support NIMA to support something that sounds like NIMA. This is why they
invented "Medicare Extra for All." It is common for the opposition to adopt
our language when we have strong support.

This is the time when the movement for NIMA needs to remain focused on our
goal of NIMA, resist compromising and escalate our pressure for NIMA. We are
closer to winning, it's time to increase our efforts to pass the finish
line.

Here are our tasks:
.We need to expose the reasons for CAP's proposal. It is designed to protect
health insurance industry profits.
.We need to educate ourselves and others about the reasons why CAP's
proposal is flawed and deficient.
.We need to educate and challenge lawmakers and candidates who speak in
favor of CAP's proposal and push them to support NIMA.
.We need to be loud and vocal in our demand for nothing less than NIMA, as
described in HR 676.
.We need to make support for HR 676 a litmus test in the upcoming elections.

We need to practice "ICU" - being independent of political party on this
issue by not tying our agenda to the corporate agenda of major political
parties, being clear about what will and what will not solve our healthcare
crisis, and being uncompromising in our demand for National Improve Medicare
for All.

With a concentrated effort for NIMA, we can overcome this distraction*** and
win National Improved Medicare for All. This is the time for all supporters
of single payer health care to focus on federal lawmakers from both parties.
Movements never realize how close they are to winning and victory often
feels far away when it is actually close at hand.

The fact that the Democrats are proposing something that sounds like NIMA
means we are gaining power. Let's use it to finally solve the healthcare
crisis in the United States and join many other countries in providing
health care for everyone. NIMA is the smallest step we can take to head down
the path of saving lives and improving health in our country.

*The 'public option' dead end occurred during the health reform process of
2009-10. Faced with widespread public support for National Improved Medicare
for All, and 80% support by Democratic Party voters, the power holders had
to find a way to suppress that support. They created the idea of a 'public
option,' a public health insurance for part of the population, and convinced
progressives that this was more politically-feasible and a back door to a
single payer healthcare system. Tens of millions of dollars were donated to
create a new coalition, Health Care for America Now (similar in name to
Healthcare-Now, a national single payer organization - this was
intentional), that organized progressives to fight for this public option
and suppress single payer supporters (they were openly hostile when we
raised single payer). Many single payer supporters fell for it, and the
movement was successfully divided and weakened. Kevin Zeese and I wrote
about this in more detail in "Obamacare: The Biggest Health Insurance Scam
in History."