Consumer Reports becomes activist!

There's a great new website and initiative up from, of all organizations, Consumer Reports. It shouldn't really be a surprise - they did some great work earlier this year on the failure of the American health insurance industry.

The Cover America Tour begins with a bus with speakers that's traveling around to bring focus on this issue. Shades of Healthcare Now! That's exactly what Donna and Larry Smith did last autumn.

They're not single-payer, but it looks to me like most of their information points in that direction. Take a look at their media page - one of the choices there is a piece on "Six Prescriptions for Change," which reports the results of a survey of what Americans want (on a page titled: "Health-care security: Losing confidence in the health-care system." Their findings:

• Coverage for all uninsured children.
• Protection against financial ruin due to a major illness or accident.
• The ability to obtain coverage regardless of a pre-existing condition.
• Coverage that continues even when people are laid off, changing jobs, or starting their own business.
• Premiums, deductibles, and out-of- pocket expenses that are affordable relative to family income.
• The ability of people to keep their current health insurance if they choose.

It's too bad that folks don't get it - that last item effectively trumps all that came before.

Cost doesn't equal quality

The renowned education author Jonathan Kozol tells a story about money and education.

The inner boroughs of New York City spent $8,000 or so per student (more now). The outer boroughs about $12,000. The really tony enclaves spent $24,000 per student. At Andover, where Bush went to school, it's $40,000.

When Kozol's conservative friends told him that the answer to our education crisis wasn't to simply throw money at the problem, he liked to reply, "Why not? It works for your kids..."

(I think we can all imagine where Bush might be today - also a federal facility - if he'd gone to an underfunded school in New Orleans or D.C.)

The impact of cost on health care outcomes is different. The rigorous Dartmouth Atlas of Health Care has shown that spending doesn't necessarily correlate with outcome. Now a survey of Medicare beneficiaries released this week in JAMA "suggests that more regional spending on medical care does not improve patients' perception of the medical care they receive..."

The researchers found that per capita expenditures were highly related to receiving more medical care, such as average number of ambulatory visits to physicians in the past year and more cardiac tests (respondents reporting receiving tests in past year, 40.1 percent [lowest average expenditures quintile] to 63.5 percent [highest average expenditures quintile]). However, 7 of the 10 measures of perceived quality, including perceived unmet needs for tests and treatment (respondents reporting unmet needs, 3.9 percent to 5.0 percent) and spending enough time with physicians (respondents reporting adequate time, 88.7 percent to 87.0 percent), were unrelated to expenditures, while the overall rating of perceived quality of care was higher in the lower-expenditure areas (respondents reporting overall care rating of 9 or 10, 63.3 percent to 55.4 percent).

How Many Support Single-Payer?

Do pundits and politicians misstate the facts or lie about single-payer and the U.S. healthcare system? Is it because they're uninformed or because they figure they can get away with it?

Steven Maviglio writes about "Single-Payer Dreamland" that "single payer polls in either single digits or low double-digits when Californians are asked what type of health care system they want. Its proponents are vocal, yet few."

Does he also think there were WMDs in Baghdad and that global warming, if it exists, is caused by sunspots?

A number of polls show something quite different than such low support both nationally and in California. Here's a national one by Gallup.

It showed that in November 2007, 41 percent of Americans were in favor of "replacing the current health care system with a new government run health care system," and 48 percent favored "maintaining the current system based mostly on private health insurance." 11 percent weren't sure.

In 2006, it was 39 percent wanting a government system; in 2005, 41 percent; in 2004, just 32 percent; in 2003, 38 percent; in 2001, 33 percent. Those wanting to retain our current for-profit system have declined from 61 percent to 48 percent, with "don't know" rising from 6 percent to 11 percent.

The bigger changes came not between 2001 and today, but rather between 1987. In 1987, answering the open-ended question of what was "the most urgent health problem facing this country at the present time?" only 1 percent said costs. (68 percent said AIDS/HIV.) Today 26 percent say costs. Then, nobody mentioned access as a problem. In the November 2007 poll, 30 percent came up with access.

A number of other resources as well show it's either uninformed or dishonest to suggest only a tiny minority of Americans support single-payer.

Poll shows most want single-payer

Graham at Over My Med Body has the wording on that AP Poll on single-payer — which seems more important to me than to most. I predicted in December that it wouldn't get much play, and indeed it hasn't.

Associated Press-Yahoo Poll
Interview dates: December 14 - 20, 2007

14. Which comes closest to your view?

34% - The United States should continue the current health insurance system in which most people get their health insurance from private employers, but some people have no insurance

65% - The United States should adopt a universal health insurance program in which everyone is covered under a program like Medicare that is run by the government and financed by taxpayers

2% - Refused / Not Answered

15. Do you consider yourself a supporter of a single-payer health care system, that is a national health plan financed by taxpayers in which all Americans would get their insurance from a single government plan, or not?

54% - Yes

44% - No

2% - Refused / Not Answered

I was struck by this comment at Over My Med Body: "... keeping competition and a profit motive in at least parts of the system preserves innovation, and that’s important to me. Getting *EVERYBODY* in the pool and defining a minimum level of benefits that working adults and their families are, in fact, *entitled* to - that’s where we need to start healthcare reform."

First of all, single-payer proposals would keep competition in the system — competition between docs and hospitals, just not between insurance companies.

Second, please explain how insurance companies have anything to do with innovation. They regularly deny covering procedures that are standard in European countries. Here those procedures are "experimental."

Third, as long as insurers are competing with one another to exclude caring for sick people and only covering healthy people, you've got a system where a big chunk of health care dollars might as well be flushed down the toilet. It's simply not sustainable. Even if you do rescind the Bush tax cuts. We can't spend a fifth or a quarter of our GDP on health care — any more than you can spend a fifth or a quarter of your family budget on it. But that's where we're headed with the current system.

New AP Poll: 54 Percent of Americans for Single-Payer

This isn't going to get a lot of play unless we push it. So let's push: According to the AP, 54 percent of Americans favor single-payer. Wow. That looks pretty close to a tipping point to me. Here are some of the points:

• Nearly two-thirds of voters polled said the United States should adopt a universal health insurance program "in which everyone is covered under a program like Medicare that is run by the government and financed by taxpayers"
  
• 54 percent said they supported a single-payer system whereby all Americans would get their health insurance through a taxpayer-financed government plan
  
• Six out of 10 said they believe it is at least somewhat likely that the U.S. economy will enter a recession next year
  
• 64 percent are worried about a major unexpected medical expense
  
• Only 37 percent say immigration is "an extremely important issue"
  

17-29-year-olds favor single-payer

The New York Times today reported that poll results show that 62 percent of young people between the ages of 17 and 29 prefer a single-payer system over what we now have. The question was explicit:

Which do you think would be better for the country: 1. Having one health insurance program covering all Americans that would be administered by the government and paid for by taxpayers, OR 2. Keeping the current system where many people get their insurance from private employers and some have no insurance.

Shame on the general public: only 47 percent answered single-payer. However, the conversation is just now starting.

You can read more about it at the New York Times and, once that's blocked, here, at the Scientific Activist. The Scientific Activist links to the pdf that gives the full results of the poll.

I'd give this one caveat. Young people have a dog in this fight. It's their future, and their children's future just as much as it is mine and all the retirees who founded Health Care for All Colorado. Young adults can be incredibly courageous, idealistic and smart. I can't think of a single social movement that succeeded without their leadership. That said, they can also be, ummm — scattered. Easily distracted. This has nothing to do with TV or video, it was ever thus.

College-age and other young adults must see that this is the anti-slavery battle of our time; the civil rights battle that will make America better. "SiCKO" will help.

Yes, Iraq is the Vietnam of our time, and Bushie is the Nixon of our era — but healthcare is the social justice issue that needs passion and persevereance to right.

Don McCanne's quote of the day

Don McCanne, former president of Physicians for a National Health Program, has a list he calls the healthcare quote of the day.

A couple people forwarded this one to me. In it, Don has cited a new CNN poll (pdf) with this question:

30. Do you think the government should provide a national health
insurance program for all Americans, even if this would require
higher taxes?

64% - Yes
35% - No
2% - No opinion

Don doesn't just leave his readers with one item to think about — he also quotes Catholic Healthcare West's study on Health Security in America (May 9, 2007, also a pdf), in which respondents said:

The time has come for universal healthcare in America. (72%)

We need universal healthcare in America, even if it means
increasing taxes. (63%)

Don writes, "If these poll numbers were cast at the ballot box, this
would constitute a clear mandate from the American public. So why do
we keep hearing that national health insurance is not politically
feasible?"

The answer may be because those poll numbers have been the same for decades. They fall pretty easily, with just a few million dollars worth of well-planned propaganda. Americans are easily scared. Politicians know it.

Minnesota docs prefer single-payer

Impressively, 63.4 percent of Minnesota physicians said a single-payer healthcare system would offer the best healthcare to the greatest number of people. That's quite a few more than the 25 percent of physicians who thought health savings account systems were best, or the 11.8 percent who were in favor of managed care.

It's not the best study in the world — the University of Minnesota mailed out a thousand questionnaires to randomly chosen Minnesota physicians, got 39 percent back and called it good — but you can't really say that pro-single-payer doctors would be more likely to mail it back than other docs. They'd be more likely to mail it back than doctors who didn't know or didn't care, but it's probably actually the anti-single-payer physicians who would be most anxious to get the survey in.

The tide's not moving in their direction, after all.