Major reform of the health system is a top priority for the general public as well as for members of the progressive group MoveOn.

In a Washington Post-ABC News Poll, more than three quarters of Americans said they wanted to see “major changes” in the health system. And of those, about two thirds wanted the President-elect Barack Obama to move immediately, rather than waiting until later in the presidential term. 

Also, about two-thirds said they were optimistic that the Obama administration would achieve “significant improvements” in the health system.

Health reform was also named as the top priority by members of MoveOn. In online voting, 65% of MoveOn members listed universal health care as one of their top three goals for 2009 – edging out even economic recovery and job creation, which finished second with 62%.

Health care industry executives and policy scholars seem ready for major changes, too.   In a poll of “opinion leaders” by the Commonwealth Fund and the trade publication Modern Healthcare, 85 percent called for changing the way doctors and hospitals are paid, to create incentives for quality rather than just for volume of service. Such payment reform is likely to be a key element of any health reform proposal from the Obama administration and Congress.

– 01/02/09

A number of CWA members have accepted the invitation of the Obama health team to express their ideas and concerns about health reform. We urge you to keep speaking up, either sending a message using our form or signing up for a houseparty.

And let us know when you respond. We'll be printing some of the responses here.

This is the first, a letter to the Obama team from Mark Gruenberg, a member of the executive council of Local 32035, the Washington-Baltimore Newspaper Guild in Washington, D.C. Mark is also a small employer, running a union news service.

I am very encouraged by your receptiveness to the opinions of citizens on the issue of reforming health care.

The Newspaper Guild/CWA, my union, has asked us to remind you that while you consider heath care reform options, please keep two concerns in mind:

(1) No employer should be able to free load off the rest of us, even if another company covers one of their workers through a spouse or a partner. The law must force EACH employer to provide insurance for their employees or pay into a public plan for un- and under-insured Americans. If any employee is covered by another person's plan, the firm has to pay into the public fund anyway. It is time to end Wal-Mart's freeloading off the public trough -- and they're only the worst of many bad apples.

(2) Pay special attention to people between the ages of 55 and 64 (I'm 55). We're too young for Medicare. Many of my colleagues cannot afford health insurance plans because of their age and health status.

Employers with older workforces and employers who offer retiree health insurance tend to have much higher health costs than employers with younger workers or don't offer health coverage to retirees. Please make sure these people are not left out in the cold and the employers who shoulder the cost burden are offered relief.

I have some experience with this, which I will detail below.

But those moves are what I call tinkering with the broken health care system. Here's what I really want, and -- according to non-skewed opinion polls -- so does most of the country: BLOW IT UP.

Health care takes one-sixth of our GDP, a proportion scheduled to rise to a quarter of it within 10 years unless something drastic is done to control costs.

And what are the cost drivers that make health care unaffordable? Insurance company overhead (30% of total costs) and expensive, often unnecessary treatments pushed by the pharmaceutical manufacturers and the medical equipment makers. Big Pharma is the most-profitable industry in the U.S., and the insurers are close behind. Guess why.

It doesn't help that all this spending does not produce excellent outcomes. We are middle of the pack among developed nations in a whole host of measures of health care quality, except in cost. There, we're first, double the next most-expensive.

The solution is to junk the present system. Pollster Celinda Lake will tell you citizens don't want that, but her polls are skewed. A huge majority prefers a single-payer GOVERNMENT-RUN system, like Medicare, but covering everyone. And Medicare, for all its faults, has only 3% overhead.

Finally, my experience: I run a small news service for union media. We have two workers. We also have health insurance. Because of our size, there IS NO COMPETITION FOR OUR BUSINESS, despite what your plan envisions (much less the opposition's "you're on your own" schemes). It's either Blue Cross or individual coverage.

Five years ago, for three straight years, BCBS hit us with -- I am not kidding -- 30% annual rate hikes.

We had to cut literally just about everything else to pay for them: Rent, business-related insurance, outside expenses, you name it. The only thing not cut was my co-worker's pay....so I had to cut mine, by two-thirds. Thanks to BCBS, I qualified for EITC. Two years ago our local government (DC) cracked down on such exploitation: Rates were frozen for one year and rose 8% last year.

I do not want to be at the mercy of that monster again. The way to end it is to abolish private insurance, throw all its execs onto the jobless line (along with its bean-counters) and enact single-payer Medicare for all.

Thank you for your consideration of my concerns.

Sincerely,

Mark Gruenberg
Press Associates Union News Service

– 12/26/08

Tom Daschle, named last week by President-elect Barack Obama as chief of the new White House Office of Health Reform, published a book on health reform last year.

The book, called Critical: What we Can Do about the Healthcare Crisis, may offer some clues about the shape of an Obama reform plan.  And  it may give even greater insight into a potential strategy to get reform passed, according to a report this week in the Los Angeles Times and an analysis from the blog of the policy journal Health Affairs.

Daschle believes reform should "put a premium on cooperation between the White House, Congress and major healthcare interest groups," the Times said. In the book, Daschle wrote that the Clinton health reform effort, crafted by a secretive task force of experts without consulting the industry or Congress "only bred resentment among the people who weren’t invited to participate." wrote.  The eventual Clinton plan faced hostility from key stakeholders and had no buy-in from Congress - a combination which doomed it to defeat.

Already, Daschle and the Obama team are showing an open process by inviting anyone interested to submit comments or attend a houseparty discussion - and we urge CWA members to make their feelings known.

Also, the reports on the Daschle book suggest, the reform effort is likely to emphasize "speed" - Clinton lost momentum by waiting a year before coming up with a bill – and “simplicity.”  As Jeff Goldsmith wrote on the Health Affairs blog, "Daschle will certainly not voluntarily produce anything remotely resembling the 1,346-page [Clinton bill] so many of us used as a doorstop."

In his book, Daschle suggests leaving many of the details of health reform – such as what benefits need to be included in coverage and what level of premium is affordable – to a board, relatively insulated from politics, which he compares to the Federal Reserve. That will allow a bill to go through Congress that sets broad principles, but doesn’t include specific details and cost projections that could bog down debate and serve as targets for opponents.

While the board gets set up, Goldsmith wrote, "This would conveniently buy Obama time for the economy to recover, time to find funding for needed federal subsidies to small businesses and the unemployed uninsured, as well as time for business to strengthen enough to afford an employer mandate."

– 12/23/08

The decline in the economy is increasing the stress on the health system – people need more treatment, but are less able to pay for it.  And the stress on the health system is accelerating the decline of the economy - medical debt is a factor in about half of bankruptcies and foreclosures.

That's why President-elect Barack Obama has recognized that health reform is part of fixing the economy.  In announcing his health reform team, Obama said, "It’s not something we can put off because we’re in an emergency.  This is part of the emergency."

There’s plenty of fresh evidence that he’s right.

• In a recent survey for AARP of people over age 45, 22 percent said they have delayed seeing a doctor, 16 percent said they have cut back on preventive care, and 16 percent said they are not very confident or not at all confident they will be able to afford the care they need.
• As people are skipping care, hospitals are faced with empty beds. The American Hospital Association reported that 38 percent of hospitals are seeing significantly fewer admissions. With investment income also declining, hospitals on average operated at a 1.6 percent loss in the third quarter of 2008, compared with a 6.1 percent positive margin in the same period in 2007. The association warned that “hospitals, which employ 5 million people nationwide, could be facing uncertain times as their financial health falters.”
• Twice as many workers as last year (38 percent vs. 19 percent) are selecting health plans with lower premiums – leaving them exposed to higher deductibles and co-payments if they do need treatment, according to Watson Wyatt, a benefits consulting firm. So although there are short-term savings, more people could be skipping care or facing medical debt in the future.

All of which helps build the case for serious reform.

As the New York Times reported, "With health insurance premiums rising this decade at four times the rate of inflation, and draining a growing share of personal income, middle-class support for an overhaul would seem to be reaching critical mass. If a broad swath of Americans feel destabilized enough by health costs, their demands for relief could help marginalize the kind of opposition from entrenched interests that has killed previous efforts."

– 12/23/08