UNIVERSAL HEALTH CARE EDUCATION FUND ~ VOLUME 5, NUMBER 1 ~ SPRING 2011

Universal Health Care Education Fund c/o Mass-Care33 Harrison Avenue, Fifth Floor, Boston, MA 02111

P: 617-723-7001, F: 617-723-7002info@masscare.org http://www.masscare.org

CommonHealthFiling Our Bill

“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 Care Financing. About forty-five other legislators have signed on as co-sponsors. Thanks to the analysis provided by Gerald Friedman, U-Mass Amherst economist (see page 3), we know that our current single-payer bill, when passed and implemented, will save the Commonwealth of Massachusetts, its businesses, families and individuals at least $9 billion per year! You can read the bill and Friedman’s analysis on the Mass-Care web site.

Like our previous bills, this one will provide quality health care for all Massachusetts residents, eliminate the large amount of insurance overhead (including huge CEO compensation and marketing) taken out of each of our health insurance premium dollars, eliminate the high cost to medical providers for dealing with the voluminous paperwork and varying regulations required by individual insurers, eliminate price gouging by setting prices for manufacturers and service providers, and encourage early intervention and prevention of diseases, and set reasonable limits 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 on establishments with 100 or more employees;2) An employee payroll tax of 2.5 percent will be assessed, replacing previous spending by employees on health premiums and out-of-pocket expenses;3) A payroll tax on the self-employed of 10 percent will be assessed, exempting the first $30,000 of payroll per self-employed resident; and4) A tax on unearned income of 12.5 percent will be assessed to fairly distribute the costs of health care across various sources of income. (Social Security and welfare and disability payments will not be considered unearned income.)

A private or public employer may agree to pay all or part of an employee’s payroll tax obligation. Such payment shall not be considered income for Massachusetts income tax purposes.

You can help to get the bill passed by informing your legislators about it and asking them to sign on as supporters if they have not already done so. You can also help by asking current co-sponsors (listed on the Mass-Care web site) to actively work to get the bill moved out of committee, acted on and passed on the floor of both houses of our legislature. - Judy Deutsch

National Action

Ben Day welcomed James Haslam from the Vermont Workers Center to our Ben Gill gala. He brought us up to date on the exciting grassroots movement for single payer in the Green Mountain State. On May 1st, as the bill moved forward but remained vulnerable to crippling amendments, supporters rallied in Mont-pelier to make sure health care would become a human right, no longer a commodity or privilege. Among the Massachusetts folks who joined the rally

were Sue & Abe Chipman from Brookline and Peter Knowlton from Taunton, heading a strong presence by the United Electrical Workers. The California single payer bill was recently reported out favorably by the Senate healthcare committee. On Capitol Hill, Representative John Conyers refiled his Medicare for All bill, HR.676. Senator Bernie Sanders of Vermont and Representative Jim McDermott of Washington have just filed a bill endorsed by the AFL-CIO that would move the country forward to single payer through partnership with the states, requiring a high standard of care nationally. - Sandy Eaton, RN

UNIVERSAL HEALTH CARE EDUCATION FUND ~ VOLUME 5, NUMBER 1 ~ SPRING 2011

Health Care Costs & the NeedlessAttack on Public Sector Employees

In order to rein in a massive budget deficit - a deficit caused more by health care costs than any other factor - the Massachusetts House of Representatives recently passed a proposal that would allow cities and towns to strip public employees of their right to bargain health care benefits, and both the Senate and Governor's office are contemplating compromise versions of this proposal. This is tragic for three reasons:

First, it is not true that public employees enjoy better wages and benefits than the rest of us. Compared with private employees with the same education level, public workers have better benefits but lower wages. This trade-off turns out to apply to all of us: the economics literature has found that employers do not pay for any health care costs, but rather pass these costs on to employees in the form of lower wages. When the country goes through periods of rapidly climbing health care costs, real wages stagnate or decline - in fact, almost all of the stagnation in lower- and middle-class wages is due to our health care system producing out-of-control costs. Unionized workers just have the luxury, if you can call it that, of trading better health coverage for their families in exchange for lower wages than private sector workers receive for the same work. If the House budget were to become a reality, it is likely that municipal employees who have been sacrificing wages for years to retain health care coverage, will lose both and fall behind their private-sector counterparts.

Second, none of this is necessary. We are the only country in the world with costs as high, and growing as rapidly, as ours. In exchange for our high and rapidly rising costs, we actually get worse health outcomes and extraordinarily poor access to needed care. Health care is now about half of the state budget, consumes almost all of municipalities' new revenue each year, and we are getting literally nothing for our new spending each year. A single payer plan for Massachusetts, which is not experimental and has been tried and proven around the globe, would save state and local governments in Massachusetts between $1.5 and $2 billion, according to estimates from UMass economist Gerald Friedman. This would close our budget deficit. Municipalities, like all other employers, would pay a 7.5% payroll tax, and would not have to face rising health care premiums ever again. Almost all municipalities currently spend upwards of 15% of payroll on health care costs - the city of Boston, for example, spends about 20%.

Lastly, although you have all heard a lot of rhetoric about public employees having lavish benefits paid for by taxpayers (which we have just disproved - public employees are paying for their own benefits with lower wages), remember who pays for most tax revenue: rich people! Massachusetts has a flat income tax, which means it is not as progressive as the federal income tax, but still - because income inequality is so high in Massachusetts - a very large share of our total tax revenue comes from high income households paying their share. When we shift costs from tax revenues onto patients, which is what the state is proposing by cutting coverage for public workers, we are also making our health care financing much more regressive, and letting high-income earners off the hook.

Mass-Care Single Payer Gala FillsRyles Jazz Club in Cambridge

It was standing room only at the 13th Annual Gala in Memory of Benjamin Gill on March 26th! While enjoying a spread of tasty snacks from S&S Deli, attendees socialized and listened to music by Bo Winiker (trumpet) and Jamie Saltman (piano).

Mass-Care co-chair Jackie Wolf welcomed everyone and introduced the first keynote speaker, UMass economist Gerald Friedman. Professor Friedman’s engaging style kept everyone’s attention as he explained the impact of single payer reform in Massachusetts and options for financing it.

During a break for dessert, everyone had a final chance to buy raffle tickets and Mass-Care items such as hats and Pat Berger’s posters before Katie Murphy conducted the raffle drawing. Joseph Lillyman’s piano solos provided the perfect background music, which even stimulated some of the attendees to dance.

The 2011 Dr. Benjamin F. Gill Memorial Awards were presented to three honorees for their consistent work in support of Universal, Single Payer Health Care in Massachusetts:

• Reverend Judy Deutsch, for her tireless efforts on behalf of single payer since 1945.

• Matthew Patrick, State Representative from the 3rd Barnstable district for five terms, who was the lead sponsor of the single-payer bill in 2009-2010 and a leading advocate for progressive energy reform and democratization of the legislature.

• Walpole Peace and Justice, who put a single–payer question on the ballot in Walpole and Norwood and won majority support in that district, as well as for a ballot question in Walpole and Dedham.

The second keynote speaker, direct from Vermont, was James Haslam, Executive Director of the Vermont Workers Center. His group has carried out a well-organized, highly successful grassroots campaign that has resulted in Vermont possibly becoming the first state in the nation to enact single payer health care legislation. Mr. Haslam’s energy and enthusiasm were inspiring to all as he detailed the steps involved in organizing the campaign.

The program ended with remarks from Ben Day.

This event was a success thanks to the leadership of Mass-Care co-chair Pat Berger. The Gala Program Booklet was attractive and fun to read(!), thanks to Ben Day and intern Claudia Chauca. Volunteers who helped produce the event included: Carol Caro, Asha Cesar, Marty Downes, John Blanchard, Vic Bloomberg, Joseph Lillyman, Bea Mikulecky, Nivedita Poola, Leo Stolbach and Maria Termini. - Bea Mikulecky

Logo of the Health Care is a Human Right Campaign of the Vermont Workers Center

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 charge that a single-payer health insurance system would exacerbate the cost problem by expanding coverage, such criticism is founded on a mistaken model of health care and is inconsistent with the experience of other countries with public health care systems providing universal access. Indeed, it appears that the only way that the United States can control health care costs and avoid fiscal and economic catastrophe would be by establishing a system of universal health insurance with a single payer.

Advocates of single-payer health insurance recognize that the rising cost of health care threatens the American economy. For decades, the cost of health insurance has been rising at over twice the general rate of inflation; the share of American income going to pay for health care has more than doubled since 1970 from 7% to nearly 17% even while more Americans are doing without health insurance or have inadequate coverage.

If health insurance were like other commodities, like shoes or bow ties, then reducing access would lower costs. But health insurance is different because insurers can increase profits by reducing access to insurance even when this drives up total expenditures. The health insurance and health care economy are different from most other markets because private companies selling insurance do not want to sell to everyone but only to these unlikely to need health insurance. Insurers profit by screening subscribers to identify those likely to submit claims and to harass them so that they will drop their coverage and go elsewhere. The collection of insurance related information has become a major source of waste in the American economy because it is not organized to improve patient care but to harass and to drive away needy subscribers and their health-care providers. Because driving away the sick is so enormously profitable for health insurers, they are doing it more often, creating the enormous bureaucratic waste that characterizes the process of billing and insurance handling. Rising by over 10% a year for the past 25 years, health insurers’ administrative costs are among the fastest rising costs in the American health care sector. Doctors in private practice now spend as much as 25% of their 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 care settings. Inadequate health insurance turns small conditions into major problems, and drives the sick from doctor’s officers 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 to economize on spending by replacing our current system with one providing universal access. I have estimated that in Massachusetts, a state with a relatively efficient health insurance system, it would be possible to lower the cost of providing health care by 17% (as much as $10 billion a year) largely by reducing the cost of administering the private insurance system with most of the savings coming within providers’ offices by reducing the costs of billing and processing insurance claims. In a report prepared for the State of Vermont, Professors Hsiao (Harvard) and Gruber (MIT) estimate that shifting to a single-payer could lead to savings of around 25% through reduced administrative cost and improved delivery of 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-payer system leads to cost savings by improving care. When Canada first adopted its current health-care financing system around 1970, the health-care share of the national gross domestic product was similar in the United States (7.1%) as in Canada (6.9%). Since then, however, health care has become dramatically more expensive in the United States where health care spending has risen by over $6,900, nearly double the increase in Canada. Had Americans experienced better health outcomes, then we might accept these higher costs. Instead, however, we have gone from a relatively healthy country to the country with the shortest life expectancy of these advanced economies. Our gain in life expectancy since 1971 (5.4 years for women) is impressive except when put beside other advanced economies (where the average increase is 7.3 years). Had the United States increased life expectancy at the same dollar cost as in other countries, we would have saved nearly $4,500 per person; had we increased life expectancy at the same pace per dollar spent as in other countries, we would have bought an extra 10 years of life expectancy.

The international comparison also provides another perspective on any supposed trade-off between cost containment and coverage expansion. In other countries than the United States, almost all of the increase in health care spending out of national income is due to better quality health care as measured by improvements in life expectancy. The problem of rising health care costs is almost unique to the United States, the only country without universal coverage and without any effective national health plan. - Professor Gerald Friedman

UNIVERSAL HEALTH CARE EDUCATION FUND ~ VOLUME 5, NUMBER 1 ~ SPRING 2011

CommonHealth, Volume 5, Number 1:Director: Benjamin DayEditor & Photographer: Sandy EatonProduction: Erin ServaesPrinting compliments of the Massachusetts Nurses Association

Ellen in MedicalandEllen Kagan has reached many thousands over the last fifteen years through her health education TV and radio series, Your Health Care: Choice or Chance? Her tales from the healthcare twilight zone will now continue to bring compassion and hope to wider audiences through

print, now avail-able on Kindle. A study published recently reveals that hospital care injures almost one in five patients. B u r e a u c r a t i c efforts have failed to improve patient safety after a de-cade of trying. Only an enlight-

ened, engaged and outraged population will establish and enforce high standards of care. Ellen has worked on the cutting edge of the movement for that standard. We continue this fight for high standards as a right of everyone encountering our profit-driven healthcare non-system. - Sandy Eaton, RN

Picture at right: Peter Knowlton and his grandson Travis celebrate May Day and enjoy the good weather in Vermont while campaigning for a just healthcare system.

Coffee with Susanna

We were gossiping, talking about almost everything,then our mood changed as Susanna dropped a bombinto our other wise comfortable conversation.

Last month she had a suspicious mammogram,her doctor ordered a second set of x rays,but her insurance company won’t pay for them.

Susanna is a single mother, a job by itself,and she works another full-time job,barely gets by and can’t afford home repairs.

My friend’s voice shakes with worry,we both know her mother died of cancer.Something is very wrong with this picture,even though my friend has insuranceshe can’t get the care she needs,because corporate profits and greedcontrol our health care industry.How long will this injustice continue?

Maria Termini

Reaching Out to CongregationsA few months ago, I started working as an outreach volunteer with Mass-Care. I have been very busy contacting churches and congregations to offer them a presentation on the promise of single payer health care. I am also writing letters to the editor. I decided to take on this task when I realized how clearly health care is a justice issue. It is crucial and natural for faith communities to work for justice in health care. I sense a lot of confusion from people about single payer health care and believe that education on this issue is the place to start.I have developed, with expert help from Dr. Pat Berger, a short presentation that explains the crisis in health care, the qualities of sustainable health care reform, what single payer health care is, and how it represents justice in health which is most truly a human right.

I also talk about how past health care reforms have failed and how the single payer bill currently in the Massachusetts legislature, the Medicare for all Massachusetts Bill, can give everyone affordable, comprehensive and sustainable health care. I would like to make single payer health care a household word in Massachusetts and believe that people will support single payer health care to the degree that they know about it and understand it.I have focused on contacting congregations near Boston, but we need to expand this outreach to the entire state. I have a background in this kind of work because of my experience with Habitat for Humanity, which involved coordinating hundreds of volunteers from many congregations who worked to build houses with poor families. I believe people of faith are ready to work for justice in health care. Please contact me if you know a congregation or group that would like a presentation or if you would like to be on our committee.- Maria Termini, 617-928-1544, leafdancer@verizon.net