I have in the past harshly criticized president Obama and the Democratic party for the way they excluded the single payer and public options in the health care debate as a favor to the health insurance industries and foisted on us a complicated health care reform package in the Affordable Care Act that does not address in any fundamental way some of the key problems of cost and access.

Now comes along an analysis by Rick Ungar that says that buried in that health care reform act was a time bomb that went off on December 2, 2011 that will destroy the private health insurance industry as we currently have it and set in motion a series of events that will inevitably lead to single payer. The key, he says, is
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Northwestern University professor of law Andrew Koppelman has a long article in the Yale Law Journal arguing that the constitutional objections that have been brought against the Patient Protection and Affordable Care Act (PPACA) health care reform package have little legal merit but that this does not mean that the current Supreme Court will uphold the law, given the propensity of some of the judges to create convoluted legal justifications to arrive at political conclusions.

The constitutional objections are silly. However, because constitutional law is abstract and technical and because almost no one reads Supreme Court opinions, the conservative majority on the Court may feel emboldened to adopt these silly objections in order to crush the most important progressive legislation in decades. One lesson of Bush v. Gore, which did no harm at all to the Court’s prestige in the eyes of the public, is that if there are any limits to the Justices’ power, those limits are political: absent a likelihood of public outrage, they can do anything they want. So the fate of health care reform may depend on the constitutional issues being understood at least well enough for shame to have some effect on the Court.

He then outlines the objections to the reform and why they cannot be sustained. He concludes with a nice summary.

What will the Supreme Court do? There is no nice way to say this: the silliness of the constitutional objections may not be enough to stop these Justices from relying on them to strike down the law. The Republican Party, increasingly, is the party of urban legends: that tax cuts for the rich always pay for themselves, that government spending does not create jobs, that government overregulation of banks caused the crash of 2008, that global warming is not happening. The unconstitutionality of health care reform is another of those legends, legitimated in American culture by frequent repetition.

The Republican Party, once a party of intellectuals and ideas, is now the captive of crazies driven by blind ideological prejudices in the service of the oligarchy. The Democratic Party has taken the place of the former Republican Party as the subtle agents of the oligarchy.

Reader Norm sent me this news item which alleges that sheer greed for excessive profits is causing one drug company (Genentech) to try to block a possible cure for macular degeneration (which can cause blindness) from being tested and approved, because the cost of this drug ($50 per dose) Avastin is forty times less that the alternative treatment Lucentis ($2,000 per dose) marketed by the same company.

The Plain Dealer also ran a story on the fact that the Cleveland Clinic ran a comparison test anyway and found that Avastin worked as well as Lucentis.

Despite the sabotaging of the single payer and the public option by president Obama and the Democratic Party during the health care reform debate, it is not yet dead.

In an interview with OpEdNews, Dr. Margaret Flowers of that excellent group PNHP (Physicians for a National Health Program) talks about the moves currently underway in the various states. Vermont seems the most promising state to be the first to implement a single payer system.

Medicare and Medicaid are not the causes of our national deficit, they are the victims of a broken health system. As our overall health care costs rise, so do the costs of Medicare and Medicaid. The most effective way to control our health care costs would be to expand and improve Medicare and put everybody in the country on Medicare instead of using hundreds of different health insurances as we do now.

The administrative savings alone of a single payer national health program would be around $400 billion. There are other ways that single payer/Medicare for All controls health care costs such as giving hospitals and other medical institutions a global budget and negotiating for the prices of pharmaceuticals, medical devices and services.
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There is a lot happening at the state level when it comes to single payer. Currently, twenty states have single payer health bills in some phase of the legislative process.

As you may know, California has passed a state single payer bill twice in 2006 and 2008. I just returned from a large health professional student-led march, rally and lobby day at the state capital in Sacramento. The California single payer coalition is continuing to move forward to pass single payer and have it signed by the new Governor. California faces such a serious budget crisis that I was told the legislature will be basing their cuts on what will result in the least number of lives lost.

We are particularly enthusiastic this year about Vermont. They are poised to pass a single payer health bill this legislative session. The state hired Dr. William Hsaio from Harvard to design their health system. He has designed health systems for five countries, the most recent being the single payer system in Taiwan. The new governor of Vermont, Peter Shumlin, ran on a strong single payer platform. And, of course, Vermont has Senator Sanders, who has been a long time proponent of single payer.

Even with all of the stars seeming to be aligned, it is going to be a difficult process to get single payer passed in Vermont. The forces who oppose this, primarily the corporations who profit from the status quo, will be putting tremendous resources into that state to stop single payer. For that reason, many of the organizations that support single payer are working to assist the state single payer movement. Single payer advocates from across the nation are volunteering or helping to raise funds for Vermont.

I encourage your readers to visit www.vermontforsinglepayer.org to learn more about the efforts there and to support them.

Legislation will also be introduced at the national level again in both the House and Senate this year. It is important to work at both the state and national levels because we cannot predict where we will be successful first. Of course, the ultimate goal is a national single payer health program so that all people living in our country will have access to care and so that we can control our health care costs at the national level. Health care costs are a significant cause of our national debt.

Ohio’s push for single payer is being driven by SPAN Ohio (Single Payer Action Network Ohio).

The singer will undoubtedly raise the ire of those who devoutly believe that “America is the greatest country in the world in every single way, always has been, and always will be and anyone who doubts that is a an anti-American Islamofascisticcommie” by comparing Canada’s single payer health care system favorably to the US system.

The Canadian-born Bieber never plans on becoming an American citizen. “You guys are evil,” he jokes. “Canada’s the best country in the world.” He adds, “We go to the doctor and we don’t need to worry about paying him, but here, your whole life, you’re broke because of medical bills. My bodyguard’s baby was premature, and now he has to pay for it. In Canada, if your baby’s premature, he stays in the hospital as long as he needs to, and then you go home.”

He’s not the only celebrity thinking that the present health care system in the US is evil.

In the previous post in this series, I said that in order to get a simple and obvious mistake corrected, I had to make 17 phone calls to the hospital’s billing office, 15 calls to my doctor’s office, 9 calls to the insurance company billing office, and 4 calls to the radiologist’s billing office.
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While people in the US struggle with health care costs, Brazil is giving away drugs for blood pressure and diabetes free to those who need them.

Brazil already gave AIDS drugs free. It can afford to do that since it is a single payer system that gives it the clout to negotiate with drug companies for lower prices.

As I wrote yesterday, my latest bone density scan, when compared with two previous scan results taken years before showed that my bone density was not only above the cut off for a diagnosis for osteoporosis but also was actually increasing with time, so there really was no cause for alarm.
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I have written before of the absurd levels of bureaucratic waste that runs through the US health care system. Here I would like to continue a report on one personal experience that illustrates this. I do this not because my medical history is interesting (it isn’t in the slightest) but to document the appalling inefficiency of the system.
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There is a common misunderstanding that the single payer system of health insurance means that the government provides all the health services. That is not true. There are many systems of single payer in which doctors and hospitals are private. It is just that the multiplicity of for-profit health insurance firms that do not add anything of value but simply introduce a vast and expensive bureaucratic layer between doctor and patient would be eliminated.

This story from the public radio program Marketplace shows how even in the rural farming sector in India, introducing a single payer system called Yeshavini has resulted in a vast improvement in health care at very low cost.

[W]hile Congress, and the rest of the country, continue to argue over who’s helped and who’s hurt by health care reform, the world’s cheapest health insurance program can be found in India. It covers at least 4 million of that country’s poorest farmers with a fairly simple philosophy: More patients means lower costs.
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About a third of all of the patients at [Dr. Devi] Shetty’s hospital are farmers from rural villages. They’re here because they have something called Yeshaswini insurance. It doesn’t cover routine doctors visits for, say, a cough or a cold, but the insurance does cover all surgical procedures. The farmer pays approximately three cents a month; the government puts in one and a half cents and farmers cooperatives operate the program.
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That volume actually allows them to negotiate really good deals, lower costs of medical equipment and drugs. And the success rate for surgery at Shetty’s hospital is as good as hospitals in the U.S. at a fraction of the cost.
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Typically, farmers have to sell their land, take out crippling loans or just not have surgery. That’s why Yeshaswini insurance is immensely popular. Farmers can choose from any one of 350 hospitals in the region.

Dr. Julius Punnen is a cardiac surgeon who helped set up the program. He says every day the hospital battles with private insurance companies to get reimbursed. But Yeshaswini is different. It was designed to provide treatment.

The private for-profit health insurance companies are a cancer on the health care system that must be eliminated.