http://www.healthcare-now.org/lieberman-gets-another-visit-from-the-grassroots-for-single-payer/

Dr. Margaret Flowers of PNHP:

“As a movement, it’s important for us to continue to educate people that this is not enough, it’s not sufficient, it’s not addressing the problem that we have, it’s not going to be universal or financially sustainable,” said Dr. Margaret Flowers, who is with Physicians for a National Health Program. “And, at this point, it’s important to turn our attention to the Senate. We still have an opportunity at the very least to try and get the Sanders single-payer amendment that would allow states to pass single-payer legislation.”

http://www.commondreams.org/view/2009/11/23-5

Donna Smith of California Nurses Association:

Time is drawing short for our Senators to hear from us. Debate will begin on November 30 on the current Senate bill. Senator Sanders needs support. He has already told us that he does not expect a win on his amendment. But we are all laying groundwork for this nation to move in the right direction before long – we know that the current bills do not "bend the cost curve" enough and we know they certainly do not bend the death or bankruptcy curve nearly enough to make the bills what this nation needs. Additionally, we want the legislation to contain language that will allow states that opt in to a single-payer system to be able to do so with the appropriate waivers from federal legal provisions which might otherwise present obstacles to doing so.

So, the ask of our Senators – each and every one, liberal, centrist or conservative – is two-fold and urgent:

1. Vote with and for Sanders’ S. 703 substitute amendment; and
2. Support state single-payer enabling language in the final bill.

Support Bernie Sanders’ S 703 amendment. Give the president a call at 1-800-578-4171, and/or call a Senator or more. Four toll-free switchboard numbers for the Senate and House: 1-800-828-0498, 1-866-338-1015, 1-866-220-0044, and 1-800-473-6711. Or email or write. It matters. The more the better.

List of senators:
http://www.senate.gov/general/contact_information/senators_cfm.cfm

FYI UPDATES

http://www.politico.com/news/stories/1109/29795.html

From Carrie Budoff Brown (Politico)

“Absolutely not," said Sen. Sherrod Brown of Ohio, one of the more liberal members of the Democratic Caucus, when asked if he was open to further discussion of the public option. “We’ve compromised four times now.” “Four members of the Senate aren’t going to tell the other 55 what to do on these issues,” he said.

Democrats are expecting multiple Republican amendments on hot-button issues such as medical malpractice, immigration and abortion. The challenge for Reid is finding a way to shield his members from taking politically difficult votes and to prevent the passage of a GOP amendment that could sink the entire deal.

[snip]

The vote Saturday was likely to resurrect interest in the idea of using a “trigger” that would kick in a public plan if states lack enough affordable health care options. That plan has the support of a Republican Sen. Olympia Snowe (R), one of the few GOP senators who might cross party lines to back the bill, though she voted against cloture on Saturday.

Some Democrats – including Obama – have signaled a preference for the trigger to bridge deep divides in the party, Landrieu, too, spoke in favor of the trigger.

http://www.politico.com/news/stories/1109/29798.html
(Carrie Brown)

Public option proponents, including Sanders and Sen. Sherrod Brown (D-Ohio), say they have already given up enough. They agreed to forgo a single-payer system. They decided not to push a government plan tied to Medicare rates. And they accepted Reid’s proposal to include the opt-out provision. That’s it, they say.

[snip]

The big player here isn’t Reid or Pelosi but the Catholic Church, which helped get the Stupak amendment into the House bill. Any abortion language may have to win the backing of the church for members to sign on – and the church is sticking by a tough anti-abortion stance that angers many liberals.

[snip]

What’s worse for Democrats is that the House and Senate have starkly different visions of how to pay for reform. The House hates the Senate tax, and the Senate hates the House tax.

Not surprisingly, politics are at play. The House went with a populist soak-the-rich tax on “millionaires” to pay for almost half the near-trillion dollar price-tag in its bill. And bowing to pressure from powerful union backers, Democrats steered clear of any tax on the so-called “Cadillac” plans – high-cost policies that many unions have negotiated for their workers over the years.

Reid relies heavily on taxing the Cadillac plans – but won’t touch a millionaires tax, which was never debated in the Senate.

“So, here we are telling the American people that we’re going to fix health care in America and the way we’re going to pay for the massive government takeover of health care is through cuts in Medicare?” said Sen. John McCain (R-Ariz.) The reductions will almost certainly cut some benefits for seniors, a fact that has become a central opposition argument echoed from Capitol Hill to K Street. The cuts are likely to bump more than half the seniors currently enrolled in the popular Medicare Advantage program. Democrats are keenly aware of the danger in a senior revolt and note that AARP, the nation’s largest seniors’s lobby, would not have endorsed reforms if they hurt seniors.

But there’s another danger to Democrats lurking in the bill – dissent toward the White House deal with the drug-makers. Many Democrats feel PhRMA got off easy by only having to kick in $80 billion in cuts toward health reform. So some liberal Democrats want to change the deal’s terms and force the industry to sell drugs to the federal government at a discount.

http://www.medicareforall.org/pages/hcreform

Information and Explanations about Medicare for All

How does this work? We pool our money together with much less government and no use of health insurance companies for medically-necessary care. Risk of hardships from medical bills is as low as it can be: risk is spread among 308,000,000 people. One public (insurance) agency, the single-payer, collects our money and promptly pays the medical claims for us. There are very little or no additional costs; prescription drugs are negotiated to a lower cost; no one receives a major bill.

Benefits. Medicare for All covers everyone with one health insurance plan that provides all medically-necessary care: Primary care; inpatient care; outpatient care; emergency care; prescription drugs; durable medical equipment; hearing services, long term care; palliative care; podiatric care; mental health services; dentistry; eye care; chiropractic care; substance abuse treatment. The efficiency of one agency and one plan saves over $400 billion/year. Go here for a list of all types of the benefits, not just the medical coverage.

Cost. Most Americans will mainly or only experience the proposed small increase of a few percent in the Medicare tax out of our paychecks. Like the U.S. Congress plan, super-rich persons will pay more.

The Medicare for All cost of health care from payroll checks will be …
— For $50,000 / year of earned income: the total health care payroll tax: $198 per month for health care
— For $12,500 / year of earned income: the total health care payroll tax: $ 49 per month for health care
— If there is only one person in the family with employment income, then that is the total payroll health care cost, since everyone automatically always has full coverage.
— See tax. — See costs and savings for more details.

— The state of New York implemented stiff regulations on health insurance companies; the U.S. Congress plans to do that. In Allegany County, one of the poorest counties of New York (NY) state, a family can get insurance for between $2,882 per month and $4,768 per month (from NY website) for partial coverage and added costs. Such huge costs are a result of the regulations
— The Medicare for All health care payroll cost ($49-$198 above) is the primary cost: no major medical bills, little or no co-pays, no deductibles.

http://www.pnhp.org/pnhp-ny/PNHP-Talking-points_Mandate-Plans.pdf

Talking points on the Mandate Plans

Overall –

• The plan is … an insurance industry bailout. Most provisions to expand coverage don’t even go into effect until 2013, after which it still leaves at least 17 million Americans uninsured.

• Private insurers get millions of mandatory new customers and about $600 billion in taxpayer subsidies.

• It forgoes over $400 billion annually in potential savings on overhead and bureaucracy in the health system – enough to cover all 47 million uninsured.

• It makes private health insurance mandatory for middle-income working people, forcing them to buy a defective product. It will become a federal crime to be uninsured, with a penalty of 2.5 percent of income, starting in 2013. … Since the plan institutionalizes different levels of benefits and allows for skimpy plans (e.g. "bronze"), the mandated insurance may not even cover their health needs.

• We will have a nation of underinsured families and businesses who will be paying money they can hardly afford for health plans that will never meet their needs.

• A Medicaid expansion will cover more low-income Americans, but coverage gains – both in Medicaid and for people receiving tax assistance to buy coverage – will be short-lived because the cost is unsustainable.

• Individuals and families with incomes up to 400 percent of poverty ($73,240 for a family of 3) are eligible for skimpy subsidies to buy coverage through a new "insurance exchange." Families of very modest means (200-400 percent of poverty) are still responsible for paying an unaffordable 8-12 percent of their income towards health insurance premiums.

• The plan bans denials of coverage based on pre-existing conditions (starting in 2013) and recissions (retro-active cancellation of coverage) immediately. But insurers are still allowed to deny claims.

• Similarly, caps on out-of-pocket expenses (at $5,000 for individuals and $10,000 for families) don’t prevent medical bankruptcy because they don’t include expenses for uncovered services.

• Insurers are supposed to spend 85 percent of premiums on care, but … insurers are able to circumvent this rule easily by categorizing administrative expenses as "clinical" or "quality improvement."

On Medicaid and community health center expansion

• The plan expands Medicaid after 2013 to additional low-income Americans … lack of funds for Medicaid at the state level, will quickly erode any gains in coverage.

• The plan increases funding for community health centers, which again, is good, but this could be done independently.

• The plan eliminates the Children’s Health Insurance Program in 2014, routing the beneficiaries into Medicaid (under 150 percent of poverty) or into the purchase of private coverage), adding hassle and possibly disrupting care arrangements for these children.

On the public option

• The public plan option is a sham. According to the Congressional Budget Office, the premiums will actually be higher than premiums in the private sector, and fewer than 2 percent of Americans will enroll. So the public plan option will be an expensive, tax-funded subsidy to private health insurance, because the public plan option will take the sickest patients off their hands. It won’t expand coverage or decrease costs.

On the employer-mandate

• Starting in 2013, employers with payrolls over $500,000 are required to provide coverage and pay a share of the premiums (72.5 % for individual, 65% for family coverage) or pay an 8 percent payroll tax.

• Employers are not required to meet benefit standards until 2018, but even then are only required to help fund the "lowest cost plan" that meets the "essential benefits package," and so may offer very skimpy coverage.

• Millions of working Americans will continue to lack coverage. In Hawaii, which has had an employer mandate since the 1970′s, many employers circumvent the requirement by hiring part-time employees or using consultants.

• The plan creates a national insurance exchange, a marketplace where individuals and small business would go (after 2013) to buy insurance. If you have subsidized coverage, you would have to buy your insurance through the exchange. … the exchange will add another layer of bureaucracy to the health system, and an additional 4 percent overhead to every health plan.

• Subsidies for low-income people to purchase coverage will be hopelessly complex, requiring verification of income, citizenship, employer size, etc.

• Millions will have their subsidies change as they change or lose jobs. Imagine finding a job, losing your insurance subsidy, then being laid off your job and applying for a subsidy all within a year. How would this work?

On evidence that this plan won’t reduce the number of uninsured or control costs

• The coverage gains from the plan won’t last. … The subsidies shrink, the Medicaid shrinks, and then you’re back at square one, where you’ve spent a lot of money and not made any progress.

• The Massachusetts plan is the model for this bill. Massachusetts expanded Medicaid (which again, is good, but you don’t need this plan to expand Medicaid) and passed an individual mandate that makes it illegal to refuse to purchase private health insurance. The fine is up to $1,068. The plan has been very expensive. The state has opted to pay for that by taking money from safety net clinics and hospitals, so that safety net providers that care for immigrants, the mentally ill, people with substance abuse, that provide primary care, they’ve seen their funds shrunken, so that money could be handed over to purchase insurance policies.

On the anti-abortion provisions

• The plan applies restrictions to policies sold through the insurance exchange to undermine women’s rights. … So, for the first time, Congress has stepped in and said that even with your own money, with private money, it’s illegal for insurance to cover abortion. It’s a tremendous step backwards for women’s rights.

On prescription drug costs

• It fails to lower drug costs for the majority of Americans and those unable to afford expense medications. Drugmakers have raised wholesale prices on brand name drugs by 9 percent this year alone in anticipation of reform.

• Biotech firms receive a windfall 12 year patent on new drugs.

• A very small share of the population, Medicare recipients who are in the doughnut hole, will receive a discount on brand-name medications.

• The doughnut hole is reduced in size until it is eliminated in 2019.

• Overall, the pharmaceutical industry is thrilled with the bill, and Wall Street has rewarded them by driving up the value of their stocks.

On undocumented immigrants

• Requires verification of citizenship to apply for subsidies for the purchase of insurance. Thus, the plan mandates that non-citizens buy insurance, but leaves it unaffordable for them.

Medicare Advantage Plans

• The plan phases out overpayments to Medicare Advantage plans. It also requires them to spend at least 85 percent of premiums on care, but as shown in states like Massachusetts, insurers can easily circumvent this rule.

Summary of commendable features – some may not make it into final bill

• Medicaid expansion (delayed until 2013) to about 10 million people

• Increased funding for community health centers (to double capacity over time) and other community programs like home visiting programs.

• Increased funding for primary care health professional education

• Phasing out of doughnut hole in Medicare prescription drug plan by 2019 and Medicare Advantage plan overpayments

• Eliminating pre-existing conditions (2013) and recissions (2010)

• Extending health benefit tax benefits available to married couples to domestic partners

• Extending parental coverage to children aged 26-27

• Progressive tax on the wealthy for funding instead of taxing health plans that are comprehensive (so-called "Cadillac" plans)