Single Payer and Public Behavioral Health

(Though this was originally published in 2006 and a few stats are out of date-- they are worse now-- I have been asked to "repost" this. One clarification may be important, the reference to "President-elect Santos" -- As was somewhat popularly known at the time, he was TV's "West Wing" young Democratic presidential candidate with an ethnic name who won the election against an elderly white republican senator from the southwest. Yeah, like that could ever really happen. Let me know your thoughts. )

We are coming to a tipping point in health insurance coverage in this country. I believe it is and should be towards universal, single payer healthcare/insurance. The question relevant here is how does public behavioral health impact what is to come. While many of us, understandably, are enshrouded in the fog of our current inefficient system, there seems little discussion of how to influence the development of structure, policy and delivery systems of behavioral healthcare in a national healthcare program.

It seems important to muster here some of the arguments and realities of this coming tipping point. Perhaps we need say no more than it is costing General Motors close to $2000 per car manufactured to pay for the health insurance of its current and past employees. This is a competitive burden for all our major employers that their foreign competitors do not have to carry. Why? Because every other “developed” country has some form of national healthcare that spreads the cost – and, not incidentally, improves the outcomes. ( The U.S. generally ranks around 25th in national healthcare outcomes.)

The administrative/non-treatment costs in utilizing private insurance ranges from 15 to 30%. Our national single payer healthcare for seniors ( MediCare) has a 3% admin rate. (As “President-elect Santos”, Senator Kennedy and Congressman Conyers and many others have been saying—we could just drop the “over-65” part of the MediCare legislation.)

Then there is that the U.S. has a consistently growing percentage of “permanently” uninsured—currently 46 million--16% of the population, with an additional 16 million underinsured.

Oh, and, by the way, between government programs and public employment, government is already paying over 60% of insurance costs.

A single payer system is estimated to save over $200 billion annually, cover everyone and improve outcomes.

The current system gives undue policy influence to private insurers and the pharmacy industry.

Rationing ? Bureaucratic control ? Yeah, right, like we don’t have that now—and it will improve under single payer.

Imagine, if you will, a society in which each of us knows that we, our families, our neighbors are free from the stress of healthcare worries and the possible financial destruction a medical crisis can portend.

And while there is so much more weighing in this balance toward a tipping point perhaps the biggest practical point is that --GM is spending nearly $2000 per car.

So what is happening out there that we need to be part of ?

Well, first of all let me speak to some pseudo-reforms. Space does not permit discussion of some of the finer points of (not-even) halfway measures—such as Massachusetts and Vermont, “consumer-directed”, health savings accounts, “Clintoncare”, etc. Suffice it to say that they all rely on and keep in place the current inefficient multiple insurance system.

What is important is that action is moving towards true single payer. My own state, California, has a bill moving through its legislature. It faces the usual resistance and suffers from state level incrementalism. But it may yet serve as a model for national healthcare.

Congressman Conyers and the Congressional Healthcare Caucus have introduced a National Health Insurance Act-HR 676. This bill is going in the right direction and needs the support of the field, consumers and practitioners. Two major national groups are supporting this process—as well as other activities. Healthcare Now (www.healthcare-now.org) is establishing “citizen hearings” through out the country as well as other actions. Physicians for a National Health Program (www.pnhp.org) have been supporting, developing proposals and making the arguments for single payer since at least 1989

Both these organizations and others have extensive websites. Yet, it is difficult to see how behavioral healthcare will be addressed/provided in these models. There are many questions that come to my mind—and that we need to be involved in to influence. Just a few-- Will services be on demand or will they need prior authorizations? Are we looking at a return to fee-for –service? Will the program essentially be a “ticket” for service ? Will there be ways to aggregate funds into programming ? Will the regulations and billing processes be as onerous as they currently are for MediCare Mental Health? Will it be allowed to truly be a “behavioral health” approach and dispense with substance abuse morality issues? Will it help promote service delivery to lower socio-economic groups and efforts against stigma? How will it impact us as employers, providers? Theory is payroll tax and employee tax will be likely revenue sources— how will these be structured so that they are more affordable than the current system ?

It won’t come for free—but it will be less expensive and provide better care. How its finances and delivery systems are structured will be best determined by those involved in its creation and maintenance. These issues need to be being addressed in all our policy and advocacy discussions.

So while you/we are dealing with the usual cascade of crisis that seem to make up our work life, we really need to attend to this point before we are tipped without being part of the tipping.

In what has become pretty much a “tag line” for PNHP—“Of all the forms of inequality, injustice in health care is the most shocking and inhumane—Dr. Martin Luther King, Jr.

Stephen Adair Vernon, LMFT; July 12, 2006 Improved MediCare For All!

Stephen-Ken Dialogue III

Ken

So I’m listening to Thom Hartmann on the radio and he’s asking Mark Gafney (?) MI AFL-CIO president the same questions I was asking you, re: how is the local, MI, media covering all this (specifically Snyder and his minions.)

I suppose you know Thom was in Lasing/E.Lansing the same time we were. I do understand that progressive radio is basically non-existent in “the ol’ stomping grounds.” So this is part of what I want to get from and about you. Clearly you, we both, are, a more aware observer/consumer of the zeitgeist, but, part of what I am interested in is the sense of “where the public is,” what do they have to consume ?, at what level of effort ?, what impact?, etc. A bunch of wonderings that probably have no definite answers (besides-- Answers ARE dangerous) but are worth circumambulating.

Anywho, the union guy tells Thom that he actually thinks that the media is telling an “ok” story. Not as much depth as necessary—but collective bargaining, suspension of governments, critical comparisons of platform to actions, etc. Seem that way to you?

It’s always a kick when Thom waxes on about Lansing—today he mentioned his brother as the press operator union rep at the State Journal. The other day he talked about his stereo store in the late 60’s on MAC Ave. ( A woman had actually called in and said she still has a turntable she bought from him)-- Stephen

Stephen

Depends what press you're talking about. MSNBC is giving the best coverage
you can imagine, led by Ed Schultz, a former Republican who saw the light.
The mainstream press is not doing much of any value. They mention the right
terms but don't go in depth.

I blogged about the rally on Thursday in Lansing, if you're interested.
Please do spread it around. http://kenwachsberger.wordpress.com/2011/03/17/inspiration-at-capitol-in-lan
sing/ --Ken

Stephen - Ken dialogue II

KEN

So pretty much the same view as from here. Though imagine that MI and WI are a bit better covered there than here. Only a bit, but perhaps not. So what do you call it when 10 teabaggers gather on a corner? A conservative revolution worthy of massive media coverage. What do you call it when 100’s of thousands progressives rally for weeks? A mob that might become violent and doesn’t clean up after itself (and may want a bite out of your cookie—I presume you’ve heard that metaphor/story going around) (I just made up that “what do you call it”s—they may need a little work.)

While I agree that Obama and the Dems blew it and try to play too nice it does remind me of the old 60’s-70’s argument of can we trust the Dems and/or is they all we got?

Just how far they can stray from their corporate masters is a continuing question. Especially when the media so defines the limits of the debate. E.G. I would love that every time some one calls Obama a socialist that the media 1. Educates them on the definition of socialism and 2. Calls them out for the the (50’s) McCarthyite s/he is.) (And my personal favorite irritant, I want them to be corrected every time they say “Democrat Party.”)

Shared Sacrifice!? When they give back the money they “legally” and illegally stole then we can talk about shared sacrifice. (And just where are THEY sacrificing anyway?) (Of the many examples--) They took the Social Security surplus ( a regressive tax) and spent it on their tax reductions and wars and now they say since the “taxpayers” will have to pay it we have to reduce benefits.

And 400 people owning as much (more) than 150 million. Is the obscenity clear just yet?

When I saw the video of thousands of people outside the WI Capitol trying to get in for the anti-union vote another image popped to mind. The dozen (if that many) people (mostly Rebup staff) imported by Karl Rove for the Brooks Brother riot that stopped the Miami-Dade count in 2000.(Rove's Replacement Brags About "Brooks Brother Riot"-- http://www.democrats.com/joel-kaplan )

I won’t even mention the assassinations that killed liberalism(all right, I just
did.)But, ever since Nixon, the Repubs have only won the presidency when they have committed treason or other crimes. Nixon/Kissinger re: the ’68 peace talks; Watergate; Reagan and Iran hostages (straight from the ’68 playbook); Bush I in covering up his Iran involvement, etc; Bush II in the voter purges, stopping the vote count (with the assist going to the Supreme’s).

And just how could the media even pretend that Bush was at all a competent contender. He had destroyed everything he had ever managed and the TX governorship is certainly no training ground for the Presidency. Maybe just an accurate coherent sentence or two should be minimal qualification.



Stephen,

The difference between the Dems and the Reps always was that the Dems always
said the right thing, at least long enough for the masses to think maybe
they might perhaps just possibly come close to doing the right thing--and
then they did the opposite. The Reps always promised to do what you hated
and they came through. Obama did a great job of co-opting the left, and he
has indeed done a few good things. But he presently is selling out as fast
as he can. Where is he on the union struggle issue. I can't hear him. What
is he doing with Bradley Manning--consenting to torture and denying he's
doing so (he asked the jailers if BM was being treated okay, they said he
was, and so he reported that he was satisfied).

It's too bad. Obama had a mandate to make major change but he was much more
interested in making major nice.

But you can't expect the corporate media to tell the truth. They're the same
folks we dealt with back when, only they're now more concentrated. There is
still the same need for the alternative media. The bloggers are our
successors but most of them have no idea what went on back when with the
underground press. That was why I invited Markos Moulitsas, founder of
dailykos.com, the most important, in my opinion, progressive blog site, to
write the foreword to volume 1, to connect the generations. It isn't because
the bloggers have turned their backs on us or think they're better than us.
It's because they don't know we existed because the schools don't talk about
the alternative press--even journalism history classes, a point I made in a
radio interview yesterday.

Stephen - Ken dialogue

No better place to start this effort at  communication with impact than a recent dialogue with ol' buddy Ken in Michigan.  Talking politics, the world and whaddaheck is gong on and whadwecando to help move the world forward.  ( where is that fulcrum, anyway?)

To Ken:

Not little influenced by the goings on back there--Been thinking about the old stomping grounds, you, et al. How are things from the MI point of view? What's the haps in WI?

From here (SF Bay Area) I certainly see an occasional burst into the general mediaof some limited conception of thousands of people protesting against the loss of collective bargaining.As minimal as that is it is more than overwhelmed by theunexamined "neutral" langauge of the talking heads of the threat pensions are to the taxpayer, or, that deficit reduction not only is immediately necessary but can only be accomplished by cutting and "shared" sacrifice(ing of the middle class on the altar of the rich) (I added that last part)

Of course I listen to and look for better, more enlightened, perspectives on the
political/personal processes of the times. Yet, even though I remain hopeful--in the long run-- I disdain my own hopefulness.

Perhaps it is always at least some Rage Against the Machine but redirecting the machine is often tantamount to destroying it. Insurance based healthcare is healthcare for the insurance companies. Single payer is healthcare for the people.

Anyway, my heart and hope is with the Solidarity reaction to Republican overreach. And though this phase, as all do, will wane, perhaps a new perch will be regained from which to operate.
--SV


To Stephen:

Democrats at the national level had a chance to make major change--including
single-payer insurance--when Obama won but they dickered around and Obama
spent too much time trying to make nice to people who hated his guts and
were committed to saying no to anything he said yes to. They still are and
he still is. Democrats could have crushed Republicans into the next century;
instead, they let Republicans define the terms of debate. I would say
Republicans are great at that but in truth Democrats are just incompetent.
Republicans say the economy is still no good under Obama. Where are Obama
and the Democrats saying the economy is bad because the Republicans voted
down the ideas that would have made it good? And now Afghanistan is Obama's
war, with no end in sight and my bet that Obama will invade Libya because
the Republicans are taunting him to.

What's happening in Wisconsin is 1) a travesty; 2) happening all over the
country. The Wisconsin Democrats came to life. This is refreshing--maybe, as
George Jackson wrote, you have to feel the worst of how bad things can be
before you begin to make them better (which is just a rework of the therapy
idea that you have to feel the pain before you can begin to get rid of it).
If this is so, then "overreach" will be an understatement when the unions
rally the rest of the disappearing middle class and do what the majority in
a democracy is supposed to do.

It can be frustrating. Sometimes you have to withdraw to regain your energy
but then you have to come out fighting.

--KW
(to be continued)