Dear Chairman Pete Stark and Members of the House Ways and Means Health Subcommittee:

As Congress prepares to embark on national health care reform, we commend you for holding a hearing on the instability of health coverage in America. Thank you for allowing individuals and organizations, who were not invited to give oral testimony, the ability to submit a written statement for consideration by the Committee.  This is the written testimony of Jill Levine and Ray DiCarlo, Ohio organizers for Healthcare-NOW, a national grassroots organization campaigning for privately delivered and publicly funded national affordable health care for all. Healthcare-Now is active in almost every state in more than 300 cities across the nation.  As founding members of the Ohio Chapter of the Physicians For a National Health Program (PNHP), we have committed our time and resources to advocate for a comprehensive national health insurance program. PNHP is a non-profit research and education organization of 15,000 physicians, medical students and health professionals who support single-payer national health insurance. We hope the Committee will consider our testimony for inclusion in the printed record of the hearing.

In 1945, President Harry S. Truman was the first U.S. president to propose a prepaid health insurance plan for all Americans through the Social Security system. Over the following years, lawmakers narrowed the scope for health insurance recipients to the elderly and the poor. Twenty years later, in 1965, Lyndon B. Johnson signed H.R. 6675, (The Social Security Act of 1965), the Medicare and Medicaid Bill, (Title XVIII and Title XIX of the Social Security Act), providing comprehensive national health insurance for all Americans age 65 and over and certain low income persons. 

Two Social Security Amendments were enacted in 1972 which expanded Medicare to provide national health insurance to two additional high risk groups – certain disabled persons and persons suffering from end-stage renal disease. Since 1972, little has been done nationally to assist the millions of uninsured middle class Americans. Absent of a national health insurance program for all Americans, states began taking the lead and designing their own state health reform initiatives. Massachusetts (1988), Oregon (1989), Minnesota (1992), Vermont (1992), Washington State (1993), Hawaii (1994), Tennessee (1994), and Maine (2003) have each passed a state initiative, with different ideological plans and funding mechanisms, but all have ended in failure. Lessons learned from these state health reform initiatives:

·        One state’s regulatory power cannot force national insurers to offer a comprehensive benefit package, accept all residents for a large purchasing pool, and offer these packages at affordable prices.

·        Program funding must be consistent and reliable during economic downturns. Since state government is constitutionally barred from running budget deficits, during an economic downturn, increased funding will be needed for the growing ranks of the uninsured and the subsidized poor. This is the very time there would likely be decreased tax revenue to fund the program.

·        Poor states, with a high number of uninsured and low median household incomes, will never be able to pass the state tax increases needed to cover the uninsured and fund the massive subsidies needed for the poor to purchase their insurance.

·        Health insurance costs cannot continue to increase at 2-3 times the rate of inflation and workers wages for sustained program survival. Program costs need to be reduced and controlled, rather than reducing patient benefits or increasing co-pays and deductibles.

·        Once a state program is up and running, health care benefits entice individuals with expensive or chronic medical conditions to become residents of that state, leading to more applicants and higher costs than anticipated.

On their own, few if any states are economically, structurally, and statutorily capable of sustaining a comprehensive affordable health insurance program for all their residents.

Today, 47 million Americans, 16% of all U.S. citizens find themselves uninsured.  Nationally, it has been estimated that 22,000 Americans died in 2006 because they were uninsured. ⁽¹⁾  Is national health insurance a right for all Americans over 65 yrs of age, but not for all others? Is one American life more valuable than another? Some Americans have paid the ultimate price- their deaths have been attributed to a lack of health insurance, ⁽²⁾ while millions more are suffering daily. Almost 100 million Americans, 47 million uninsured plus an estimated 50 million underinsured, are now postponing needed care when sick, not getting recommended preventive health screenings, using emergency rooms for primary care, and/or amassing high medical debt.

In today’s economy, America’s health care cost trends cannot be fiscally sustained. Health insurance premiums are now rising at twice the rate of wages and inflation. ⁽³⁾  Health insurance rates have increased 73% since 2000⁽⁴⁾ forcing employers to shift more of their health insurance costs onto their employees and to cut or eliminate benefits. The average premium for family health insurance today is $12,106/year.⁽⁵⁾  The average American family is less able to afford basic comprehensive insurance to cover all medically necessary care, so they buy what they can afford at the time. Families with health insurance are now finding that the premiums, deductibles, and co-pays, leave them unable to pay for their share of any medical bills incurred. With almost half of all bankruptcies now caused by medical bills, millions of families are just one major illness away from declaring bankruptcy. Three-fourths of those bankrupt had health insurance at the time they got sick or injured. These health care trends need to be stopped. Now is the time for an efficient national health insurance program that is affordable for all Americans.

The U.S. National Health Insurance Act, H.R. 676, has already been introduced in the U.S. House of Representatives and currently has 91 co-sponsors. This single-payer national health insurance model puts the health of American citizens before the profits of the insurance companies. Studies by the U.S. General Accounting Office and many others have shown that this reform model will save at least 10% of all health care spending from administrative cost savings. Medicare spends 4 cents per health care dollar on administration while the private sector insurance companies spend 20-30 cents per dollar. Additional cost savings from eliminating the profit and overhead of the private health insurance industry,  negotiating fair and reasonable drug prices through bulk purchasing of prescription drugs and putting all Americans in one large risk pool will be realized. These savings will combine to save Americans over 400 billion dollars annually which is more than enough to cover all of our nation’s  47 million uninsured and the estimated 50 million underinsured without any increase in health care spending. The single-payer reform model is also the best model to control ever increasing health insurance costs.  

H.R. 676 has considerable state, city, and county support.  It was recently endorsed by the U.S. Conference of Mayors, representing over 1,000 cities with populations over 30,000. It has been endorsed by the Kentucky and New Hampshire House of Representatives, the New York State Assembly, and by dozens of cities and counties from Baltimore to San Francisco and from Warren County Tennessee to the majority Republican Renssalaer County Legislature in New York.

Public support is firmly behind a guaranteed national health insurance program for all. According to the latest nationwide survey, 65% of all Americans believe that: “The United States should adopt a universal health insurance program in which everybody is covered under a program like Medicare that is run by the government and financed by taxpayers.”⁽⁶⁾  Physician support is strong too. According to the latest survey published in the Annals of Internal Medicine, 59% of all physicians now “support government legislation to establish national health insurance.” ⁽⁷⁾  The American College of Physicians, deans of major medical schools, former editors of the New England Journal of Medicine, and former surgeon generals are all supporting a single-payer national health insurance reform model. Union support for an “Expanded and Improved Medicare for All Program like H.R. 676, The U.S. National Health Insurance Act” is widespread. H.R. 676 has been endorsed by 447 union organizations in 49 states including 110 Central Labor Councils and Area Labor Federations and 36 state AFL-CIO’s (KY, PA, CT, OH, DE, ND, WA, SC, WY, VT, FL, WI, WV, SD, NC, MO, MN, ME, AR, MD-DC, TX, IA, AZ, TN, OR, GA, OK, KS, CO, IN, AL, CA, AK, MI, MT and NE). International union endorsements include the SEIU, UAW, NEA, ILWU, NALC, IAM, Plumbers & Pipefitters (UA), Musicians (AFM), UE, CNA/NNOC, SMWIA, IFPTE and OPEIU.  The General Assembly of the Presbyterian Church USA, the General Assembly of the Unitarian Universalists, the United Church of Christ, and the United Methodist Global Board of Church and Society have all endorsed H.R. 676.

Thank-you Mr. Chairman and members of the Committee, for providing us this opportunity to focus your attention on the need for a national solution to America’s health care problems.

Jill Levine and Ray DiCarlo, Co-Chairs
Healthcare Now Committee
Patriots for Change
Physicians For a National Health Program – Ohio Chapter

Sources

1. Urban Institute, January 2008
2. “Care Without Coverage”, Institute of Medicine, 2002
3. KFF/HRET Survey of Employer-Sponsored Health Benefits, 1999-2007; KPMG Survey of Employer-Sponsored Health Benefits, 1993, 1996; HIAA, 1988, 1989, 1990; Bureau of Labor Statistics, Consumer Price Index (U.S. City Average of Annual Inflation, 1988-2007; Bureau of Labor Statistics, Seasonally Adjusted Data from the Current Employment Statistics Survey, 1988-2007. Note:  Data on premium increases reflect cost of premiums for family of four.
4. Kaiser Family Foundation. (2005). Trends and indicators in the changing health care marketplace. Menlo Park, CA: Kaiser Family Foundation.
5. Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 2007.
6. AP-Yahoo poll, December 2007
7. Annals of Internal Medicine, April 2008.