Letter to Governor Strickland

Several members of PNHP Ohio have agreed to send a letter to Governor Strickland and his State Coverage Initiative advisory group encouraging them to model single payer reform in Ohio. One of the Governor's advisory committee members has continued to encourage us to push this idea. We will see if it has any effect.

We await the announcement of a health reform bill promised by Representative Raussen who heads the committee responsible for health care. We don't expect much except for the usual "market forces" ideas that are likely to be ineffective such as subsidies that will likely still leave insurance unaffordable and some reforms in the small group insurance market. We will respond when the time comes.

The letter is below. Feel free to send another copy to Governor Strickland at http://apps.das.ohio.gov/govpublic/contact.aspx. The State Coverage Initiative allows public input at its web site http://www.healthcarereform.ohio.gov/input.aspx



Dear Governor Strickland,
We, the undersigned founders of the Ohio chapter of Physicians for a National Health Program are writing to encourage you to include a single payer type reform in the models being considered by the State Coverage Initiative. We commend your decision as the first Ohio Governor to begin a serious effort to address health care coverage, and for keeping deliberations of your advisory committee and the SCI team transparent with opportunity for public input on your website.
We would like to request that you include an actuarialy sound single payer model such as the Health Care for All Ohioans Act or the Health Care for all Colorado among the five models proposed for reform as part of your State Coverage Initiative. We understand that as part of the initiative, the state will hire an actuary to estimate the cost and coverage effects of up to five options for reform. Unfortunately, single payer state based reform is not among the choices despite a long history of support for such ideas in Ohio dating back to 1990.
The November 20th minutes of the Advisory Committee indicate consideration of an insurance connector, a reinsurance program, a high risk pool and Section 125 employee plans. The Massachusetts experience with a connector shows that working families get bare bones coverage while insurers keep a big chunk of premiums for inefficient administration and profits. Connector costs are soaring, and benefits are being cut after only one year. If this program proves to be unsustainable in a state like Massachusetts, it certainly cannot survive in Ohio .
The Massachusetts plan included a mandate to buy insurance because it would otherwise become just another high risk pool as sick patients with high health expenses chose coverage and the healthy low income families would not purchase this expensive coverage. A riddle- what is the difference between a mandatory premium payment and a tax? Answer- A mandatory premium allows insurers to keep a larger percentage of the money collected before health care is delivered (20% for private for profit insurers vs. 3% for Medicare).
What about tax credits? They have been modeled by the CBO. Even with a credit worth 50% of the premium only an additional 4% of typical uninsured workers will buy insurance. Tax credits will not work without a mandate and they will be very expensive if they are to be effective. (See above). Same riddle- same answer.
A recent study of Ohio by Families USA modeled an example of a family of 4 with pre-tax income of $60,000. After taxes, this fell to $48,480. After calculating the average costs for housing, utilities, transportation, food, clothing, education, entertainment and other personal expenses, only $2990 remained for health care premiums and out of pocket costs. Under a single payer program health care costs would be better controlled and all would have affordable coverage. Under proposals which force people to buy private plans, many people will require tax-supported measures such as credits and subsidies. Given the precarious economic situation in Ohio, it makes sense to consider a model which has been shown repeatedly by the Congressional Budget Office and the Lewin Group to save enough money to cover all the uninsured.
National health insurance, as proposed in HB 676, (Conyers and Kucinich) would replace private premiums with fair payroll assessments. These funds, added to current public spending, would create a single insurance pool adequate to cover all Americans with no added spending according to the CBO. Here in Ohio. The Health Care for All Ohioans Act could do the same thing for all Ohioans. Ohio could lead the way.
Health care costs are hurting the competitiveness of our products in the world markets. Despite the insurance industries’ creations (HMO’s, PPO’s, HSA’s, FEHBP, CALPERS, small business insurance purchasing pools, high risk individual insurance purchasing pools), we have failed to control our health costs or expand coverage.

The Health Care For All Ohioans Act, or similar single payer proposals such that proposed in Colorado, could cover us comprehensively at no added cost just like an improved and expanded Medicare. It guarantees cost control so it is good for business and our health. It is conservative of the basic structure of Ohio's health care system in that it changes mainly the financing. It would ease our efforts to improve quality. It is conservative of individual freedom and responsibility in that it allows free choice of provider and eliminates financial barriers to preventive and chronic disease care. Single payer reform would cover everyone, save lives, save money, and we believe it is the right thing to do. We hope that you will reconsider and model a single payer type reform along with other approaches being considered by the SCI.

Sincerely,

Johnathon Ross MD, MPH -Toledo
Alice Faryna MD -Columbus
Don Rucknagel MD-Cincinatti
Brent Adler MD-Bexley
Phil Lichtenstein MD-Cincinatti
Joseph Shapiro MD-Toledo
Jerome Leibman MD-Cleveland
Pamela Cobb MD-Dublin
Freeda Flynn MD-Cincinatti
Carol Lebeiko MD-Columbus
Michael Bissell MD, PhD, MPH
Megan Testa MD- Cleveland
Timothy W. Smith DO- Cincinatti
George Randt MD- Cleveland
Edward Goldberger MD- Toledo
Richard Salzer MD
Karen Kirkham MD- Dayton
George Wineberg MD- Yellow Springs