Observations on Senate Banking and Insurance Committee hearing on PA single payer plan

Observations of Dr. Walter Tsou, former Philadelphia Health Commissioner, and Chuck Pennacchio, Executive Director of Healthcare for All Pennsylvania, on yesterday's (12.16.09) Pennsylvania Senate Banking and Insurance Committee hearing on SB 400.

Chuck Pennacchio:

In addition to Walter's more detailed observations and insights below, I'd like to make a few key points intended to translate events and chart a path forward for passage of SB 400/HB 1660 at the earliest possible moment.

First, it was obvious that our SB 400 testifiers -- including Senator Jim Ferlo's tone-setting statement at the top -- were far better prepared, passionate, and on-point than our opponents.  But no need to take our word for it.  The glowing wrap-up comments of Chairman White, his decision to extend the hearing time an additional 50 minutes, his desire to continue the hearings and research and bill-writing process, as well as his personal congratulatory handshake while saying, "your panel did a terrific job," give us real hope that we are within shouting distance of accomplishing what all of us need -- a healthcare system that, in moral and economic terms, puts patient care and dignity first and foremost.

I was also pleased with the preparedness, comments, and questions of Senator Jake Corman, part of the GOP leadership team, Chair of Senate Appropriations, and member of Banking and Insurance.  His grasp of issues, embrace of our "new ideas,"  openness to our fair-share health and wellness tax, and query of SB 400 opponents (exposing their ignorance of Single Payer) are all good signs.  

This leads me to a broader discussion of the significance of what happened yesterday...

I know, I know, you say, we've been here before.  Right?  Politicians raising our hopes and then letting us down.  Actually, so far and past and present experiences inform me, I perceive elements remarkably different and, I believe, promising.  

For starters, it's time to imagine what is unimaginable to many (or most?) citizen activists.  And yet, the "unimaginable" is a course Healthcare for All Pennsylvania has been on since 2006 -- a course that subsequent events have borne out.  

Based on a repeatedly validated assumption that, because of the destructive effects of campaign contributions from health insurance, pharmaceutical, and allied interests to politicians in both major parties, as well as a political culture of "incrementalism," we must be fiercely non-partisan, evidence-based, organizationally sound, forthright and flexible, and mindful of our federalist constitution and political history.  

In other words, we have long held that the winning coalition around the proven Single Payer Solution will be comprised of "conscience Republicans" and "conscience Democrats," beginning with one of our "modeling" fifty states.  And, in the case of Pennsylvania, not only do we have political advantages that others do not, but we have what appears to be a thoughtful and courageous GOP leadership on the joined issues of healthcare delivery, healthcare economics, and healthcare financing.  Put another way, we have legislative leadership in the State Senate that "gets it" -- analysis of problems, openness to policy prescriptions, and a feel for the political choreography needed to bridge policy pieces, key players, and central institutions.   

Finally, and by way of consensus emerging from yesterday's historic Banking and Insurance Committee hearing, our next critical step is to raise the funding to complete our ECONOMIC IMPACT STUDY.  Two months ago, you and other HC4APA supporters provided the $5,000 in seed money to get us to the point where we are today.  Now, with the study prospectus in hand and bidding negotiations finalized, it is on all of us to raise an additional $49,000 to complete our EIS and, provided the learning experiences of other states, "grease the legislative skids."  We truly are that close.  So, obviously, if you can give, do so to the best of your ability.  If you know others who can contribute, please ask them to help as well.  And if you know folks who are serious enough about considering a donation, but need a briefing on SB 400/HB 1660, let us know that as well. 

Dr. Walter Tsou:

"My overall impression was this was an enormously successful and impressive showing for Pennsylvania state single payer.  Yes, I may be biased, but our four panelists did a superb job in explaining the Family and Business Health Security Act.  To explain why I say this, consider the concluding remarks of Senator Don White, Republican Chair of the Senate Banking and Insurance Committee.  First, Senator White offered that "there were those who said I should not have this hearing" -- a clear rebuke of the fearful during this time of healthcare and economic crisis.  Second, whereas in his opening comments he downplayed expectations for the hearing as a "fact-finding session only," by the end, his praise of the Single Payer presenters was so "positive," he declared that this opening act was just the beginning of a series of hearings on this most important topic.

  

 The hearing began with Senator White, a former insurance broker, welcoming everyone and inviting Senator Jim Ferlo, the lead sponsor of SB 400, to present some opening thoughts.  Ferlo explained the need to look at different approaches rather than be tied to the usual failed insurance model.  Among other attributes, he said that the state Single Payer plan would free employers from the onerous burden of skyrocketing health insurance costs by, instead, providing healthcare for everyone at far less cost.

Chuck Pennacchio, Executive Director of Healthcare for all PA spoke next and further explained the particulars of the state-level, Single Payer approach, and how it represents values we can all embrace: freedom, choice, fiscal conservatism, personal responsibility, modeling solutions, constitutional federalism, fair-share taxation, efficiency, transparency, accountability, jobs creation, bureaucratic streamlining, investment and reinvestment, coordinated and comprehensive care, reduced rationing, restored patient-provider relationship, healthy outcomes, tort remedy, end bankruptcy fears, healthcare education, "medical home" data base, and more.

Patricia Eakin, RN from Philadelphia explained that she was a nurse in one of the busiest ERs in Pennsylvania at Temple and that she sees the problems of the lack of insurance on a daily basis.  She gave some examples of the problems faced by people who have lack insurance.  She noted how her hospital was losing money because they had to spend limited resources on billing personnel, and had to absorb, and/or pass along, financial losses on people without insurance or on Medicaid.

Dwight Michaels, MD, a Republican, and family practice doctor from Gettysburg, spoke about how his experience with private insurance bureaucrats had driven him to support the Single Payer Solution.  He said it is increasingly difficult to practice medicine because his five-person practice struggles daily with 20 different insurance plans, all with different rules.  This bureaucratic nightmare makes it impossible to spend quality time with his patients because he is forced to justify more and more of his procedures with the insurance carriers.  Dr. Michaels' testimony was a vivid description of the life of a family doctor in a dysfunctional system.

David Steil, a former Republican state legislator and head of a small manufacturing business was another inspired choice.  Not only did he know all of the Senators but, as a creative-thinking lawmaker, he broke the stereotype that all Single Payer supporters are lefties.  Mr. Steil spoke about how he tries to run a business, but the cost and hassle of health insurance has made his company more vulnerable in an international market where his non-American competitors have far cheaper health costs.

I think this panel worked extremely well.  Not only were they excellent speakers, but they spoke from real world experiences, not as paid lobbyists.  And two were Republicans which was an added bonus.  The committee had many questions, but none were nasty and all seemed genuinely interested in the real world experiences of the panelists.  And the room was packed with 90% supporters of SB 400.  I don't think this was lost on the committee.

The opposing panel were all known lobbyists for their respective interest groups.  They gave the usual refrain of condemning single payer.

NFIB speaker - he simply declared that small businesses don't want Single Payer, but admitted that healthcare costs are the number one concern of businesses.  They want the same outcomes that only Single Payer provides.  But since that involves "government bureaucracy," it cannot possibly work.

PA Medical Society - wants tort reform but not Single Payer because it would be too powerful in controlling reimbursements (and costs).

Capitol Blue Cross - gave a confusing talk about the problems with the Washington federal bill and then simply concluded that SB 400 is just like the Washington bill and should be rejected.  Of course, nothing in the federal bill even resembles Single Payer, which is why it is so unpopular. 

Hospital Association of PA - opposes any government controls generically.  Gave a knee-jerk opposition to Single Payer.

Insurance Federation of PA - same as the hospitals.  They oppose Single Payer as "monopolistic" -- working from the assumption that the 35-cents-on-the-healthcare-dollar insurance "middle man" is indispensable, and that a little more regulation and industry "innovation" will solve cost issues.

There was not much time for questions but, frankly, they were special interest lobbyists and not a very interesting opposing panel.  If this was a debate, the clear winners were the Single Payer SB 400 panel who did a great service in advancing state-level Single Payer today.

Happy Holidays to everyone.  And thanks for all you do.

Chuck and Walter