Sorry, your health care coverage can't actually be used.

=================================

Subject: Important Information About Your Health Coverage
Date: Fri, 6 Dec 2013
From: vthealthconnect@state.vt.us
To: [ ]@[ ].net

Dear [ ],

Hello! We are writing to let you know that you have a new notice regarding your bill for health care benefits from Vermont Health Connect. To view your notice, please click on the link below and log in to your account.

Your notice is: Premium Invoice

www.vermonthealthconnect.gov

After logging into your account, click on ‘My Account’ and select the ‘My Profile’ tab. Once there, click on ‘View Documents’ from the ‘Quick Links’ box. If you have any questions regarding this notice, please call Vermont Health Connect Customer Support toll-free at 1-855-899-9600, Monday-Friday 8am-8pm and Saturdays 8am-1pm (except holidays and holiday weekends).

Thank you,

Vermont Health Connect

=================================

Subject: Re: Important Information About Your Health Coverage
Date: Fri, 06 Dec 2013
From: [ ] <[ ]@[ ].net>
To: vthealthconnect@state.vt.us

There doesn't appear to be a way to log in. There is a "logout" button, which remains "logout" after clicking it. No "login" button or pane.

In fact, because of the consequent inability to check my account and the lack of reply by telephone [since applying on line], I just sent in a paper application today. Which I guess is now unnecessary as far as setting up an account.

I think I would like a paper notice/statement/bill.

Thanks.

=================================

Subject: RE: Important Information About Your Health Coverage
Date: Mon, 9 Dec 2013
From: AHS - VT Health Connect
To: '[ ]' <[ ]@[ ].net>

Dear [ ],

Thank you for writing.

To log in to your account, please go to https://portal.healthconnect.vermont.gov/ and click on “Start Here” found next to where you see “Are you looking for coverage for yourself or your family?” On the next page, please click either on “Login to your Account” or “Apply Now” as either will bring you to the log-in screen. Once you are logged into your account, you will be able to access your invoice using the directions in your original e-mail.

[Makes sense? Even if you have an account, you have to illogically click "Are you looking for coverage for yourself or your family?" to get to it. But perhaps that was an admission of the truth recorded here.]

As you've requested, we'll send a paper invoice to you in the mail. You can expect to receive this invoice within a week.

Please let us know if we can help you with anything else.

Kind regards,
Rebecca

Vermont Health Connect
Customer Support – 855-899-9600

Check out our website for updated information!

Links:
Vermont Health Connect: http://info.healthconnect.vermont.gov/
YouTube Channel: http://www.youtube.com/vthealthconnect

=================================

Subject: Your Vermont Health Connect Invoice
Date: Tue, 17 Dec 2013
From: Vermont Health Connect
To: [ ] <[ ]@[ ].net>

Dear [ ],

Thank you for completing your application for health insurance coverage through Vermont Health Connect. You may have received two invoices this month – one for your new (2014) Vermont Health Connect health plan, which begins January 1, 2014, and one for your former (2013) health plan, which was recently given the option of extending up to March 31, 2104.

You only need to pay the bill for the plan you wish to have effective on January 1. You do not need to pay the other bill. If you want help making the choice of which bill to pay, please call our Customer Support Center toll-free at 1-855-899-9600 and reference the code “VHC1215.” A customer service representative will then talk you through your options. Please note that our call volume is high at this time. We thank you in advance for your patience. If you applied through a Navigator, you could consult him or her as well.

Please note that you do not need to take any additional steps to cancel your former plan. Your 2013 health plan will automatically expire after you pay your premium and your 2014 plan takes effect.

We are open from 8:00 a.m. to 8:00 p.m. Mondays-Fridays and 8:00 a.m. to 1:00 p.m. on Saturdays.

Sincerely,

Vermont Health Connect Customer Service

=================================

Subject: Starting coverage in February
Date: Sat, 11 Jan 2014
From: [ ] <[ ]@[ ].net>
To: vthealthconnect@state.vt.us

I set up my account and selected a plan very early and received an invoice by mail (as requested) in December. However, I had already paid my Catamount Care premium for January, so I did not pay the premium for the new plan.

Now I need to make sure that I will get another invoice (by mail, please) for the new plans, to start coverage in February.

=================================

Subject: RE: Starting coverage in February
Date: Mon, 20 Jan 2014
From: AHS - VT Health Connect
To: '[ ]' <[ ]@[ ].net>

Dear [ ],

Thank you for writing. We're so sorry for the delay in replying to your email.

I've reviewed your account and see that you also called and spoke with someone about this last week. As they told you, it is fine for you to just pay your premium for February. Your account has been marked so that your policy will start in February.

Please let us know if we can help you with anything else.

Kind regards,
Rebecca

Vermont Health Connect

=================================

Subject: Important Information About Your Health Coverage
Date: Wed, 5 Feb 2014
From: vthealthconnect@state.vt.us
To: [ ]@[ ].net

Dear [ ],

Hello! We are writing to let you know that you have a new notice regarding your bill for health care benefits from Vermont Health Connect. To view your notice, please click on the link below and log in to your account.

Your notice is: Premium Invoice

www.vermonthealthconnect.gov

After logging into your account, click on ‘My Account’ and select the ‘My Profile’ tab. Once there, click on ‘View Documents’ from the ‘Quick Links’ box. If you have any questions regarding this notice, please call Vermont Health Connect Customer Support toll-free at 1-855-899-9600, Monday-Friday 8am-8pm and Saturdays 8am-1pm (except holidays and holiday weekends).

[Steps to view invoice:
• Click "Are you looking for coverage for yourself or your family?"
• Click "Log in"
• Click "My Account"
• Click "My Profile"
• Find the "Quick Links" box and Click "View Documents"
• Click the listed documents until you reveal the current invoice]

Thank you,

Vermont Health Connect

=================================

Subject: Re: Starting coverage in February
Date: Mon, 10 Mar 2014
From: [ ] <[ ]@[ ].net>
To: AHS - VT Health Connect

Today I received a "Payment past due/Termination Notice" from BCBS [Blue Cross/Blue Shield]. As noted below, this is because I was assured that it was OK to ignore the January premium and that the new policy was to begin in February. This was necessary because the invoice for January coverage under Catamount Care was due (and paid) before the invoice for the new BCBS policy under VHC was available.

According to the BCBS notice, "Vermont Health Connect has reported that full payment has not been received for your health insurance."

Please resolve this.

=================================

Subject: RE: Starting coverage in February
Date: Thu, 13 Mar 2014
From: AHS - VT Health Connect
To: '[ ]' <[ ]@[ ].net>

Dear [ ],

Thank you for contacting us. We're very sorry that you received the past due notice from BCBS. I see that you have paid each of your invoices well in advance of the due dates, and as you noted, the fault is entirely ours for not yet making that change to your coverage start date. Unfortunately, we don't have that functionality to make the change once your plan is in force, but we are working on it and will correct your account as soon as we are able.

You actually have a 90 day grace period, so there is no danger of your plan being terminated as long as you keep paying your monthly premiums as you have been doing.

Please let us know if we can be of any further assistance.

Kind regards,
Ellen

Vermont Health Connect

=================================

And so I have been paying the monthly premium to Vermont Health Connect, ignoring the monthly "PAST DUE/NOTICE OF TERMINATION" notices from BCBS.

Secure in the knowledge that we do indeed have continuing "affordable health insurance" (which Vermont was already providing for almost everybody, effectively and without major problems: the "Catamount Care" referred to above). Secure, that is, as long as we would never need it, as it turned out.

I had an annual check-up scheduled in early October and was told by the doctor's office that a check of insurance status revealed it to be "pending". For that reason, they would not be able to submit the bill. I learned from a call to BCBS on Oct. 1 that "pending" in this case meant that I was behind in payments, because they still considered my coverage to have begun on Jan. 1 instead of Feb. 1, and therefore still expected an extra month of payment. In other words, despite the reassurance from Vermont Health Connect 8 months before that "we are working on it and will correct your account as soon as we are able", they still had not. Furthermore, the reassurance that "there is no danger of your plan being terminated as long as you keep paying your monthly premiums as you have been doing" turned out to be meaningless, since my regular doctor wouldn't risk billing to a "pending" insurance account. The person I talked with at BCBS helpfully transfered me to Vermont Health Connect, noting that she had heard that they may be "a few months" behind.

Thank goodness we have not been in any emergency situation or in urgent need of a prescription refill.

From Vermont Health Connect I now (!) learned that changing the start date required a new application because it is a "change of status". And so I was transfered to another office to handle that. The woman there, like everyone I have talked with at every step, it should be said, was very helpful and was able to use the original application to make a new one for coverage starting Feb. 1, ie 8 months earlier, to expire Dec. 31, ie in less than 3 months.

Now we were expected to have "new" insurance active in a couple of weeks, a new card in a week after that. Just in time to start the whole charade over again for coverage next year.

We essentially have had no usable insurance coverage since Feb. 1, despite regularly paying monthly premiums for it. What surprises lie in wait for us in the new cycle beginning Jan. 1, 2015, with a promised automatic renewal of coverage? Or in April, when the IRS recalculates everybody's share of their previous year of premiums?

The faster we move to a single payer system the better! Federally, Medicare was supposed to steadily expand in the 1960s to cover everyone, not just the elderly (but then it would have covered draft dodgers and black panthers along with "deserving" citizens like oneself). If the US government can not or will not provide that very basic service to all those who live within its borders, then the states need to go it alone. And I mean not just setting up some mash-up of federal support and state-provided health coverage, although that would be a welcome step despite the likelihood of its being as dysfunctional as the current private-public mash-up — I mean breaking away altogether from the government of Washington. Because health care is just one of its many failures, and war to gain world hegemony seems to be its only goal, war ordnance its only economy, squandering our common wealth as well as our lives, sacrificing them to an end that can only be catastrophic.

[Update:  Two and a half weeks later, we've received no notice about the "new" coverage, but instead a series of premium invoices (up to 4 so far), each one different from the last and none of them reflecting a resolution.]

[Update:  Four weeks later, we haven't received a new insurance card or any notice about the "new" coverage.]

[Update:  A month later, BCBS remains uninformed of the change, which Vermont Health Connect says was "finalized" on Oct. 14 (under a different "service request" no. than the "confirmation no." originally provided).]

[Update:  Five weeks later, the "change of circumstance center" has promised to notify BCBS today, which was supposed to have been done on Oct. 14 but was not. The reason another 2 weeks was required in the first place was because there is a child on S-CHIP, and that "start of coverage" (despite being continually covered under the auspices of the state for some 13 years already) was not supposed to change from January to February, so a new "change of circumstance" (the only change being the system's, not ours) had to be created to disinclude the S-CHIP part — it was done, but then someone neglected to tell BCBS. Oh, and a new "master case" number. Could it be more complicated? More counterproductive (unless, of course, prevention of care is precisely the intention)??]

[Update:  Five-and-a-half weeks later, BCBS remains uninformed of the change, which the Vermont Health Connect "change center" now says was "finalized" on Oct. 29 and confirmed that it was sent to "billing" who would then notify BCBS, which process could take 15 days, likely more as they are busy starting enrollment for next year. Vermont Health Connect customer service confirms the change, that the start date has been changed, billing reconciled, and BCBS informed. However, BCBS finds no change -- and it's not on the latest weekly confirmation list from Vermont Health Connect, waiting to be processed. BCBS suggests checking in another week.]

[Update:  A month and a half later, the "last invoice for 2014" has arrived, showing a "balance forward" of 10 times the new premium amount, presumably representing the charges for February through November of our "new" coverage, ignoring the year of payments for our "old" coverage for those same months. Then, inexplicably, the amount due adds only the SCHIP charge, not the next month's premium. Aieee!]

Further notes from 2015: 

May 13:  "Use this updated form [1095-A] when you complete IRS Form 8962 and file your federal income tax return [last month]."

Premiums due:  January 26: $627.52. February 26: $313.76. March 26: ($2.30). April 26: $311.46. May 26: ($238.36). June 26: $75.40. July 26: $313.76.

June 8:  Notice from Blue Cross–Blue Shield: "Payment Past Due." Go to newly launched Vermont Health Connect web site for any information that might be there: My Health Plans: "No current plans found."

June 25:  "A refund has been issued to you in the amount of $20.00."

July 16:  Notice from IRS: "Our records show that you did not file a 2014 tax return to reconcile advance payments of the Premium Tax Credit. … We received a copy of form 1095-A, Health Insurance Marketplace Statement, issued to you by your Health Insurance Marketplace showing … You are required to file a a 2014 federal tax return with Form 8962, Premium Tax Credit, to reconcile …" So it seems that filing Form 8962 with the correct information from one's own records — because the 1095-A form originally provided was obviously incorrect — instead of the updated 1095-A that came a month after the tax filing deadline (and which was still incorrect) [see May 13, above] is not recognized as a possibility, is as good as failing to file at all, and in fact nullifies the 1040 and everything as if never filed at all!

See a new report from 2016:  Vermont Health Connect: “Current wait times are 90 minutes”

Single-Payer Medicare-for-All Legislation Introduced

WASHINGTON, May 10 -- Sen. Bernie Sanders (I-Vt.) announced today that he introduced legislation to provide health care for every American through a Medicare-for-all type single-payer system.

Rep. Jim McDermott (D-Wash.) filed a companion bill in the House to provide better care for more patients at less cost by eliminating the middle-man role played by private insurance companies that rake off billions of dollars in profits.

The twin measures, both called the American Health Security Act of 2011, would provide federal guidelines and strong minimum standards for states to administer single-payer health care programs.

"The United States is the only major nation in the industrialized world that does not guarantee health care as a right to its people," Sanders said at a press conference on Capitol Hill. "Meanwhile, we spend about twice as much per capita on health care with worse results than others that spend far less. It is time that we bring about a fundamental transformation of the American health care system. It is time for us to end private, for-profit participation in delivering basic coverage. It is time for the United States to provide a Medicare-for-all single-payer health coverage program."

McDermott said, "The new health care law made big progress towards covering many more people and finding ways to lower cost. However, I think the best way to reduce costs and guarantee coverage for all is through a Single-payer system like Medicare. This bill does just that - it builds on the new health care law by giving states the flexibility they need to go to a single-payer system of their own. It will also reduce costs, and Americans will be healthier."

Sanders and McDermott were joined at the press conference by leaders of organizations supporting the measure, including Arlene Baker-Holt, executive vice president of the AFL-CIO; Jean Ross, co-president of the National Nurses United; and Greg Junemann, president of the International Federation of Professional and Technical Engineers.

While making the case for a single-payer system nationwide, Sanders applauded the Vermont Legislature which earlier this month voted to put the state on the path toward a single-payer system. Vermont, Sanders said, could become a model for the nation. ...

human rights, Vermont

The 3% Nonsolution

A common figure for annual health care spending in the U.S. is 2.5 trillion dollars (according to the Dept. of Health and Human Services (HHS), it was 2.34 trillion dollars in 2008 and projected to have been 2.47 trillion in 2009 and to be 2.57 trillion in 2010).

The "historic" health care bill just signed into law has an estimated cost of just under 1 trillion dollars (938 billion). But that's over 10 years. So make it 100 billion dollars annually, or about half the cost of the crusades in Iraq and Afghanistan.

Thus, the bill will represent less than 4% of the country's health care spending.

Small change indeed.

Especially as HHS projects total spending to increase to almost 4.5 trillion dollars by 2019.

This "monumental" reform bill will represent less than 2.7% of the next 10 years' health care spending.

Its only significance is criminalizing not having insurance and forcing people into private "coverage". A cruel mockery of care, this is blatant extortion on behalf of corporate profits.

Doug Racine sabotages single-payer in Vermont

As reported last week, gubernatorial candidate Senator Doug Racine "unveiled his long-awaited health care reform bill", In fact, his bill is a revision of S.88, an already-introduced bill to establish a single-payer system and universal coverage in Vermont (along with its companion bill in the house, H.100). Racine's version, however, changes it to instead establish a committee to study a few options for a couple of years that might then move us towards universal "access".

This is despicable.

human rights, Vermont

Medicare for all!

Stop the medical insurance bail-out bill! Dave Lindorff writes at Counterpunch:

When Obama came to my neighborhood this week to press for public support for his health “reform” bill, he wasn’t just greeted by tea-party hecklers. Speaking to a large group of mostly supportive students and local residents at Arcadia University in Glenside, the president at one point mentioned that “people on the left” want “single-payer.” But before he could add that that approach wasn’t going to happen, he found himself drowned out by cheers calling for Medicare for all and single-payer.

That kind of says it all.

I’m with Marcia Angell, editor of the New England Journal of Medicine. The Obama plan for health care “reform”, as well as the two versions passed by the House and the Senate, are all devious disasters that do nothing to solve the nation’s burgeoning health care crisis, and in fact, will make it worse.

The only thing to do at this point is to take the whole stinking pile of paper and put it in the compost heap. Kill it.

This whole effort was never about reform from the day last March when the new president called on Congress to begin deliberations on health care reform. It was about catering to the wishes of the big players in the Medical Industrial Complex--the big pharmaceutical multinationals, the hospital companies, the physicians and, most of all, the insurance industry. People and their health care needs had little or nothing to do with this.

That’s why we’ve ended up with proposals that would do nothing to control costs, that would force health young people to buy unregulated, high-cost and high-profit plans that would be money in the bank for the insurance industry, and that would finance any subsidies for the poor by cutting back on benefits for the only group of Americans who currently have a form of single-payer insurance--the elderly with their Medicare.

President Obama began this whole obscene nightmare with a lie, when he said that even though single-payer systems clearly work to open access to all and keep costs down while providing better overall health results in places like Canada and some European countries, they cannot be applied in America “because that would mean starting over from scratch.” He knew when he said it that this was a lie. America already has a well-run and successful single-payer healthcare program in place that is bigger than the entire Canadian health care system, and that’s Medicare, which was established in 1965, and which currently finances the care of 45 million Americans. You just have to be 65 or disabled to be eligible for it.

As Dr. Angell pointed out on a recent Bill Moyers Journal segment, the simplest way to solve America’s health care crisis would be to just start a gradual expansion of Medicare, say by lowering the age of coverage to 55, and then 45, and then 35, until everyone was covered and the insurance industry was pushed out of the health sector. ... Medicare gives the elderly a freer choice of physician and treatment than any but the most gold-plated private insurance executive health care plan.

Obama continued this lie when he claimed, in his last mention of the issue during his State of the Union address to Congress, that he and Congress had considered every idea. In fact, he and Congress have for the last year, carefully prevented any consideration of the idea of single-payer, or of expanding Medicare to cover every American. Bills that would do that, authored by Rep. John Conyers (D-MI) in the House and Sen. Bernie Sanders (I-VT) in the Senate, were blocked from hearings or votes in both Houses by Democratic leaders, at the White House’s urging, while the White House itself barred single-payer advocates from any of its discussions.

Instead the president met behind closed doors with the lobbyists of the various health care industries, to cut deals with each sector in order to gain their support for his “reform” plan. It was as if the Department of Justice had called meetings with the various crime families of the Cosa Nostra in order to cut deals before developing a plan to “tackle” the Mafia. ...

The US currently devotes 17.5 percent of Gross Domestic Product to health care, and if this “reform” in any of its guises is passed, that share of the economy devoted to health care will quickly rise past 20 percent, with no end in sight. This is madness. Expanding Medicare to cover everyone, as I have written earlier, would actually save everyone money immediately, and the country as a whole. Consider that the most expensive consumers of health care--the elderly--are already in the system. Adding younger, healthier people to Medicare would cost incrementally much less. That’s why the Canadians spend about 9 percent of their GDP on healthcare, while covering every Canadian, while we spend nearly twice as much and leave 47 million of our citizens uninsured and unable to visit a doctor.

How could it be cheaper to add everyone to Medicare? Expanding Medicare to cover everyone would probably cost somewhere between $800 billion and $1 trillion a year. That sounds like a lot of money, until you consider that we already spend $100 billion a year to care for veterans through the Veterans Administration, and $400 billion a year to care for the poor through Medicaid. We also spend $300 billion a year subsidizing hospitals that have to provide “free” charity care to the poor who don’t qualify for Medicaid, too. Since all those people would be covered by Medicare under Medicare-for-All, that’s $800 billion a year in current expenditures saved right there.

... You don’t want to pay more taxes? Well wait. If you were covered by Medicare, you and your employer would no longer have to pay for private insurance, which would mean a savings to workers of thousands of dollars a year, and even more to employers who currently pay the majority of health insurance premiums for employees. The net savings would be enormous.

Nobody has talked about this.

Universal Medicare would make American companies more competitive in the global marketplace, where other companies are not responsible for health care costs of their workers. It would make Americans wealthier, because they would no longer be paying for health care out of their own pockets. It would make everyone more secure, because they would no longer have to fear losing access to health care if they lost their job, and would eliminate most bankrupties, which are reportedly caused by medical bills.

So we know what needs to be done.

And we know that the current “reforms” on offer don’t do it.

So Dr. Angell is right. Obamacare needs to die.

There is reason to hope that it will die. Republicans oppose it, though not for any decent reason. They want unregulated private insurance and unlimited profits for health care industries. Ditto some conservative Democrats, who are also anti-government ideologues whose wallets are stuffed with health industry swag. But their reasons for oppposing health bill don’t matter. All that is needed is for a few progressive members of the House and Senate to admit that the health bills being considered are not reform, but the antithesis of reform, and to also vote against it, and Obamacare will be dead.

At that point we can start seriously demanding that the Congress and the President act to bring us real health reform in the way that really works: expanding Medicare to cover everyone.

Healthcare is a Human Right: VT postcard campaign

Healthcare is a Human Right

Click the above link to sign a postcard to be delivered to legislative leaders in Vermont on Jan. 6, the first day of the next session.

human rights, Vermont

10 Questions to Ask at ObamaCare Town Hall Meetings

Dave Lindorff, at Counterpunch (click the title of this post):

1. If Canada's single-payer system is so god-awful, why have repeated Conservative governments at the provincial and national level in Canada never touched it? Canada is a democracy. If Canadians don't like their health care system, why haven't they gotten rid of it in 35 years? Since the system there is run by the separate provinces, many of which are very politically conservative, why has not one province ever tried to get rid of single-payer?

2. Why is rationing by income, as we do it here, better than rationing by need, as they do it in Canada?

3. Wouldn't single-payer mean that companies could no longer threaten working people with the loss of their health insurance? Why is this a bad idea?

4. The bigger the insurance pool, the better. So doesn't having a national pool, as with single-payer, make the most sense?

5. Why should we be allowing politicians who are taking money from the medical industry to write the new health care legislation?

6. How can the Congress be developing a health system reform scheme and not even invite experts from Canada down to explain their successful system?

7. If Medicare--a single-payer system here in America--is so popular with the elderly, how come it's no good for the rest of us?

8. Isn't it true that Medicare currently finances the most costly patient group--the elderly and infirm--so that extending it to the rest of the population--most of whom are young and healthy--would be much cheaper, per person?

9. The AMA, the Pharmaceutical Industry, and the Insurance Industry all bitterly opposed Medicare in 1964-5 when it was being debated in Congress and passed into law, with the right, led by Ronald Reagan, calling it creeping socialism. It became a life-saver for the elderly and didn't turn the US into a soviet republic. Why should we give a tinker's damn what those same three industry groups and the Republican right think of expanding single-payer now?

10. The executives of Canadian subsidiaries of US companies all support Canada's single-payer system, and even lobby collectively to have it expanded and better funded. Why does Congress listen to the executives of the parent companies here at home, and not invite those Canadian execs down to explain why they like single-payer?

human rights

Two Health Care Systems: One works, the other doesn't

Michael Rachlis writes in the Aug. 3 Los Angeles Times:

Universal health insurance is on the American policy agenda for the fifth time since World War II. In the 1960s, the U.S. chose public coverage for only the elderly and the very poor, while Canada opted for a universal program for hospitals and physicians' services. As a policy analyst, I know there are lessons to be learned from studying the effect of different approaches in similar jurisdictions. But, as a Canadian with lots of American friends and relatives, I am saddened that Americans seem incapable of learning them.

Our countries are joined at the hip. We peacefully share a continent, a British heritage of representative government and now ownership of GM. And, until 50 years ago, we had similar health systems, healthcare costs and vital statistics.

The U.S.' and Canada's different health insurance decisions make up the world's largest health policy experiment. And the results?

On coverage, all Canadians have insurance for hospital and physician services. There are no deductibles or co-pays. Most provinces also provide coverage for programs for home care, long-term care, pharmaceuticals and durable medical equipment, although there are co-pays.

On the U.S. side, 46 million people have no insurance, millions are underinsured and healthcare bills bankrupt more than 1 million Americans every year.

Lesson No. 1: A single-payer system would eliminate most U.S. coverage problems.

On costs, Canada spends 10% of its economy on healthcare; the U.S. spends 16%. The extra 6% of GDP amounts to more than $800 billion per year. The spending gap between the two nations is almost entirely because of higher overhead. Canadians don't need thousands of actuaries to set premiums or thousands of lawyers to deny care. Even the U.S. Medicare program has 80% to 90% lower administrative costs than private Medicare Advantage policies. And providers and suppliers can't charge as much when they have to deal with a single payer.

Lessons No. 2 and 3: Single-payer systems reduce duplicative administrative costs and can negotiate lower prices.

Because most of the difference in spending is for non-patient care, Canadians actually get more of most services. We see the doctor more often and take more drugs. We even have more lung transplant surgery. We do get less heart surgery, but not so much less that we are any more likely to die of heart attacks. And we now live nearly three years longer, and our infant mortality is 20% lower.

Lesson No. 4: Single-payer plans can deliver the goods because their funding goes to services, not overhead.

The Canadian system does have its problems, and these also provide important lessons. Notwithstanding a few well-publicized and misleading cases, Canadians needing urgent care get immediate treatment. But we do wait too long for much elective care, including appointments with family doctors and specialists and selected surgical procedures. We also do a poor job managing chronic disease.

However, according to the New York-based Commonwealth Fund, both the American and the Canadian systems fare badly in these areas. In fact, an April U.S. Government Accountability Office report noted that U.S. emergency room wait times have increased, and patients who should be seen immediately are now waiting an average of 28 minutes. The GAO has also raised concerns about two- to four-month waiting times for mammograms.

On closer examination, most of these problems have little to do with public insurance or even overall resources. Despite the delays, the GAO said there is enough mammogram capacity.

These problems are largely caused by our shared politico-cultural barriers to quality of care. In 19th century North America, doctors waged a campaign against quacks and snake-oil salesmen and attained a legislative monopoly on medical practice. In return, they promised to set and enforce standards of practice. By and large, it didn't happen. And perverse incentives like fee-for-service make things even worse.

Using techniques like those championed by the Boston-based Institute for Healthcare Improvement, providers can eliminate most delays. In Hamilton, Ontario, 17 psychiatrists have linked up with 100 family doctors and 80 social workers to offer some of the world's best access to mental health services. And in Toronto, simple process improvements mean you can now get your hip assessed in one week and get a new one, if you need it, within a month.

Lesson No. 5: Canadian healthcare delivery problems have nothing to do with our single-payer system and can be fixed by re-engineering for quality.

U.S. health policy would be miles ahead if policymakers could learn these lessons. But they seem less interested in Canada's, or any other nation's, experience than ever. Why?

American democracy runs on money. Pharmaceutical and insurance companies have the fuel. Analysts see hundreds of billions of premiums wasted on overhead that could fund care for the uninsured. But industry executives and shareholders see bonuses and dividends.

Compounding the confusion is traditional American ignorance of what happens north of the border, which makes it easy to mislead people. Boilerplate anti-government rhetoric does the same. The U.S. media, legislators and even presidents have claimed that our "socialized" system doesn't let us choose our own doctors. In fact, Canadians have free choice of physicians. It's Americans these days who are restricted to "in-plan" doctors.

Unfortunately, many Americans won't get to hear the straight goods because vested interests are promoting a caricature of the Canadian experience.

A PETITION TO CONGRESS Supporting Single-Payer Health Care

Whereas:

• 46 million Americans are currently without health insurance;


• 60 million Americans, both insured and uninsured, have inadequate access to primary care due to a shortage of physicians and other health service providers in their community;


• 100 million Americans have no insurance to cover dental needs;


• 116 million adults, nearly two-thirds of all non-seniors, struggled to pay medical bills, went without needed care because of cost, were uninsured for a time, or were underinsured in the last year;


• The United States spends $2.3 trillion each year on health care, 16 percent of its Gross Domestic Product;


• Americans spend $7,129 per person on health care, 50 percent more than other industrialized countries, including those with universal care;


• The U.S. does not get what it pays for. We rank among the lowest in the health outcome rankings of developed countries, and on several major indices rank below some third-world nations;


• The number of health insurance industry bureaucrats has grown at 25 times the growth of physicians in the past 30 years;


• In 2006, the six largest insurance companies made $11 billion in profits even after paying for direct health care costs, administrative costs and marketing costs.

And, whereas:

• Medicare has administrative costs far lower than any private health insurance plan;


• The potential savings on health insurance paperwork, more than $350 billion per year, is enough to provide comprehensive coverage to every uninsured American;


• Only a single-payer Medicare-for-all plan can realize these enormous savings and provide comprehensive and affordable health care to every citizen.

Now, therefore:

• We, the undersigned, urge the United States Congress to pass a single-payer Medicare-for-all program which will provide quality, comprehensive health care for all Americans.