Progressive People of Faith
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A group of folks who are not ashamed of their faith or their progressive values and refuse to let the radical right define what makes a person faithful or monopolize the public square on faith matters.
I gave the following testimony in front of the Pennsylvania House of Representatives Insurance Committee in public hearings in Pittsburgh on 9/19/06: (The same arguments apply at the National level - but I tailored the discussion to my own state since I was speaking before a State legislative committee)
I am Dr. Barry Tepperman. I have practiced the medical specialty of Radiation Oncology in the United States for 23 years, in a variety of practice and market settings. I was born and raised and trained in my profession in Canada. I am trained in and teach medical ethics, and hold an MBA degree in Health Administration. Currently I am a member of the Department of Radiation Oncology at Allegheny General Hospital and Chief of Radiation Therapy for the Pittsburgh VA Health System, but in these remarks I speak for myself alone and my comments do not represent the views of either organization. I want to thank Representative DeLuca for the opportunity to testify before the House Insurance Committee today.
The Declaration of Independence speaks to â��unalienable rightsâ�� including â��life, liberty, and the pursuit of happinessâ��. The Declaration of Rights of the Pennsylvania Constitution speaks of universal â��inherent and indefeasible rightsâ��, which include enjoying and defending life and liberty, of acquiring, possessing, and protecting property and reputation, and of pursuing their own happiness. One need ask whether there are conditions under which in the daily life of a Pennsylvania resident these rights are compromised or denied. I respond that in the absence of optimal physical, emotional, and psychological health or the opportunity to be as fully as possible restored to such a state, these rights cannot be achieved. If an individual's quality of life is compromised for want of health care, life and liberty are devalued, happiness â�" for him and for those who care for him - is unachievable, property and reputation are meaningless. I maintain that by implication of these sweeping but generally accepted statements this nation grants a fundamental and irrefutable right to health and to health care. In order to meet the constitutional test of equal protection, such care needs to be of equal quality and equally accessible to all residents of the state, in a fashion which does not discriminate according to factors such as financial resources or potential, current employment or future prospects, physical ability, current or prior infirmity, site of residence, or the profit needs of third parties â�" much less the generally regarded criteria of race, religion, ethnicity, or age.
Pennsylvania society differentiates in access to health care between the rural and the urban, between ethnic and racial groups, those housed and those homeless, to create castes of medical untouchables â�" the uninsured, the underinsured, the uninsurable, those who can access the system only after a minimal problem has progressed through neglect and want of access to crisis proportions. Even those who are as fully insured as this system allows are distinguished according to their private insurer and the quality of their insurance. This creates the medically ethically untenable situation where, according to what they will pay for and what employers have contracted for, in the same physicians' practice treating comparable patients different insurers will demand different standards of care â�" a distinction based on the insurers' need for profit and not on any scientific evidence or medical logic. The current canon of medical ethics reasons acceptable behavior from four basic principles â�" one of which is justice - simple fairness and equity in the use and application of resources. Our current system denies care to many and violates that ethical precept in the care of countless more. Only a system that guarantees equal access for all and a single standard of care based on scientific evidence will pass the test of equal protection for all Pennsylvania residents â�" and I would submit to you that only through a single-payer universal health care system can that be achieved.
The link between employment and access to health care can be justified only in a society that accepts that a person's worth is determined by employment and level of income, and that an individual's access to health care and the quality of that care should be determined and proportionate to that measure of worth. The link we have now between employment and health insurance is egregious. It holds employees in positions that would otherwise be undesirable and discourages them from changing employers for advancement, places employees who leave or lose their positions in jeopardy of losing their assets and their lives. It places a disproportionate burden on honorable employers who are attempting to care for their employees to pay the passed-through costs of care for those who are unemployed or employed but uninsured. When this burden is placed on the employers of the state, the economic imperatives of keeping business viable may force them to reduce or eliminate benefits, move jobs offshore... or face closing. The opportunity cost to all of Pennsylvania of such choices is massive. The current system may allow a substantial proportion of the population to be insured in some fashion â�" but for employers, employees, and the rest of the state it creates a lose-lose-lose proposition.
By ensuring universal access and coverage for all residents, the passthrough of the costs of care for the uninsured and underinsured to those holding or paying for insurance is eliminated, and the costs of care are spread equitably in the State. If the for-profit sector is taken out of the health care market and providers work to an evidence-based single standard of care, the obligation of the payor of insurance premiums to fund the profit margins of investors and to pay for predictable overutilization at investor-owned facilities is eliminated. If the administration of health care in the State can approach the administrative efficiencies of the federal Medicare and Medicaid programs, the overhead attributable to administrative costs is reduced from 15-20% of health care related expenditures to 3-5%. This further reduces overhead costs at the level of the individual health care provider by reducing staffing time and overhead devoted to insurer authorizations and denial management. Promoting a single standard of care based on best science reduces the costs inherent in medical malpractice litigation. The costs of prescription drugs and medical equipment would be reduced by aggressive negotiation at a state-wide level. But all of these are paper savings, and achieving this equity demands an actual source of capital. The least regressive sources of taxation to pay for health care would be derived from payroll taxes shared between employer and employee, and a health care surcharge on the earned income taxes of the highest 5% of earners. It has been estimated that for a Pennsylvania-only plan, a payroll tax surcharge of 5% and an earned income health tax surcharge of 10% would meet the cost requirements of a generously comprehensive universal health plan, all at costs to individual employers and residents of the state that in 95% of cases would be less than the insured and employers who provide insurance currently pay.
The Canadian experience with a single-payer system has led to urban legends in these discussions â�" of rationing, waiting lists, denials of care. In the time available I can only inform the Committee that these arose out of lack of provision for funding of new technologies in that system as originally developed in 1964 and were corrected more than a decade ago. In a country where we are overbuilt in advanced technologies we would not face such issues â�" the issue would be more one of making the most appropriate use in the public interest of the technologies in place.
Members of the Committee, achieving universal health care for all Pennsylvania residents is a Constitutional obligation in fulfillment of a fundamental right that has been too long neglected. Our current system is designed neither to be equitable nor universal â�" but it follows the â��golden ruleâ�� â�" those who have the gold make the rules and benefit from them, and is fundamentally undemocratic. It is well beyond broken â�" and must be replaced. Its replacement is not only practical, it represents a fundamental reduction in costs dedicated to health care in Pennsylvania while offering a massive upgrade in access and quality that serves a universal need and right that has been too long ignored. The only question.... is the political will to act.
I am Dr. Barry Tepperman. I have practiced the medical specialty of Radiation Oncology in the United States for 23 years, in a variety of practice and market settings. I was born and raised and trained in my profession in Canada. I am trained in and teach medical ethics, and hold an MBA degree in Health Administration. Currently I am a member of the Department of Radiation Oncology at Allegheny General Hospital and Chief of Radiation Therapy for the Pittsburgh VA Health System, but in these remarks I speak for myself alone and my comments do not represent the views of either organization. I want to thank Representative DeLuca for the opportunity to testify before the House Insurance Committee today.
The Declaration of Independence speaks to â��unalienable rightsâ�� including â��life, liberty, and the pursuit of happinessâ��. The Declaration of Rights of the Pennsylvania Constitution speaks of universal â��inherent and indefeasible rightsâ��, which include enjoying and defending life and liberty, of acquiring, possessing, and protecting property and reputation, and of pursuing their own happiness. One need ask whether there are conditions under which in the daily life of a Pennsylvania resident these rights are compromised or denied. I respond that in the absence of optimal physical, emotional, and psychological health or the opportunity to be as fully as possible restored to such a state, these rights cannot be achieved. If an individual's quality of life is compromised for want of health care, life and liberty are devalued, happiness â�" for him and for those who care for him - is unachievable, property and reputation are meaningless. I maintain that by implication of these sweeping but generally accepted statements this nation grants a fundamental and irrefutable right to health and to health care. In order to meet the constitutional test of equal protection, such care needs to be of equal quality and equally accessible to all residents of the state, in a fashion which does not discriminate according to factors such as financial resources or potential, current employment or future prospects, physical ability, current or prior infirmity, site of residence, or the profit needs of third parties â�" much less the generally regarded criteria of race, religion, ethnicity, or age.
Pennsylvania society differentiates in access to health care between the rural and the urban, between ethnic and racial groups, those housed and those homeless, to create castes of medical untouchables â�" the uninsured, the underinsured, the uninsurable, those who can access the system only after a minimal problem has progressed through neglect and want of access to crisis proportions. Even those who are as fully insured as this system allows are distinguished according to their private insurer and the quality of their insurance. This creates the medically ethically untenable situation where, according to what they will pay for and what employers have contracted for, in the same physicians' practice treating comparable patients different insurers will demand different standards of care â�" a distinction based on the insurers' need for profit and not on any scientific evidence or medical logic. The current canon of medical ethics reasons acceptable behavior from four basic principles â�" one of which is justice - simple fairness and equity in the use and application of resources. Our current system denies care to many and violates that ethical precept in the care of countless more. Only a system that guarantees equal access for all and a single standard of care based on scientific evidence will pass the test of equal protection for all Pennsylvania residents â�" and I would submit to you that only through a single-payer universal health care system can that be achieved.
The link between employment and access to health care can be justified only in a society that accepts that a person's worth is determined by employment and level of income, and that an individual's access to health care and the quality of that care should be determined and proportionate to that measure of worth. The link we have now between employment and health insurance is egregious. It holds employees in positions that would otherwise be undesirable and discourages them from changing employers for advancement, places employees who leave or lose their positions in jeopardy of losing their assets and their lives. It places a disproportionate burden on honorable employers who are attempting to care for their employees to pay the passed-through costs of care for those who are unemployed or employed but uninsured. When this burden is placed on the employers of the state, the economic imperatives of keeping business viable may force them to reduce or eliminate benefits, move jobs offshore... or face closing. The opportunity cost to all of Pennsylvania of such choices is massive. The current system may allow a substantial proportion of the population to be insured in some fashion â�" but for employers, employees, and the rest of the state it creates a lose-lose-lose proposition.
By ensuring universal access and coverage for all residents, the passthrough of the costs of care for the uninsured and underinsured to those holding or paying for insurance is eliminated, and the costs of care are spread equitably in the State. If the for-profit sector is taken out of the health care market and providers work to an evidence-based single standard of care, the obligation of the payor of insurance premiums to fund the profit margins of investors and to pay for predictable overutilization at investor-owned facilities is eliminated. If the administration of health care in the State can approach the administrative efficiencies of the federal Medicare and Medicaid programs, the overhead attributable to administrative costs is reduced from 15-20% of health care related expenditures to 3-5%. This further reduces overhead costs at the level of the individual health care provider by reducing staffing time and overhead devoted to insurer authorizations and denial management. Promoting a single standard of care based on best science reduces the costs inherent in medical malpractice litigation. The costs of prescription drugs and medical equipment would be reduced by aggressive negotiation at a state-wide level. But all of these are paper savings, and achieving this equity demands an actual source of capital. The least regressive sources of taxation to pay for health care would be derived from payroll taxes shared between employer and employee, and a health care surcharge on the earned income taxes of the highest 5% of earners. It has been estimated that for a Pennsylvania-only plan, a payroll tax surcharge of 5% and an earned income health tax surcharge of 10% would meet the cost requirements of a generously comprehensive universal health plan, all at costs to individual employers and residents of the state that in 95% of cases would be less than the insured and employers who provide insurance currently pay.
The Canadian experience with a single-payer system has led to urban legends in these discussions â�" of rationing, waiting lists, denials of care. In the time available I can only inform the Committee that these arose out of lack of provision for funding of new technologies in that system as originally developed in 1964 and were corrected more than a decade ago. In a country where we are overbuilt in advanced technologies we would not face such issues â�" the issue would be more one of making the most appropriate use in the public interest of the technologies in place.
Members of the Committee, achieving universal health care for all Pennsylvania residents is a Constitutional obligation in fulfillment of a fundamental right that has been too long neglected. Our current system is designed neither to be equitable nor universal â�" but it follows the â��golden ruleâ�� â�" those who have the gold make the rules and benefit from them, and is fundamentally undemocratic. It is well beyond broken â�" and must be replaced. Its replacement is not only practical, it represents a fundamental reduction in costs dedicated to health care in Pennsylvania while offering a massive upgrade in access and quality that serves a universal need and right that has been too long ignored. The only question.... is the political will to act.
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