News

The New York Times
August 31, 2004
Full Text of the Remarks of Senate Majority Leader Bill Frist

This victory for our Party (2003 Medicare legislation)— and above all for Seniors — is part of a larger battle we’re fighting on behalf of every American. How we do so is crucial. Our opponents have a way of confusing compassion with dependency. We believe true compassion encourages and empowers Americans to be responsible and take control of their own lives.

That’s what President Bush and the Republican Congress did when we made Health Savings Accounts — HSAs — the law of the land. With an HSA you can
invest tax-free in a personal savings account. You can roll it over year to year or withdraw funds if you get sick … without paying a penny of tax. YOU own it. YOU invest it. YOU grow it. YOU control it. It is YOURS.

So here’s the choice: do we grow the bureaucracy and gouge you with higher
taxes, as Mr. Kerry will do? Or, do we let the American people grow their own HSAs and own their health care, as George Bush wants to do? We’ve made
our choice.

http://www.nytimes.com/2004/08/31/politics/campaign/01TEXT-FRIST.html

Comment: My comments here are about policy. They are partisan only in the
respect that politicians have staked out their policy positions, as they clearly should. The democratic process is at its best when we vote based on an understanding of the policy stances of the candidates.

Tomorrow evening, President Bush will advocate for the “ownership society.” This concept supports individual responsibility and opposes dependency. In his speech, Sen. Frist quite explicitly expresses the view that Americans should take responsibility for their own health care through mechanisms such as Health Savings Accounts (HSAs), while avoiding dependency on others. Quite implicit in this is the fact that funding for health care should come primarily from an individual’s own funds rather than from a pool of funds to which everyone contributes, whether that be private insurance or a public program such as Medicare.

What would happen if each American funded a separate account for his or her
own health care? About 70% of our population uses only about 10% of the health care delivered in this nation. The other 30% utilizes 90% of the care
(5% utilize over half of all care). If you split up the risk pool into individual accounts then 10% of care will be funded by 70% of the population, whereas 90% of health care costs would be funded by the other 30%. For that 30%, that would average over $18,000 per individual per year (90% of the $1.79 trillion 2004 health expenditure divided by 30% of 290 million population). Conversely, for the healthy 70%, their annual contribution would average less than $900. This does not include the consideration that there would be winners and losers within each group, depending on amount of need. Clearly most individuals with significant health care needs could not afford to fund personal accounts that would be adequate for their needs.

To be realistic, the Republican leadership does not entirely dismiss dependency on others in that they recognize the necessity of high deductible (catastrophic) insurance to cover those who do have major losses. But how well would that work? They claim that catastrophic plans are very affordable and they prove this by citing the premium for healthy young individuals with no preexisting disorders which may be about $1000/year. But what would the premium actually be? Let’s say that we ask each individual to place $5000 in an individual account (though a mechanism would need to be in place to fund the accounts of those with no disposable income). You have now pulled $1.45 trillion out of the contribution to the risk pool ($5000 times 290 million population), leaving $340 billion ($1.79 trillion minus 1.45 trillion) to fund the $1.18 trillion worth of care (an amount that we are already spending) that would fall under the catastrophic coverage for the 30% with needs (90% of $1.79 trillion less the $5000 times 30% of the 290 million population that is the patients’ share of the contribution from their own accounts). That “low cost” high deductible plan actually would cost $4000 per each man, woman and child. Add that to the $5000 for each and
suddenly protection from financial loss costs close to $9000 per capita or
$36,000 for a family of four! That $9000 per capita adds up to a national health
care bill of $2.6 trillion ($9000 times 290 million population) rather than the $1.79 trillion we are currently paying. That extra $800 billion exposes the fraud behind the concept of individual accounts. Those extra funds are inequitable, regressively funded personal savings - nothing more, nothing less.

Perhaps high deductible insurance doesn’t really fit in with the ownership society, and we should just allow those with health care needs to do the best that they can. We can provide them with compassion as they struggle with their needs. Or maybe, just maybe, we should accept the concept that we need to take care of those with needs by paying for their care out of a pool that we all fund on an equitable basis.

Naw… those with needs would be abandoning their personal responsibility to
take care of themselves and their loved ones, and really wouldn’t be worthy of our compassion. I’ve “confused compassion with dependency,” and Dr. Frist
understands the difference.

Posted by pnhp at 09:51 AM | Permalink

USA TODAY
Posted 8/29/2004
Scientists want research papers freely available
By Dan Vergano

Twenty-five Nobel Prize-winning scientists today are calling for the government to make all taxpayer-funded research papers freely available.

Signers include DNA co-discoverer James Watson and former National Institutes of Health chief Harold Varmus, a longtime supporter of open access.

“As scientists and taxpayers, too, we therefore object to barriers that hinder, delay or block the spread of scientific knowledge supported by federal tax dollars - including our own works.”

Science is driven by researchers publishing results to communicate findings, collect funding and gain tenure. About 25,000 scientific and scholarly journals worldwide publish studies. Most hold copyrights to papers, charging single-paper access fees as high as $28. Yearly subscription fees rose 226% from 1986 to 2000 and averaged $840 this year (though for one journal, Brain Research, the subscription runs $18,856), says the Association of Research Libraries. Publishers say the fees are necessary for journals to survive, even for taxpayer-funded studies.

Taxpayers pay for researchers to prepare, review and edit manuscripts, the says, while scientific societies and large publishing firms reap the profits.

Over the past three years, calls from scientists and research librarians for open access to studies have grown louder, spurred by rising Internet use and higher costs for subscriptions. About 1,200 open-access journals now exist, up from five in 1992. Open-access publishers charge study authors a printing fee and release the information freely. For example, the publication fee for PLoS Biology is $1,500.

As the scientists make their case to Congress and to NIH chief Elias Zerhouni, Zerhouni meets today and Tuesday with scientists to discuss a June House Appropriations Committee directive to make electronic copies of NIH-funded research available for free within six months of publication, beginning next year. He met with publishers in July and endorsed the committee’s idea in principle. “We need a balanced policy that preserves the ability of journals and publishers to play a major role,” he says.

Alan Leshner, chief of the American Association for the Advancement of Science, which publishes Science magazine, says, “I think all the problems are workable” for the free-access publishing plan. “The question is how to do it so we can still pay our bills.”

NIH is the big dog of basic research funding with a $28 billion budget, making it a focus of the open-access debate. The federal government funds about 59% of all academic research and development, followed by universities (20%) and state and local government (7.1%), according to the National Research Council.

“The whole discussion of how we share research results is a very productive one,” Leshner says. “Science is about communicating results to serve society.”

http://www.usatoday.com/news/science/2004-08-29-free-research_x.htm

Comment: Harold Varmus and colleagues initiated a movement toward open
access publication of scientific research by establishing PLoS (Public Library of Science). Last year PLoS introduced its first publication: PLoS Biology. Next month, the inaugural issue of their new publication, PLoS Medicine, will be released.

This is a historic moment in medicine. PLoS Medicine is an open access, peer-reviewed medical journal. Open access is explained on the PLoS Medicine website:

“All works published in PLoS Medicine are open access, licensed under the Creative Commons Attribution License. Everything is immediately available online without cost to anyone, anywhere - to read, download, redistribute, include in databases, and otherwise use - subject only to the condition that the original authorship is properly attributed. Copyright is retained by the author.”

One of the most exciting aspects is that poor nations will have free access to the very latest in medical thought and research, no longer hindered by the current high cost of obtaining access to the medical literature.

I encourage you to peruse the website of PLoS Medicine:
http://www.plosmedicine.org/medicine/

Posted by pnhp at 01:14 PM | Permalink

Record Level of Americans Not Insured on Health
By MILT FREUDENHEIM

Published: August 27, 2004

Rising costs for health coverage and a continuing fall-off in the number of workers in employer-sponsored health plans are among the reasons that a greater number of people did not have health insurance last year, experts say.

The increase in uninsured people last year, as reported by the United States Census Bureau yesterday, was 1.4 million, to a record 45 million.

More than 10 million of those without insurance were young people, 25 to 34 years old, government officials said, an increase of 576,000 from 2002. “Young adults got hammered,” said John F. Holahan, a health economist at the Urban Institute, a nonprofit research center in Washington.

In 2002, there were 43.6 million people without insurance, or 15.2 percent of the census estimate of 288.3 million Americans. The proportion of people who were uninsured grew only slightly last year, to 15.6 percent. That reflected growth in the total population and 3.2 million more people added to government health programs including Medicare, Medicaid and state coverage for children. More than one in four Americans is in a public program.

As the population grew, the number of people who had insurance also increased, by one million, to 243.3 million last year, also a record, the Census Bureau said.

Health insurance is a hotly debated campaign issue. Senator John Kerry has promised new subsidies to extend coverage to more people. The Bush campaign points to a feature of the new Medicare law that provides tax breaks for special savings accounts to help people pay for care.

Senator Judd Gregg of New Hampshire, who led a recent Republican panel that studied health insurance issues, said the “uptick” in the number of uninsured “reflects the still sluggish economy” in 2003. He said one million new jobs had been added since then.

Bill Frist of Tennessee, the Senate majority leader, said the numbers also reflected “a decade-long downward trend in the proportion of Americans who receive health insurance through their employers.”

Len M. Nichols, vice president of the nonprofit Center for Studying Health Systems Change in Washington, said, “The question is whether the recovery will be strong enough to generate good jobs with health insurance to counter the fact that health insurance is more costly now.”

Surveys by research groups show that health costs continue to rise much faster than wages and other costs borne by employers. Economists say the employment trend is still moving away from jobs that provide generous coverage.

Employers are already planning for steep increases in health costs for 2005. A separate survey of 916 employers released yesterday by Mercer Human Resource Consulting, a benefits consulting firm, said costs of current coverage would rise about 13 percent next year. Many employers plan to cut back on benefits and shift more of the costs to their workers to slow the increase to 9.6 percent, on average, Mercer said.

The cuts will “increase the pressure on small employers to discontinue coverage or increase their employees’ share of premiums,” said Blaine Bos, a Mercer survey spokesman. The upshot will be “more employees saying, ‘I don’t see the value of that’ and going without insurance,” he said.

There were 20.6 million uninsured full-time workers last year, the Census Bureau said, an increase of 1.6 million over the last two years.

The Census Bureau said that 12.1 million people without insurance were members of families with annual incomes of $50,000 or more, including 6 million in families that made at least $75,000 a year. Some conservative economists contend that these people could afford to pay for insurance.

“Households that earn $50,000 per year or more account for about 90 percent of the increase in the number of uninsured over the past 10 years,” according to the National Center for Policy Analysis, a research center based in Dallas that says it opposes government solutions to public policy problems.

Health policy experts who advocate a greater government role say a family with $50,000 in total income has trouble affording family coverage, which typically costs more than $9,000 annually, unless it obtains help from an employer or the government. They say many of these people are self-employed or work for small businesses that find health costs daunting.

This year the number of uninsured people in families with incomes of $50,000 or more increased by 704,000, the census report said. It also said there were 619,000 people without insurance in families with incomes of less than $25,000.

Although a number of states, including Texas, have cut back on children’s health programs, the number of uninsured children declined slightly, to 8.4 million, but remained at 11.4 percent of all children, last year. The proportion of poor children without insurance was 19.2 percent.

The proportion of uninsured people held steady among Hispanic, Asian and black Americans. About 18.5 percent of blacks, 18.7 percent of Asian-Americans and 32.7 percent of Hispanics did not have insurance.

With large numbers of Hispanic residents, Texas and New Mexico have the highest proportions of uninsured people, the Census Bureau said. Both had average uninsured rates of more than 20 percent over the three years from 2001 to 2003. The three-year average was 19.4 percent in Louisiana, 18.7 percent each in California and Oklahoma, and 17.8 percent in Alaska.

The states with the lowest three-year averages were Minnesota, at 8.2 percent; Rhode Island, at 9.3 percent; and Iowa and Wisconsin, at 9.5 percent each. Massachusetts, New Hampshire and Vermont were also at the low end, with 9.9 percent.

The uninsured rate was 15.5 percent in New York, 13.7 percent in New Jersey and 10.4 percent in Connecticut.

Posted by pnhp at 09:27 AM | Permalink

The true colors of the partisan divide on health care

Background for today’s Quote of the Day: California has served as a unique laboratory for the application of health care policies in the reform movement. The process is handicapped by the fact that a two-thirds vote is required in both the Assembly and the Senate if a measure would result in a tax increase. Since the Republicans control over one-third of each chamber, and they vote as a block against any tax increase, reform measures have been limited to those that do not require significant additional state spending.

Although in this environment it would be almost impossible to enact a state-funded system of universal coverage, it is truly remarkable what the legislators have been able to accomplish with the support of dedicated advocates such as the leadership of California’s Health Access.

Today’s message discusses one small but important issue: the excessive fees charged uninsured patients who have no choice when they must access the health care system on an emergency basis. The debate over this legislation
is very instructive because it reveals the true colors of those on each side of the partisan divide.

I am especially indebted to Anthony Wright, Executive Director of Health Access, who granted me permission to distribute excerpts from his message for today.

Quote of the Day:

HEALTH ACCESS UPDATE
Tuesday, August 24, 2004

CA ASSEMBLY VOTES TO PROHIBIT HOSPITAL OVERCHARGING OF UNINSURED

On Monday, August 23rd, the California Assembly passed SB379 (Ortiz) to
prohibit hospitals from overcharging uninsured patients, and provide other consumer protections. Both SB379, and a similar bill, AB232 (Chan) are expected to be voted on in the Senate and, if successful, be sent to Governor Schwarzenegger’s desk by the end of the week. Both bills would provide first-in-the-nation consumer protections for self-pay hospital patients.

SPECIFIC PROTECTIONS FOR HOSPITAL PATIENTS: The bills that address aggressive hospital billing and collections, SB 379 and AB232, are similar. They address an issue raised by dozens of “uninsured and overcharged” patients that have been sent to collections, court, or bankruptcy for the simple act of seeking needed care. Both bills ensure that self-pay hospital patients:

Are informed of their consumer rights and financial options; Have at least 120 days before being sent to collections; If they are under 400% of the federal poverty level (under $60,000 for a family of three), don’t pay more than the Medicare, Medi-Cal or worker’s compensation rate for treatment.

A fact sheet on the bill is available at:
http://www.health-access.org/ab232_fact_sheet.htm

The text for AB232 (Chan) is at: http://www.leginfo.ca.gov/pub/bill/asm/ab_0201-0250/ab_232_bill_20040817_amended_sen.html

The text for SB379 (Ortiz) is at: http://www.leginfo.ca.gov/pub/bill/sen/sb_0351-0400/sb_379_bill_20040817_amended_asm.html

ASSEMBLY DEBATE: Assemblywoman Wilma Chan, the author of AB232 (sponsored by Health Access California), served as the floor manager on the debate on SB379, by Senator Deborah Ortiz. She started the discussion by talking about a specific patient who, when her health insurance ran out, was forced to pay four times the amount that her insurance had paid for a similar treatment. Chan made the point that hospital debt is a leading cause of personal bankruptcy.

REPUBLICAN OPPOSITION: Several Republicans rose to argue against the bill,including Assemblymen Tim Leslie, Tom Harman, Dennis Mountjoy, Ray Haynes, and at the end of the discussion, Tony Strickland.

Leslie questioned why “Democrats want to attack hospitals, and they are continuing to make hospital operations more difficult.”

Harman made several points in his objections. “Hospitals are businesses.They are run like any other business, whether it is a manufacturing business, a service business, a barber shop, a beauty salon.” He mistakenly stated that, “this bill simply says, well, you’ve got to provide free medical care to certain types of patients… that you can’t use wage garnishment or a collections agency.… Well, how else are they going to collect it if they don’t pay it?” He admitted that “we need to have a plan where everyone can get the necessary medical treatment that they need.

I support that in some fashion, I don’t know exactly what it would be.” Finally, he referenced the individual story that Chan cited in her opening: “I’m sorry, but maybe that person should have had better health coverage, maybe that person should have thought about this problem. That’s what we have bankruptcy court for.… Is it any different than a contract debt? How is it different from any other kind of debt? I submit to you that it is not.”

Mountjoy also misrepresented the bill, stating that it said that “if you are a hospital that is serving a patient, and if they are low-income, you gotta give it to them. Well, why don’t we do that for plumbers?… And the electrician, he ought to give you a break, too. Where in the Constitution does it say that we owe folks health care?… We don’t own them health care.” He continued, “why should we put the burden on a business like hospitals?… They are a business not unlike any other. They are there to make a profit, they have a board of directors that looks for that every month.”

Haynes decried the “Orwellian state” he was in. “When you order somebody to give stuff away for free, or you order somebody to work for free, that is what is known in the parlance as slavery. We are basically ordering hospitals to be our slaves.”

Later, Strickland stated that “part of the reason why costs have gone up in the hospital is that the hospitals are providing a lot of charity care. The uninsured are not paying their hospital bills.… The hospitals are shutting down their emergency rooms because they are providing too much charity care.”

DEMOCRATIC REBUTTALS:. Democrats that rebutted these claims include Assemblymembers Lloyd Levine, Hannah-Beth Jackson, and Jackie Goldberg. Levine responded, “more and more people are going without health care in California. And frankly, I actually… resent the implication that they should have had thought of this sooner, and gee, they should have had health insurance. The cost of health insurance is continuing to skyrocket…, many families cannot afford health insurance, and to say ‘oh, it is their fault,’ really misses the point.… We need to pass this bill and do everything we can to make sure people have access to health care when they need it.”

Jackson brought the discussion back to the question that the bill addresses:
“Is it correct that many hospitals charge uninsured people higher rates than what they charge and are willing to receive from insurance companies and Medicare?” She continued: “This is a bill that tells hospitals that you can’t take advantage of poor people who don’t have insurance… Let’s be fair to the people that are least able to pay by not forcing them to pay more than you and I who have the benefit of having health insurance. It is a sad state of affairs when anybody takes a predatory practice to charge the least able to pay more money for any service because they can… The goal is to give everybody, whether they are rich or poor, a chance to have quality health care at a fair and reasonable price.”

Goldberg also clarified that the bill “asks that the hospitals require nothing more than the higher of Medi-Cal, Medicare, or worker’s comp.So it is not free. And why is this business different than any other business? Well, this business you can’t live without, in some cases.” She also cited statistics that showed that while the uninsured are a small percentage of the patients in many hospital chains, they account for a disproportionate share of the profits. “The only way that could be true is to be gouging those folks as compared to people who have insurance…”

Chan closed by rebutting the arguments: “This does not in any way call for free care. Back in the 80s, I believe, there were strict limits on what a hospital could charge. This does not even go that far… It just says,if you go to the hospital, there should be some ceiling on what you can be charged. Collection agencies can be called in, but this bill gives the person a chance.” She concluded: “We are not talking about something free here, we are talking about basic fairness.”

The bill passed with an unofficial vote of 41-31, along party lines.

Health Access California:
http://www.health-access.org/

Comment: Although there is certainly a partisan divide over concepts of the appropriate roles of government and the marketplace in addressing problematic social issues, in general many Americans believe market forces must be allowed the freedom to address these issues without significant government intervention. But most also believe that when the market is unable correct significant social injustices then the government should enter to provide policies that will satisfy our quest for simple fairness.

I find it difficult to believe that most politically conservative individuals personally identify with the comments made by the Republican legislators in this debate on price gouging of the insured for emergency care. I believe that if Republicans knew what their own elected legislators were doing they would replace them with conservatives who were, in fact, truly compassionate. They need to prove that Compassionate Conservatism is not the Big Lie.

Posted by pnhp at 09:29 AM | Permalink

HMO workers strike over health benefits

SEATTLE (AP) — About 1,700 nurses and other health care workers formed picket lines to start a five-day strike against Group Health Cooperative — one of the nation’s oldest HMOs — over the cost of their own health benefits. Nurses, medical assistants, therapists and others represented by Service Employees International Union Local 1199 began striking at 18 clinics in western Washington, union spokesman Carter Wright said Monday. Negotiations between the two sides ended last week.

Before the walkout began, Group Health transferred an undisclosed number of maternity patients, rescheduled outpatient surgery and postponed back-to-school physical exams. Nonstriking employees and outside replacement workers filled in for the union members. The walkout is scheduled to end at midnight Friday. Group Health, a nonprofit health maintenance organization begun in 1947, says it needs its employees to pay more for health benefits to save money and prevent the HMO from passing on costs to members in the form of higher premiums.

Union workers now get benefits with no premiums or deductibles. They make $5 co-payments for office visits and prescriptions. Group Health wants to raise co-payments to $15, institute deductibles and charge premiums on a sliding scale. Union members say they are willing to contribute more but not as much as Group Health has sought, adding that some employees could not afford health coverage under the cooperative’s proposal. Union members range from nurses making $70,000 a year to custodians making $24,000. Group Health is the second largest consumer-governed HMO in the nation

Posted by pnhp at 03:19 PM | Permalink

Mike Luff on Canada’s vacillating solidarity

In the last Quote of the Day message, a Globe and Mail article on Canadian solidarity and the right to health care ended with: “When they came to take away the rights of the destitute, I was not destitute, so I did not speak out. Then they came to take the rights of the ill.”

My comment following the quote posed the question: “Whether in the United States or Canada, is it solidarity that is vacillating, or is it merely due to our all too feeble efforts to involve ourselves in the political process?”

Mike Luff, National Representative for Canada’s National Union of Public and General Employees (NUPGE) responds:

With respect to your question (above), I would submit the following response: it’s not an “either/or” issue. The problem is both diminishing solidarity and confidence in the political process. But I believe we can change this. By honestly answering two deceptively simple questions: If not us, who? If not now, when? Allow me to elaborate, please.

Conviction and courage are almost nonexistent in politics in Canada and the US. It’s so bad we even tell jokes about it. One I heard goes like this.

Question: Why is a politician like a banana?
Answer: Because he starts out green, turns yellow and then goes rotten. But it is no laughing matter. The problem is not that politicians don’t live up to our expectations - the problem is that they too often do live up to our expectations and behave like politicians. They too often show no conviction and courage. They too often play us for suckers. This is what we’ve come to expect from the “people’s representatives” in Ottawa and Washington. It’s very dangerous. Because it pushes most people to give up on politics. To throw our hands up and follow the famous bumper sticker advice: “Don’t vote. It only encourages ‘em.” That’s the real danger. Because the more people give up on politics the closer we edge to giving up on democracy itself.

But we do have the power to stop the drift to democratic despair. To do this we must come on strong. Remind people that to give up on politics is to give up on ourselves - and that we are not about to do that. We must rally regular, everyday people with the conviction they can hold out for themselves and we must give them the courage to use their ballots to finally do it. We must state and restate our conviction that it is regular, everyday folks who make history every day when we shut off the alarm clock, get the kids off to school and go into work. We must have the courage to say this is our world and we are not about to throw up our hands and lose it by default to the fools in Ottawa and Washington - elections will be won and lost until we get what we want.

The example of how we got Medicare in Canada in the first place should give us strength. The people that thought up and fought for Canada’s Medicare didn’t put their faith in politics or politicians. They put their faith in people, in each other. There were 105 people at the founding meeting of the movement to fight for Canada’s Medicare. There were 20 construction workers; 19 unemployed men and women; 15 farmers; 12 members of Parliament; six housewives; six teachers; six railway workers; six nurses; three journalists; two lawyers; two union leaders; two steam engineers; one miner; one professor; one hotel keeper; one retired minister; one merchant; and one motion picture operator. And not one stuffed shirt in the lot. They were all regular folks. They had nothing much going for them except their belief in themselves, their common desire to make the world into a better place and their faith in the power of ordinary people to do extraordinary things.

It is what made them strong then. It is what makes us strong now. It is what will keep us strong in the future.

It’s just a fact that civilization doesn’t happen because we leave it to other people. We have to stand up and fight for it - as if the cause depends on each one of us, because it really does! We must make it plain that we are going to hold out for what is right and just and ours. We must do this because we owe it to ourselves and to all the other women and men of good will who came before us and all those who will follow. We must be, as they were and will be, the change we wish to see in the world. Let us together openly declare that we are the ones who will lead by example, with conviction and courage, and we will do it now!

Mike Luff
National Representative
National Union of Public and General Employees (NUPGE)
NUPGE is Canada’s second largest union.)

Posted by pnhp at 09:34 AM | Permalink

Experts Say President Bush’s Health Proposal Would Fall Short of Estimates for Expanded Coverage, Washington Post Reports

Several independent analyses of President Bush’s proposal to extend health care to 10 million uninsured U.S. residents at a cost of $102 billion over 10 years found that the “hard data fell far short of the claims,” the Washington Post reports. The Congressional Budget Office, the Treasury Department, academics and the Bush campaign Web site “suggest that under the best circumstances, Bush’s plans for health care would extend coverage to no more than six million people over the next decade,” according to the Post. It is possible that the proposal would only result in two million additional insured people, the Post reports. Henry Aaron, health policy expert at the Brookings Institution, said, “There’s little reason to expect that there would be any reduction in the overall numbers of Americans without health insurance. We’re swimming against a rather swift current in our efforts to reduce the number of uninsured, and the power of President Bush’s proposals to move against that current is, it seems to me, very, very limited.” Megan Hauck, deputy policy director for health care in the Bush campaign, “generally touts” that the proposal would expand coverage to 10 million uninsured through tax credits, association health plans and health savings accounts, the Post reports. However, she agreed that it could expand coverage to as few as six million.

Tax Credits

Based on testimony by a Treasury Department official, the Bush campaign estimates that about five million people would use a $1,000 tax credit to purchase health insurance. However, Jonathan Gruber, an economist at the Massachusetts Institute of Technology, said that some businesses could drop coverage as a result and that his analysis shows the Bush policy could result in 1.8 million newly insured.

Association Health Plans

Hauck said that the Bush campaign’s plan to allow the formation of association health plans would result in an increase of two million insured residents. The figure comes from a January 2000 CBO report that estimated the plans would attract 10,000 to two million members; however, a July 2003 CBO analysis of such plans found that about 600,000 U.S. residents would join health plans. Mercer Risk, Finance and Insurance Consulting estimated that association health plans could lead to an increase of one million uninsured U.S. residents because of an increase in small business insurance premiums.

Health Savings Accounts

The Bush campaign also has said it could expand health coverage to three million people through health savings accounts. Hauck said an internal campaign estimate found the accounts would extend coverage to 1.1 million people, and that an additional 1.9 million would receive coverage through a Bush proposal to make premiums for such coverage tax-deductible. Gruber and Paul Ginsburg, president of the Center for Studying Health System Change, said HSAs would have a minimal impact on the rate of uninsured because some people who are likely to open such accounts are already insured. Gruber said that expanding use of health savings accounts by making premiums tax-deductible would increase the number of uninsured by about 350,000 when combined with Bush’s tax credit policy.

Past Proposals

According to the Post, the “assertions Bush makes about his first-term health care record” are exaggerated. For instance, he speaks about more than four million seniors who previously lacked prescription drug coverage as enrolling in the new Medicare drug discount card program. However, he fails to note that 2.9 million of those seniors were signed up automatically as a result of their participation in a Medicare managed care plan. Further, the Bush campaign Web site states that the administration has expanded eligibility under Medicaid and SCHIP to more than 2.6 million people. Diane Rowland, executive director of the Kaiser Commission on Medicaid and the Uninsured, said that the statement “is not really true,” adding, “In reality only 200,000 of them got coverage” because of policies enacted by the Bush administration. Rowland said, “Part of the reason more people were covered is the economy got so bad that people lost income. There were more low-income people under Bush than previously, so they became eligible for public programs.” Hauck said the figures cited by Rowland are “awfully low” (Connolly, Washington Post, 8/22).

Bush’s Domestic Agenda

In related news, the Los Angeles Times on Monday examined Bush’s domestic agenda — including his plan to expand use of health savings accounts, which the paper says “may not appear that weighty or new” but “still add[s] up to something big.” Articulating his vision for an “ownership society,” Bush said, “During the next four years, we’ll help more citizens to own their health plan, to own a piece of their retirement, to own their own home or their own small business” (Vieth, Los Angeles Times, 8/23).

Posted by pnhp at 02:58 PM | Permalink

Allyson Pollock. NHS plc. The privatisation of our health care. London: Verso September 2004

It’s here at last. In this eagerly-awaited book, Allyson Pollock draws together the many strands of her research and experience, and that of her colleagues in the Public Health Policy Unit. Using historical detail, financial analysis, and personal anecdote, she paints the big picture of how the National Health Service, once offering the population “freedom from fear” “from cradle to grave”, has been delivered, under cover of “diversity”, “local ownership”, and “the right to choose” into the hands of private providers.

James Lancaster
Public Health Policy Unit t: 44 (0)20 7679 4985 (UCL: 24985)
School of Public Policy f: 44 (0)20 7916 8536

Posted by pnhp at 02:50 PM | Permalink

Annals of Internal Medicine
August 17, 2004
Diabetes Care Quality in the Veterans Affairs Health Care System and Commercial Managed Care: The TRIAD Study
By Eve A. Kerr, MD, MPH, et al

We believe that this is the first study to use equivalent instruments and methods to compare quality of diabetes care for patients treated in the VA system with quality for those in commercial managed care systems. We should note that the average results for diabetes quality among the commercial managed care plans participating in this study are at or near the top of diabetes performance when compared with national results for commercial plans participating in the National Committee for Quality Assurance accreditation process. Despite this relatively high level of performance in the commercial plans, we found that the processes of care and 2 intermediate outcomes for VA study participants were better than or as good as those for commercial managed care participants. In many cases, the observed differences in quality of care between VA and commercial managed care were large.

…as an integrated health care system, the VA system has implemented several simultaneous, national-level strategies, such as an integrated electronic medical record, unified nationwide guidelines, service integration, alignment of payment incentives, and effective performance monitoring. While almost all commercial managed care plans also had established diabetes quality improvement and monitoring systems, the Chronic Care Model suggests that changes in several domains of care and investment in quality by organizational leaders are necessary to move the quality needle effectively.

Our results suggest that a federally sponsored national health care organization can provide care that is equivalent to or better than that provided by high-performing commercial managed care plans.

http://www.annals.org/cgi/content/full/141/4/272

Comment: So much for “the government can’t do anything right.”

Posted by pnhp at 09:13 AM | Permalink

The Globe and Mail
August 20, 2004
Then they came for health care
By Rick Salutin

It has been a summer of dire warning about eroding health care, leading doomfully toward a health summit in September. This is not new. For a decade, virtually the entire political class and opinion elites have said our health care is not “sustainable,” as if it is a coastline faced by a weather system. The sole public voice (aside from the public) to reject this fatalism has been Roy Romanow. This week, he noted that tax cuts have cost $250-billion in revenue since 1996 while health costs have risen just $108-billion. In other words, the decline in health care is a result of free human choice.

The reason public opinion has resisted elite wisdom about our hopeless health care is not that people adore those “free” doctor visits, but that they have come to see it as a basic right. It may not have begun that way,but it soon took on that air. This sense of health care as a right makes it resistant to fiscal fear-mongering. What would you say if you were told we cannot afford free speech, or democracy, due to current economic conditions? Health care is different and similar. But rights can be lost, as well as gained. To shed light on how that happens, let me take another case: the right to be free of destitution, known disparagingly as welfare.(Welfare is not just about being poor but being destitute. Welfare incomes are often about 15 per cent of average income and miles below the poverty line.)

The sense of welfare as a human right emerged in the 1960s, like health care. It, too, occurred by stealth. Till then, welfare had been akin to charity, bestowed by their betters on the poor, who were seen as partially or wholly responsible for their plight. But during the Depression, the destitute started being seen as victims of market forces largely outside of their control. The token of this change was the 1966 Canada Assistance Plan (CAP), which offered federal funding for welfare as long as the provinces made it universally available, provided a decent living standard and removed distinctions between the worthy and unworthy poor. It was a kind of informal acceptance of the right not to be destitute.

The retraction of this right — one of the “givebacks” of the 1990s — was the work of then-finance minister Paul Martin. His 1995 budget abolished the CAP, replacing it with the Canada Health and Social Transfer, a pot of money the provinces were handed with far fewer conditions attached. Ontario and B.C. swiftly brought in the old divisions between the worthy and unworthy poor, plus programs such as workfare. The right of Canadians not to be destitute was effectively repealed. It’s striking that this did not extend to the health component of federal funding. There, standards stayed in place and the right to health care stood. The ill as a class were now treated as more fully human, as mirrored by their rights, than the poor — surely due to calculating the votes involved.

This was bad news for the poor. But I’d say it was also bad news for the rest of us. The loss of the right not to be destitute makes the poor less fully human. The non-poor, meanwhile, become more fully human, and they get to show it by lording it over the poor, deciding their fate by giving or withholding welfare. This kind of social breakup is the essence of charity,which was defined in 1825, for instance, as something that exists “to signify the promoting of the happiness of our inferiors.” Welcome to the 19th century. Less human solidarity, more division and strife.

The accumulation of human rights is a social, historical process. It isn’t handed down once and for all. It can move ahead and fall back. If you can find a reason to deny the rights of the destitute, you can do the same for those of the ill. Why not give health care only to those who deserve it, who exercise, don’t smoke etc. It is not inherently illogical. The same for free speech. You can find reasons to withdraw it: terror, moral decay . . . The right to vote? At one time, it went only to those with property or other virtues.

When they came to take away the rights of the destitute, I was not destitute, so I did not speak out. Then they came to take the rights of the ill.

http://www.theglobeandmail.com/servlet/ArticleNews/TPStory/LAC/20040820/COSALU20/TPHealth/

Comment: Whether in the United States or Canada, is it solidarity that is vacillating? Or is it merely due to our all too feeble efforts to involve ourselves in the political process?

Posted by pnhp at 08:54 AM | Permalink

The Dallas Morning News
July 31, 2004, Saturday

McKinney, Texas, drugstore offers prescriptions at no profit for needy
By Paul Meyer

To order prescription drugs for less, please visit:
http://cheapdrugsforall.com

McKINNEY, Texas — As pill prices rise, politicians wrangle and some customers search north of the border for help, one of Texas’ oldest drugstores is offering a novel remedy grounded in old-fashioned values.

Last month, Smith Drug Co. began selling prescriptions at no profit for underinsured and uninsured customers a move some doctors and industry observers call unprecedented in their experience.

“It’s really not fair to the customers to take advantage of them,” said Kaylei Mosier, owner of the 145-year-old store in McKinney’s historic downtown.

Take the drug ciprofloxacin, a generic medication commonly prescribed to treat infections. For 20 500-milligram pills, customers spend $ 84.59 at a Walgreens.com. CanadaPharmacy.com charges $ 36 for the same amount, based on a 100-pill order.

At Smith Drug, it costs $ 10.22, including a $ 7 charge for labor and overhead, according to a letter sent to doctors this month.

“Generic drugs are the ones that are marked up the most, have the greatest variation [in cost] and make the pharmacies the most money,” said Devon M. Herrick, research manager for the National Center for Policy Analysis.

Both the Texas Pharmacy Association and American Pharmacists Association said Friday that they haven’t heard of another pharmacy with a similar program.

“This is the first experience I’ve heard of somebody willing to sell at cost,” said David Gonzales, director of public affairs for the Texas Pharmacy Association.

“You have other pharmacies that would question the wisdom of doing that from a profit standpoint, but that would be a business question.”

Carla Chandler, 42, has insurance that covers three of her five medications. For one of the others, she called every pharmacy in the area and says she was quoted about $ 240 at one store. At Smith, the bill was $ 16.68. Drug delivery was free.

“My mouth dropped open. I said, ‘Excuse me, that can’t be right,’ ” Ms. Chandler said when she learned the cost of her medication at Smith Drug.

“If it wasn’t for them, it would mean we would have to go without paying one of our major bills.”

The same applies to Marjorie J. Washington, 76, who became uninsured after moving here from Missouri.

Ms. Washington, with six prescriptions, said prices she pays at Smith Drug are less than her co-payments under her old insurance.

“I wouldn’t have any money if it wasn’t for them,” she said. “I couldn’t do anything but eat and buy drugs.”

McKinney urologist Jerry Frankel, a member of Physicians for a National Health Program, said he tries to send all his patients, insured or not, to the pharmacy after learning of the new policy.

“You can’t make a living just taking care of uninsured people,” he said.

“I’m trying to direct people with open minds and good insurance to go there as well.”

Posted by pnhp at 01:28 PM | Permalink

New Hampshire uses market reform to cover the healthy

The Union Leader
August 18, 2004
State health insurance ‘reform’ is making matters worse
By Burt Cohen

I know I’m not the only one whose health insurance premium has long since surpassed my mortgage. This is crazy.

But hang on to your seat. Thanks to a bill sponsored by Sen. Russell Prescott, R-Kingston, it’s going to get much worse. Prescott’s infamous Senate Bill 110, with Gov. Craig Benson’s active support, became law despite overwhelming evidence it would do great harm.

The simple premise of SB 110 was that, by allowing market forces free rein,more health insurance companies would be drawn to New Hampshire, and health insurance costs would drop. My goodness, it didn’t turn out that way.The actual results are that insurance will now be cheaper for the young and healthy (who generally don’t even buy health insurance), but more expensive for the old and sick. Premiums are skyrocketing from 25 percent to 75 percent, or more, for small businesses and families across New Hampshire.

It was obvious at the time that SB 110 was about cherry picking. It enables insurance companies to make more money by being more selective in who they underwrite. They can now charge higher rates for small groups according to
geographic region, as well as age or health.

The public good is served when the healthy help pay the costs of caring for the sick. And it’s not like we have a choice in getting sick. While it is certainly fair to have bad drivers pay more for insurance, is it fair to charge the sick more for their unchosen predicament? Yet that’s exactly how SB 110 works.

It’s hard to imagine, but thanks to Sen. Prescott’s bill, today our New Hampshire government is prying deep into private personal information.You must list every health problem, and every medication taken by anyone in your family during the past five years. So here we have it: The state of New Hampshire, through SB 110, is now serving the interests of the health insurance industry against the interests of the citizens.

Yes, we have to do something. More and more health care providers are coming to the conclusion that it’s time to create a national solution,something like an expanded Medicare system.

http://www.theunionleader.com/articles_showfast.html?article=42473

New Hampshire’s Chapter 420-G: Portability, Availability, and Renewability of Health Coverage:
http://www.gencourt.state.nh.us/rsa/html/indexes/420-G.html

Comment: The splitting of insurance coverage into high risk and low risk pools is not some theoretical policy proposal by advocates of “consumer directed” health coverage. It is already here. Health coverage is being made affordable for the larger sector of our population that is relatively healthy. Those with higher health care needs are being shoved into unaffordable high cost pools.

We desperately need to establish one single universal risk pool that spreads the costs equitably. Is this concept really so complex that we should remain frozen in inaction?

Posted by pnhp at 10:16 AM | Permalink

Another View: State health insurance ‘reform’ is making matters worse
By BURT COHEN
Guest Commentary

WHICH COSTS you more: your mortgage or your health insurance? From talking to many neighbors, I know I’m not the only one whose health insurance premium has long since surpassed my mortgage. This is crazy.

But hang on to your seat. Thanks to a bill sponsored by Sen. Russell Prescott, R-Kingston, it’s going to get much worse. Prescott’s infamous Senate Bill 110, with Gov. Craig Benson’s active support, became law despite overwhelming evidence it would do great harm. Citizens of all political stripes are up in arms, as they should be.

The simple premise of SB 110 was that, by allowing market forces free rein, more health insurance companies would be drawn to New Hampshire, and health insurance costs would drop. My goodness, it didn’t turn out that way. The actual results are that insurance will now be cheaper for the young and healthy (who generally don’t even buy health insurance), but more expensive for the old and sick. Premiums are skyrocketing from 25 percent to 75 percent, or more, for small businesses and families across New Hampshire.

The argument for passing SB 110 was that insurance costs are high, so we’ve got to do something — anything. Well, actually no, not if it makes matters worse. I am reminded of Barbara Tuchman’s perceptive book “The March of Folly,” in which folly is defined as “government pursuit of a policy contrary to the self-interest of the constituency involved . . . a policy which is perceived to be counter-productive in its own time, not merely by hindsight.” SB 110 clearly fits that definition.

It was obvious at the time that SB 110 was about cherry picking. It enables insurance companies to make more money by being more selective in who they underwrite. They can now charge higher rates for small groups according to geographic region, as well as age or health. Any legislation that forces employers in the economically depressed North Country to pay more, shift costs to employees or drop health insurance altogether is completely counter-productive. It is not in our state’s best interest.

The public good is served when the healthy help pay the costs of caring for the sick. And it’s not like we have a choice in getting sick. While it is certainly fair to have bad drivers pay more for insurance, is it fair to charge the sick more for their unchosen predicament? Yet that’s exactly how SB 110 works.

Another odious part of the new law requires employees to fill out the “New Hampshire Family Health Statement” questionnaire. I’ve talked to many employers who hate being forced to ask these invasive questions of their loyal employees. It’s hard to imagine, but thanks to Sen. Prescott’s bill, today our New Hampshire government is prying deep into private personal information. You must list every health problem, and every medication taken by anyone in your family during the past five years. So here we have it: The state of New Hampshire, through SB 110, is now serving the interests of the health insurance industry against the interests of the citizens.

And what about Sen. Prescott’s claim that insurance companies would flood into New Hampshire? According to the Insurance Commission, since the bill became law in January, just one insurance company has come to this state, period. The three or four others who may come had signaled their intent to enter the market prior to SB 110’s passage.

And it’s not just patients who are getting whacked by our insurance mess. Ask your physician what he or she thinks of SB 110. To them it means a huge amount of new paperwork, with no benefit to anybody. Except, of course, the insurers.

Yes, we have to do something. More and more health care providers are coming to the conclusion that it’s time to create a national solution, something like an expanded Medicare system.

New Hampshire’s new experiment is not a solution. It’s a big problem, and it’s getting worse. The fact is that people across America are struggling with health care costs that are out of reach. Allowing cherry picking by the insurers does not help; it causes harm. Prescott’s puzzling plan is no fix at all. It merely makes a bad problem worse. Voters can take this matter into their own hands. Before you cast a vote in November, it would serve you well to ask your Senate or House candidate how he or she feels about repealing SB 110.

Burt Cohen is a Democratic state senator from New Castle.

Posted by pnhp at 01:05 PM | Permalink

Excluding preganancy from insurance risk pools

Los Angeles Times
August 18, 2004
State Bill Mandates Maternity Coverage
By Marc Lifsher

The measure by Sen. Jackie Speier (D-Hillsborough) would affect a relatively small number of Californians: the 354,000 who get their health insurance outside of employer-provided group plans and don’t buy maternity coverage.

Kaiser Permanente, the state’s largest healthcare provider, thinks maternity care should be part of any basic health service. Slightly smaller rival Blue Cross of California, a subsidiary of WellPoint Health Networks Inc., contends that getting pregnant is a choice and that outlawing the exclusion would drive up insurance costs.

Speier and her supporters say they want to protect women against discrimination and prevent insurance companies from exploiting a legal loophole by covering only certain medical conditions - a practice known as cherry-picking. (Federal law prohibits insurers from excluding maternity benefits from employer health plans, which cover 97% of Californians who have health insurance.)

“If you’re going to tailor healthcare to the individual . everybody’s costs would skyrocket,” Speier said. “The reason that healthcare works now is because we spread the risks over the entire population.”

Although (Gov. Schwarzenegger) hasn’t taken an official position, his insurance advisor, Scott K. Reid, wrote a letter to Speier opposing the bill. “This bill would limit choice in the marketplace and increase costs for consumers who desire a lower-cost insurance product that excludes maternity coverage,” he said.

http://www.latimes.com/business/la-fi-maternity18aug18,1,2163960.story?coll=la-home-business

Comment: Customizing insurance coverage by allowing shoppers to choose from a menu of options for coverage would reduce costs for those who likely would not need the services declined. But for those who are clustered with individuals who have greater specific needs, the costs of the segregated pools would be significantly higher and unaffordable for many. An equitable insurance pool shifts costs from those with greater needs and dilutes those costs amongst the greater number of individuals with much more modest needs.

Segregating higher cost individuals into separate pools is irrational, but assessing financial penalties on pregnant women is inhumane. We should establish our own equitably-funded universal insurance pool and tell Blue Cross/WellPoint to get lost.

Posted by pnhp at 09:16 AM | Permalink

Laura&Jerry

A Medical Emergency in Ireland Shows Strengths of National Health Service
By Laura Zimmermann, second year medical student,
Northwestern University Feinberg School of Medicine.

While gingerly treading among the limestone slabs of the Burren in County Clare, Ireland, my 71-year old grandmother fell and broke her hip. While my father retrieved the rented minibus, my siblings and I carried my grandmother, moaning in pain, past grazing cows to the main road. We raced to the ER of the local hospital in Galway, where the staff immediately took her back to the examining area. We waited anxiously in the lobby, worried about her injury, but relieved that she was receiving emergency attention.

As a second-year medical student at Northwestern University, I look back on this traumatic family vacation in the summer of 2000 and recognize a lesson in health care systems. In the United States, where tens of millions of people go without needed care because of the cost, opponents of national health insurance often claim that patients will end up waiting in long lines for sub-par care. However, this is not what happened to my grandmother when she was treated by the Irish national health service.

My grandmother was diagnosed with a complete fracture of the femur. Her leg was, in effect, detached from her body. Less than twenty-four hours later, we greeted my grandmother, fresh out of surgery. Both she and my entire family were relieved when told she would need ten days to recover before she could leave Galway hospital. My grandmother stayed in a pleasant hospital room called “the Sun Room,” and quickly made friends with her roommates and nurses. Her doctor was “just the nicest man.” Altogether, the hospital provided my Grandmother with emergency care, orthopedic surgery, physical therapy, nursing care, and a lovely hospital room for ten days. Within a few months of arriving home, my Grandmother’s recovery was complete, and she walked without assistance.

Given the amount and quality of the care my grandmother received, the entire family was shocked when the bill arrived. The Irish health service charged my grandmother’s insurance company $6,100 for all the care she received in Ireland. According to Blue Cross/Blue Shield, a U.S. hospital would charge about $35,000, including only four days of hospitalization, and not including emergency treatment.

My grandmother’s care in the Irish national health service was swift, compassionate, high-quality, and effective. “The experience was as good as it could have been considering I broke a bone,” my grandmother says. Unfortunately, my grandmother broke her other femur three years later. That hip still hurts her, while her “Irish hip,” she likes to note, is just fine. Her share of the bill for her care, at a hospital in Illinois, despite having extra coverage on top of her Medicare coverage, was not only more than the entire bill in Ireland, but the bills were so very confusing, they took a lot of my parents’ time to straighten out.

I hope to provide the best care for all of my future patients, not just the wealthy and well-insured ones. Also, patients should not have to face financial ruin in addition to illness. Over a million Americans go bankrupt over medical bills every year, despite the fact that 75 percent of them have health insurance.
The United States has a lot to learn about health care from County Galway, Ireland. Just ask my grandmother, “Jerry.”

Posted by pnhp at 01:26 PM | Permalink

Canadian drugs aren’t the cure
By Robert Kuttner  |  August 18, 2004

THERE IS something quite lunatic about the entire debate on whether to permit imports of drugs from Canada. It’s not as if Canada manufactures drugs more cheaply. Nor are drugs like trees, or bauxite, or hydro power, which just happen to be naturally plentiful in Canada.

No, the cheaper Canadian drugs are the same ones sold at higher prices in the United States, and either exported or licensed for manufacture in Canada.

Why are they cheaper up north? Because Canada has a policy of controlling drug prices through its national health insurance system. As Deborah Stone, a health policy expert at Dartmouth, has observed, it’s not the drugs we should be importing, it’s the policy.

But the pharmaceutical lobby has so much power in the United States that cheaper drug prices are off the political radar screen. In fact, the recent Medicare bill pushed through Congress by the Bush administration explicitly prohibits Medicare, the largest bulk purchaser of pharmaceutical drugs, from negotiating cut-rate bulk prices. A consequence of these sky-high drug prices is that seniors who elect to take the new Medicare drug coverage must pay thousands of dollars out of pocket each year before the coverage fully kicks in. (Senator Kerry, to his credit, would reverse this policy.)

Instead of debating head-on whether the United States should have a national health program like Canada’s, or at least controlled drug prices, the news media have generally accepted the nonsensical premise that the battle is about imports and that the issue is the safety of drugs from Canada. This is the drug industry line, and it’s a complete red herring. In fact, there is no documented case of an American getting sick because of tainted or adulterated drugs brought in from Canada. On the contrary, Canadian safety standards are at least as strict as our own. But Bush appointees at the FDA, as a service to their allies in the pharmaceutical industry, have tried to make the public focus on safety. Why? Because if drug imports from Canada became widespread, the domestic structure of drug overpricing would collapse. Everyone would buy from Canada.

If the administration were not hostile to the idea of drug imports or cheaper drug prices, it would be easy to set up safety spot checks. Indeed, in areas where the administration promotes free trade, it satisfies its safety concerns with spot checks of raw agricultural products imported from countries whose rudimentary sanitary standards are far less sophisticated than Canada’s. To add insult to injury, the administration is actually pressing America’s trading partners who have lower drug prices to raise those prices so that our high prices won’t stick out like a sore thumb and tempt Americans to seek cheaper drugs from abroad.

The drug industry and its friends in the administration contend that the exorbitant prices are necessary to pay for research. You’ve probably seen the TV ads in which an idealistic research scientist at a drug company vows to find a cure for Parkinson’s or Alzheimer’s, mentioning in passing that it costs $800 million to “bring a new drug to market.”

But as author Merrill Goozner documents in his book, “The $800 Million Pill,” much of the money attributed to “research” goes to advertising and copy-cat drugs rather than true breakthroughs, and much of the actual research is financed by taxpayers through the National Institutes of Health). Economist Dean Baker has calculated that only about one dollar in five that US consumers spend on inflated drug prices go to finance drug research. Baker adds up all the money contributed by taxpayers to drug companies through Medicare, Medicare, the Veterans Administration, and NIH. He concludes that it would be more cost-effective to pay for all drug research through government grants and then put the results in the public domain. Manufacturers, as in the case of aspirin, doxycycline, and other off-patent drugs, would then earn only a normal profit, and all drugs would be far cheaper.

Scientists would still innovate. The pioneers of antibiotics weren’t in it to get rich. Nor was Dr. Jonas Salk. Their breakthroughs quickly went into the public domain to help the greatest number at the lowest cost.

It’s charming that the Republican governor of New Hampshire, Craig Benson, is suing the FDA to allow Canadian pharmacies to fill US prescriptions and that congressmen of both parties have sponsored bills to legalize imports. But these worthies are fighting the wrong fight and ducking the real one. Forget Canada. We need a national policy to lower drug prices right here in the USA.

Posted by pnhp at 01:05 PM | Permalink

From the ice age to the genome project
by Michael Kennedy
(Asklepiad Press, 2004)

Discovery of beneficial drugs or other therapy requires some capability for scientific analysis, studying the effects of administration to sick patients and recognizing evidence of improvement. Before such analysis is possible, the natural history of disease and the diagnosis of different maladies must be known. Greek physicians were capable of scientific observation and ancient medicine was mostly a matter of diagnosis and prognostication since useful remedies were few. The physician who was successful was a good observer and able to predict the outcome of the illness. He often took credit for successful outcomes that he had nothing to do with, a characteristic that makes him seem only more modern.

Asklepiad Press:
http://www.asklepiadpress.com/order.htm

Borders/Amazon reviews:
http://www.amazon.com/exec/obidos/tg/detail/-/0974946648/qid=1092759272/sr=1-1/ref=sr_1_1/103-0155879-1115008?v=glance&s=books

Comment: What does a book on the history of disease and medicine have to do with health care reform? The simple answer is the well acknowledged concept that those who fail to understand the errors of history are doomed to repeat them. But an even greater value of this book is that it provides a clear perspective of the historical basis of our existing health care system.

Understanding that perspective is essential if we expect to design a truly rational system of reform. As a transition into our contemplation of reform, Dr. Kennedy ends his book with a chapter on the economics of medicine.

There is another quality of this book that I should mention. It is truly enjoyable reading. I read it within view of Old Faithful in Yellowstone. I actually missed several eruptions of the geyser because I was so deeply absorbed in the story that Dr. Kennedy has to tell.

The next time that you are looking for some escape literature, make it worth your while. Read Mike Kennedy’s book. It will be fun, and it will recharge your enthusiasm for reform.

Posted by pnhp at 09:43 AM | Permalink

Highlights of the Health Care for All Ohioans Act

1. The Health Care for All Ohioans Act, referred to here as “the Plan,” provides coverage for the full range of inpatient and outpatient hospital care, preventive care, mental health, vision, hearing, prescription drugs, dental, emergency services, rehabilitation services, hospice care, home care, health maintenance care, medical supplies, and all other necessary medical services as determined by any state licensed, certified, or registered health care practitioner. It provides timely emergency health care services in each county, including hospital care and triage, and necessary transportation in each county to access covered health care services.

2. Coverage will be provided regardless of income or employment status and there will be no exclusions for pre-existing conditions.

3. There will be no copayments or deductibles.

4. Patients will have free choice of health care providers and hospitals. People who today lack coverage will be able to see doctors and other providers when needed, and will benefit from preventive care and early intervention.

5. Payments to health care providers for all covered services will be made from a single public fund, called the Ohio Health Care Fund. The Plan will be funded by payroll taxes paid by employers, a gross receipts tax on businesses, personal tax increases limited ONLY to those earning more than $87,900 annually, $11.6 billion in administrative cost savings, and funds from government sources.

6. Since health care bills will be paid from a single public fund, insurance companies will no longer have a role in the system and the billions of dollars in profits they take from it will go instead for patient care.

7. Workers under collective bargaining agreements will enjoy the same benefits as everyone else. If benefits under these agreements are less than what the Plan provides, employers must pay the cost of increasing benefits to the level of the Plan, with the employers paying all the premiums, co-payments and deductibles; or the employer and the union may renegotiate and begin coverage under the Plan immediately. The Plan will automatically cover workers when their collective bargaining agreements expire.

8. Public employers – on a state, county, school district and municipal level – will pay much less for employees’ health care coverage than they do today, since their payroll tax for health care will not exceed 3.85% of the total payroll. Private employers who today provide benefits will also save because the combination of the payroll tax and the gross receipts tax on businesses, which is not to exceed 3%, is much less than what many of these employers and businesses pay today for health care coverage for their employees.

9. Workers employed by health insurance companies and others who lose jobs as a result of the changes brought about by the Health Care for All Ohioans Act will receive, at public expense, retraining and financial assistance for up to two years. Many of these workers will be able to find employment in the public sector implementing the new Plan.

10. There will be a marked reduction in physicians’ costs for billing since payment for services rendered will come from one public fund, not 1500 private insurers. And payment will be guaranteed from that public fund. Malpractice insurance will also be less expensive since medical bills will no longer be part of jury awards.

Issued by Single-Payer Action Network Ohio (SPAN Ohio)

Click here to see the table based on annual incomes

View Initiative Petition

Click to view list of endorsers

Posted by pnhp at 03:50 PM | Permalink

Pharmacy Benefit Managers: Health Care Cost Containment or Consumer Rip-Off? 
Corporate Truth Squad Alert #12 – August 13, 2004

Prescription drug prices are the fastest growing segment of runaway health care costs – increasing at double-digit rates over the last seven years, according to the Kaiser Family Foundation.  Consumers, especially older Americans, are paying ever-higher prices with no end in sight.  And a July 2004 study concluded that the cost of prescription drugs has risen so sharply that the average share of income (or the drug cost burden) spent by individuals on prescription drugs has increased from .8% in 1990 to 1.2% in 1998, accelerating to 1.8% in 2002.

Pharmacy Benefit Managers (PBMs), greatly impact access to and the costs of prescription drugs. They are an outgrowth of the managed care industry intended to keep drug costs down and to ensure quality of care, use their buying power to negotiate rebates from drug manufacturers and discounts from retail pharmacies.  But there are new and troubling questions about what PBMs do with those savings.  Are the savings being passed on to consumers or used to ensure the highest quality of drugs?  Or are they being used to enrich PBMs?

What’s At Stake?
The stakes are enormous. PBMs administer and manage prescription drug benefit programs for a wide range of clients – HMOs, employers, preferred provider organizations, Medicaid and other state programs, and other health plans. PBMs play a major role in the purchasing and distribution of drugs.  They purchase drugs in huge volumes through a large network, negotiating rebates from the drug manufacturers and discounts from retail pharmacies, and process hundreds-of-millions of pharmaceutical claims a year.  At the same time, however, they also run their own mail-order service centers.

State governments have a particular interest in the practices of PBMs as they increasingly use the bulk purchasing power of Medicaid beneficiaries, the uninsured or other groups in their state to negotiate lower drug prices. But since PBMs administer these programs, states may not be reaping the full savings of their market power.

And, PBMs will play a major role as administrators of the new prescription drug provisions in the 2003 Medicare Modernization and Improvement Act. A September 2003 study concluded that PBM self-dealing could cost the Medicare program and beneficiaries as much as $30 billion from 2004 to 2013.
 
According to the Centers for Medicare and Medicaid Services, spending for prescription drugs in America totaled $162.4 billion in 2002.  That’s four times higher than total spending since 1990.  PBMs have enormous power in this lucrative arrangement.  The New York Times reported on January 5, 2002 that there are 60 PBMs in America administering drug plans for about 200 million consumers – equaling 84% of individuals who have health insurance. 
 
Case Study:  Do PBMs Profit at Expense of Their Clients and Consumers?
Recent state investigations and several lawsuits have begun to raise the question of who benefits the most from PBMs.  Do PBMs keep the savings they negotiate for their own profits rather than passing them on to consumers?  Do they pad their profits by steering consumers to more costly drugs instead of the highest quality drugs at the lowest cost? 

Although 60 PBMs administer drug plans nationwide, three companies (Caremark, Express Scripts, and Medco) control close to half of the business.  According to financial data submitted by these three companies, they enjoyed billion dollar earnings in 2003.  Caremark had revenues of $9.1 billion managing more than 114 million prescriptions.  Advance PCS recently merged with Caremark, but before the merger rolled up $14 billion in annual revenues and managed 502 million prescriptions.  Express Scripts had $13 billion in revenues and processed more than 410 million pharmacy claims.  Medco had revenues of $34 billion and administered 532 million prescriptions. 
 
A pilot study conducted for the Journal of the American Pharmacists Association found wide gaps between what a PBM pays a pharmacy for a drug and what it bills the end user.  While the study concluded that PBMs average a $5 to $10 markup on generic and brand name drug transactions, it also found some much larger gaps, including one case in which a PBM billed an employer $215 for a generic stomach medicine, Ranitidine, but only paid the pharmacy $15 for the drug. 

In addition, PBMs may be using financial incentives to choose which drugs they offer.  One study found that drug companies pay rebates to PBMs for placing their products on special usage lists called formularies.  PBMs typically retain up to 30% of the manufacturers’ rebates, so they have an incentive to swap for drugs that pay higher rebates even if the drug costs the end user more. 
 
State Investigations Raise Questions about PBM Business Practices

The business practices of all three major PBMs are being investigated by a number of states around the country. On July 28, 2004, the St. Louis Post-Dispatch reported that twenty states are investigating Express Scripts, one of the nation’s largest PBMs.  The article also indicated that 19 other states are seeking documents related to a wide range of its business practices.  Since then, New York has also filed suit against them, alleging the company breached its contract with the state and broke other civil laws. The New York state litigation is centered on the practice of switching patients from one drug to another in order to boost its own profits.  In April, Medco, another large PBM, agreed to a $29 million settlement with 20 states, including New York, from litigation alleging the same abuses.  According to an August 5, 2004 article in the Kaiser Daily Health Policy Report, “Caremark Rx announced last month that it is being investigated by attorneys general from 19 states . . . .” On August 12, the Wall Street Journal reported that an additional four states had requested information about how Caremark Rx (which subsumed Advance PCS on March 24, 2004) is meeting requirements of their consumer protection laws.

State Attorneys General are stepping in to investigate PBM abuses even though PBMs are not comprehensively regulated by state or federal agencies.  Unlike pharmacies, no states require licensing for PBMs – except when they dispense medication directly through mail-order activities.  Also, states don’t regulate PBMs through their insurance regulations as they do the managed care industry. 

As questions have arisen regarding possible conflict of interests in the dual roles PBMs play, the National Legislative Association (NLA) on Prescription Drug Prices – currently comprised of 10 states – has decided to work towards the formation of an independent non-partisan Pharmacy Benefit Administer that will “facilitate aggregating the purchasing power of states, businesses, and individuals.”

Consumer Advocates Join the Fight to Reduce Rx Drug Prices

The Prescription Access Litigation (PAL) Project has joined forces with the American Federation of State, County and Municipal Employees (AFSCME) to sue the four largest PBMs in the nation, charging they are responsible for higher prescription drug costs.  The four PBMs named in the lawsuit are Advance PCS; Caremark Rx, Inc.; Express Scripts; and Medco Health.  The April 2003 complaint alleges that these four companies pocket savings on their drug purchases instead of passing them on to health plans and their members. According to the lawsuit, the PBMs have “willfully contributed to escalating drug costs, and have failed in their fiduciary duty to those client health plans.”

In addition, PAL has joined with the AARP Foundation Litigation and the Legal Counsel for the Elderly in a friend of the court (amicus) brief supporting the District of Columbia’s efforts to regulate PBMs and make them more accountable.  The amicus brief describes the enormous power that PBMs have:
PBMs do not manufacture, distribute, prescribe, or ultimately even pay for prescription drugs, yet they often determine what drug a patient will receive and at what price.

PBMs have consistently refused to disclose their pricing structures and the deals they negotiate with drug companies.  According to AARP and the Legal Counsel for the Elderly, studies have shown more transparency would save consumers money:
What seems clear from this navigation of the PBM maze is that prescription benefit plan sponsors (either private employers or government entities) should insist on full disclosure of cash flows to and through the PBM that is administering their drug benefit.  Without this level of scrutiny, the plan sponsor cannot be sure if its PBM is providing good service for a fair price or is acting primarily in its own interest.

The PBM industry successfully fought back efforts to include strong transparency provisions in the new Medicare law, according to the Corporate Research Project of Good Jobs First. (See “Cost Cutters or Con Artists? Pharmacy Benefit Managers Under Fire,” Corporate Research E-Letter No. 42, December 2003) Instead, Congress adopted a weaker provision, requiring that the Federal Trade Commission study whether PBMs will have a conflict of interest in providing the new Medicare prescription drug benefit through their own mail order pharmacies, thereby resulting in increased Medicare spending. 

For more information about this alert, the Corporate Truth Squad Campaign, or for a PDF version of this document, please call Helen Gonzales, USAction Policy Director, at 202-624-1730.

Posted by pnhp at 10:56 AM | Permalink

Canadian health care better than we think
By Dave Zweifel
August 16, 2004

Thanks to years of propaganda from the giant corporations with a vested interest in the U.S. health system, Americans have a somewhat jaundiced view of Canada’s national health insurance program.

We’re told that Canadians have to wait for simple procedures and that there are huge waiting lines for surgery. Doctors aren’t compensated adequately. We’ve been told that so often that we think it’s true. Almost all of it, however, is false.

The Canadian plan sometimes is short of money as government there, like here, is constantly under pressure to make cuts. But Canada’s single-payer program functions much better than our system. We spend an incredible $1.6 trillion for health care every year under our convoluted system, but still have 45 million citizens without any coverage. At a minimum in Canada everyone has health care and at a much lesser cost.

Pat Cornwell, one of this column’s regular readers, sent me an article written by a Canadian doctor after he and a group of colleagues spent some time working in our U.S. health system. Suffice it to say that America’s health insurers and drug companies aren’t passing the article around.

It was printed recently in Public Citizen’s health letter to underscore how messed up our health system has become.

“I just don’t get it,” the Canadian doc began. “Health care in America and the present debate regarding its reform don’t make any sense to me - no way. Even now, with a year’s stateside experience under my belt, I am still utterly baffled by what seems to be incompatibility between apparent fundamentals of the U.S. health care system and its professed goal of improving American health.

“Many Americans have tried diligently to explain their system to us but we’re still perplexed. And to compound perplexity, even while we were struggling to understand the American system of health care delivery, we were challenged from every side to defend the Canadian one. This was not totally unexpected, but the overload of misinformation among Americans about Canadian health care definitely was.”

He goes on to question why Americans have this compulsion to link health care and employment.

“What does being employed have to do with need for health care? Don’t the jobless also get sick?” he asked. “It seems to me that if you are so unlucky as to become ill enough to require health care, this may limit your opportunities for current or future employment.”

The doctor also wonders why the U.S. system has separate health programs for different groups: “gold-plated plans for the affluent, more meager plans for the less well-off, Medicaid for the poor (some of the poor, to be strictly accurate), Medicare for the elderly and disabled?”

But what perplexes him most about the U.S. system is why Americans don’t demand that adequate health care be defined as a universal human right.

“America has led the world in establishing ‘rights’ to many things … is it not time for a ‘right’ to adequate health care, extended to and enjoyed by all?” he wrote.

Dave Zweifel is editor of The Capital Times. E-mail: dzweifel@madison.com.

About Dave

Dave Zweifel has been editor of The Capital Times since 1983. A native of New Glarus, Wis. and a graduate of the University of Wisconsin-Madison, his life-long goal was to be the editor of this newspaper. He has had more luck achieving that than his other fondest hope — watching the Chicago Cubs win the World Series. He served for many years as president of the Wisconsin Freedom of Information Council and served two years as a juror for the Pulitzer Prizes.

Posted by pnhp at 10:28 AM | Permalink

Last February in City Council chambers, the Bloomington community came together behind Bloomington Hospital and against the concept of a private for-profit competing hospital in our community. The idea was defeated, but it has not died. Dr. Tiwari and unnamed other backers now threaten to build their new hospital in the county where there are no zoning restrictions to stop them. What was a bad idea in the winter is still a bad idea this summer.

In Canada, where their medical system is privately run but financed by the government like our Medicare, there has been talk of trying to improve efficiency and reduce cost by building some for-profit hospitals, and so a group of researchers from McMaster University in Ontario, along with other investigators from throughout Canada, recently published a thorough review of all the printed literature from the U.S. experience where for-profit and not-for-profit hospitals were concerned. Their study, published in the Canadian Medical Journal June 8, showed that patients at for-profit hospitals had higher mortality and higher costs than at not-for-profit hospitals. An editorial accompanied it, written by renowned Harvard researchers Drs. Steffie Woolhandler and David Himmelstein, and it applies to our local situation.

Woolhandler and Himmelstein start by pointing out that “some aspects of life are too precious, intimate or corruptible to entrust to the market. We prohibit selling kidneys and buying wives or judges.” But private investment in health care has been expanding. “In the United States, investor-owned firms have come to dominate renal dialysis, nursing home care, inpatient psychiatric and rehabilitation facilities and health maintenance organizations (HMOs). They have made significant inroads among acute care hospitals (now owning about 13 percent of such facilities), as well as outpatient surgical centers, home care agencies and even hospices. The for-profit barbarians are at the gates.”
It seems so intuitively obvious that if hospitals compete, then prices should come down. Statistics from the Indiana Hospital Association don’t bear that out, with hospital charges in Bedford and Terre Haute, towns with two competing hospitals, considerably higher than those at Bloomington Hospital. The Harvard doctors point out that those who favor for-profit health care argue that the profit motive optimizes care and minimizes costs. But the findings of the study didn’t bear that out. “Why does investor ownership increase costs?” they ask. “Investor-owned hospitals are profit maximizers, not cost minimizers. Strategies that bolster profitability often worsen efficiency and drive up costs. Columbia/HCA, the largest hospital firm in the United States, has paid the U.S. government $1.7 billion in settlements for fraud, the payment of kickbacks to physicians and overbilling of Medicare. … When Columbia/HCA’s CEO resigned in the face of fraud investigations, he left with a $10 million severance package and $324 million in company stock.”

Himmelstein and Woolhandler go on to ask: “Why do for-profit firms that offer inferior products at inflated prices survive in the market? Several prerequisites for the competitive free market described in textbooks are absent in health care. First, it is absurd to think that frail elderly and seriously ill patients, who consume the most care, can act as informed consumers (i.e., comparison-shop, reduce demand when suppliers raise prices or accurately appraise quality). Even less vulnerable patients can have difficulty gauging whether a hospital’s luxurious appurtenances bespeak good care. Second, the ‘product’ of health care is notoriously difficult to evaluate, even for sophisticated buyers like government.”
I cannot say it any better than Drs. Himmelstein and Woolhandler. Their article ends with a message that could have been written specifically for Bloomington:
“For-profit specialty hospitals have blossomed across the United States. Most of these new hospitals duplicate services available at nearby not-for-profit general hospitals, but the newcomers avoid money-losing programs such as geriatric care and emergency departments (a common entry point for uninsured patients). The profits accrue to the investors, the losses to the not-for-profit hospitals, and the total costs to society rise through the unnecessary duplication of expensive facilities. Behind false claims of efficiency lies a much uglier truth. Investor-owned care embodies a new value system that severs the community roots and Samaritan traditions of hospitals, makes physicians and nurses into instruments of investors, and views patients as commodities. Investor ownership marks the triumph of greed.”

Posted by pnhp at 02:40 PM | Permalink

Is Switzerland’s health care consumer-driven?
JAMA
September 8, 2004
Consumer-Driven Health Care
Lessons From Switzerland
By Regina E. Herzlinger, DBA; Ramin Parsa-Parsi, MD, MPH

Conclusion

Switzerland’s universal-coverage health care system consumes a larger fraction of gross domestic product than most other countries, likely reflecting its citizens’ preferences and resources. Health care expenditures are closely linked to income. Yet, in contrast with the United States, whose health care expenditures are the highest percentage of gross domestic product in the world and where more than 40 million citizens are uninsured, the consumer-driven Swiss health care system achieves 30% lower per capita health care costs and universal coverage while providing reasonable quality of care. These results can be attributed primarily to the control exercised by Swiss consumers and the relatively high cost transparency of the system, requirement for universal coverage, and risk adjustment of insurers. Additional savings would likely be ttained with liberalization of provider coverage and reimbursement policies.
http://jama.ama-assn.org/cgi/content/full/292/10/1213
And…

JAMA
September 8, 2004
The Swiss Health System
Regulated Competition Without Managed Care
By Uwe E. Reinhardt, PhD

Conclusion

Health services research seeking to test hypotheses on the basis of
nonexperimental data frequently faces the problem that a given database
can
support 2 or more rival hypotheses. The Swiss health system is a case in point.
In the view of Herzlinger and Parsa-Parsi, the Swiss health system provides
empirical support for what is now known in the United States as consumer-directed health care. That approach expects insurance policies with high deductibles and coinsurance to convert hitherto excessively insured, passive recipients of health care into vigilant shoppers for health care, motivated to control both its cost and its quality and capable of doing so. Because Swiss households do bear relatively high out-of-pocket costs for both health insurance and health care, one can appreciate how this interpretation might be reached.
However, others might not be persuaded by this argument, for several reasons. First, across nations there appears to be no correlation between cost sharing and per capita health spending. Relative to Switzerland, Germany, the Netherlands, and Canada, for example, have much lower levels of cost sharing by patients but also much lower per capita spending on health care. Second, cost sharing by patients in Switzerland is unlikely to have begotten the allegedly superior quality of Swiss health care because, as Herzlinger and Parsa-Parsi point out, Swiss patients have virtually no information on the quality of the care they receive.

Finally, what is most impressive about the Swiss health system is the role tight government regulation plays throughout the entire system. One can plausibly rgue that this regulation is chiefly responsible for both the high quality and (relative to the United States) low cost of Swiss health care. Absent that regulation, the Swiss health system probably would metamorphose into something resembling the much less regulated, high-cost US system, which is both more inefficient and more inequitable than the Swiss system, as Herzlinger and Parsa-Parsi take pains to point out.

http://jama.ama-assn.org/cgi/content/full/292/10/1227

Comment: The rhetoric of reform has shifted from managed care to consumer-driven health care (CDHC). The health care system in Switzerland has several features of the CDHC model supported by Regina Herzlinger and others here in the United States. Supporters of CDHC will cite the Swiss experience as proof that CDHC is highly successful in improving health care value by placing the consumer in control. As Herzlinger and Parsa-Parsi state in their article, it would be even more successful if additional features of the model were adopted.

Uwe Reinhardt, in his commentary, concedes that the given database on the
Swiss health system can support rival hypotheses. However the wish-it-were-true comments that provide support for the CDHC hypothesis is countered by the fact that (1) there is no correlation between consumer-sensitive cost sharing and per capita health spending, and (2) superior quality could not have been achieved by Swiss health care shoppers because they have no reliable source on health care quality. CDHC has not been the source of the market ideal of higher quality at lower cost. Before our nation dives into a transformed CDHC system, we should look at some of Herzlinger and Parsa-Parsi’s “Lessons for the United States” wherein the Swiss CDHC model falls short:”To attain cost control and consumer responsiveness, it is necessary to permit considerable experimentation in insurance policies’ coverage, benefits, and terms…”
“To reward efficient, effective providers, it is necessary to permit health care providers to innovate freely in the delivery of health care and its pricing… Providers will thus be motivated to innovate in health care services for the sick and to earn revenues by responding to consumer demand rather than relying on guaranteed budgets or clients.”

“Over time, the growth in compulsory benefits has absorbed an increasing fraction of the consumers’ payment, thus compromising the consumer-driven
aspects of the Swiss system. To avoid growth in compulsory benefits, it is necessary to require coverage in terms of dollars, not benefits; for example, require insurance for all health care expenses exceeding a certain amount, rather than specific benefits.”

This is not code language. Any health policy analyst understands precisely the policy implications of these concepts. Not realizing that these articles would be released today, in yesterday’s Quote of the Day message I discussed mandatory purchase of insurance by individuals (individual mandate) in a highly regulated insurance environment. This seems to describe the Swiss system fairly accurately. Loosening regulatory controls and depending more on marketplace choice, as Herzlinger and Parsa-Parsi suggest, would threaten rather than enhance the value that the Swiss are currently receiving in health care.

Moving in the other direction, merging all insurers into a single payer would provide the opportunity to ensure maximal value by corralling costs and by rewarding providers for quality. Consumers understand that they will never have enough knowledge to fully orchestrate their own care. They just want to have confidence in a system that is designed to provide maximal value. And single payer is specifically designed to do just that.

Posted by pnhp at 10:57 AM | Permalink

FOR IMMEDIATE RELEASE 
Contact:  Dr. Elinor Christensen
August 8, 2004                                                     
EChris7@aol.com
(312) 782-6006                    
 
Statement by Dr. Elinor Christensen on Lessons from Single Payer Health Systems in Scotland, Norway, and Finland
                 
Available for media interviews and lectures on health care reform and the flawed Bush and Kerry health plans

I am a family medicine physician whose medical career of 40 plus years has included private practice, inner city maternal and child health clinics, twenty years of college health, including medical administration, and rural health care in two underserved communities.  I learned so much from each of these experiences, serving patients to the best of my ability with a variety of encumberances.
 
My most satisfying experience was working for twenty years as staff physician and later as medical director at a private university with a mandatory, low cost, comprehensive single payer universal health plan covering all students enrolled in the university.  We were able to deliver high quality comprehensive health care at a very reasonable cost because everyone was in a single risk pool.  Also the administration of the plan was simple and cost effective.
 
Since retirement I have spent a week each of three countries with single payer universal health programs which are successful and enthusiastically used and appreciated by their citizens.  The countries I have visited are Norway, Finland, and Scotland to study their successful programs including services provided, how it is funded, how it is administered, maximum out of pocket expenditure per person per year, and any problems.  These countries are spending half as much per capita as we are spending and having better outcomes because everyone is covered from birth to death and everyone is included in a single risk pool (single payer) and everyone has easy access to the  personal physician of their choice. Health education and prevention, as well as early intervention, play an integral part in the success of their universal health care plans and excellent outcomes.
 
I am available for media interviews and lectures to discuss the successful models of health care that exist in other countries, and to share my personal experience of the savings and administrative simplicity possible under single payer.   I am also available to advise public officials and political candidates at all levels of government.  
 
Americans deserve a better health care system that serves everyone.  We can design and implement an optimal universal health care plan which meets the needs of our people, lifts the burden from business, and controls skyrocketing health care costs at the same time. 
 
It is time for leaders in medicine and government to have vision and courage and to do the right thing.
 
                                        ####
 
Dr. Christensen is a former President of the American Medical Women’s Association* and is the co-chair of the Colorado chapter of Physicians for a National Health Program, a national organization with over 12,000 members with headquarters in Chicago.
 
* Affiliation for identification purposes only.

Posted by pnhp at 09:14 AM | Permalink

Labor and the Health Crisis
by Kip Sullivan
August 04, 2004
 
Workers in every Industry from trucking to telecommunications, know that there’s a health care crisis in the United States. Yet the AFL- CIO refuses to endorse the only proposal that can rein in health care inflation without damaging quality of care: a single-payer system.

In a single-payer system, one insurer or payer (typically a government agency) reimburses doctors and hospitals. Oddly, though it refuses to endorse universal single-payer, the AFL-CIO has endorsed Medicare, a single-payer health care system for the elderly.

The AFL-CIO’s illogical position - single-payer for the elderly but not for the rest - has contributed to labor’s feeble influence on the national health care debate.

THE CASE FOR SINGLE-PAYER

Two features are essential to an ideal single-payer system. First, one payer (or insurer), rather than hundreds of insurers, reimburses providers (doctors and hospitals) and drug manufacturers.

This cuts administrative costs for insurers because a public insurer devotes a much lower proportion of revenues to overhead (marketing, supervising doctors, underwriting, lobbying, obscene salaries for management, and profits) than private-sector insurers do. It also cuts administrative costs for providers because providers have to bill only one payer, not hundreds.

This feature, by itself, would cut the U.S. health care bill by 10-15 percent if it were extended to all Americans.

Second, the one payer in a single-payer system must have the authority to set limits on what doctors, hospitals, and drug companies charge. This feature could easily cut another 10-15 percent.

Medicare is not an ideal single-payer system, but it does contain both of these essential features. It is the sole payer for Medicare’s 41 million beneficiaries for the services it covers, and it has the authority to set limits on what doctors and hospitals charge. (Unfortunately, thanks to legislation passed last year, Medicare will have no authority to set limits on drug company prices once Medicare drug coverage commences in January 2006.)

MEDICARE FOR ALL

Because Medicare resembles a single-payer system, it is far and away the most efficient health insurance program in the nation, public or private. Medicare’s overhead costs eat up only two to three percent of its revenues, while private-sector plans divert roughly 20 percent of their revenues to overhead.

For this reason, and because Medicare pays providers slightly less than private insurers pay them, Medicare’s per capita costs rose at an average rate of 9.6 percent annually between 1970 and 2000, versus 11.1 percent for private sector insurers. And, perhaps most importantly, traditional Medicare has achieved greater efficiency without resorting to the private sector’s favorite cost-containment tactic-routinely refusing to pay for necessary medical services.

If Congress passed legislation giving Medicare the authority to limit drug prices and lowering Medicare’s eligibility age from 65 to zero, we would have a national single-payer system, what single-payer advocates often refer to as Medicare-for-all.

UNIONS AND SINGLE-PAYER

Although several AFL-CIO affiliates have long supported a national single-payer system, the national AFL-CIO has deliberately avoided endorsing single-payer. Today, a section of the AFL-CIO’s website entitled ‘How can we fix our health care system?’ says not a word about single-payer.

The website does mention, however, the National Coalition on Health Care, to which the AFL-CIO belongs. The NCHC consists of big corporations (including AT&T, GE, Pfizer, and United Health Group, the nation’s largest health insurance company), churches, and unions.

Like the AFL-CIO, the NCHC avoids supporting fundamental health care reform, instead calling public attention to our health care system’s deficiencies and the need for universal coverage.

(Many people equate single-payer with universal coverage, but the two are not synonymous. A government could, in theory, establish a single-payer system and not cover its uninsured. Similarly, universal coverage could be achieved without fundamental health care reform, by, for example, raising taxes high enough to pay for health insurance for the nation’s 44 million uninsured, and turning the new revenues over to the health insurance industry.)

LABOR‘S PARALYSIS

The AFL-CIO has never explained why it won’t endorse single-payer, leaving observers to draw their own conclusions. In a 1999 article for The Journal of Health Politics, Policy and Law, Marie Gottschalk focused on the fact that some unions, including many in the building trades, run their own insurance plans (called Taft-Hartley funds), which would disappear under a single-payer system.

According to Gottschalk, in 1991 AFL-CIO President Lane Kirkland and SEIU President John J. Sweeney led the internal campaign to keep the AFL-CIO from endorsing single-payer. The issue came to a head that year because premium inflation had hit double digits for several years in a row, and because the single-payer movement had succeeded in introducing single-payer legislation in several state legislatures and the House of Representatives.

Single-payer advocates, including unions such as AFSCME and UAW, believed that labor’s endorsement would add significantly to single-payer’s credibility with politicians and the media. But the federation’s health policy committee split eight-eight on a motion to endorse single-payer.

A second possible reason for the AFL-CIO’s single-payer paralysis is the Democratic Party’s tendency towards either paralysis or bogus solutions on health care, coupled with the AFL-CIO’s tendency to follow the Democrats on health policy, rather than lead them.

In the early 1990s, the AFL-CIO in Minnesota stood by while Democrats campaigned for ‘managed competition,’ the doomed theory that pushing people into HMOs would solve the health care crisis. When ‘managed competition’ bit the dust in the late 1990s, Minnesota’s Democratic legislative leadership simply stopped talking about fundamental reform, and the AFL- CIO did not challenge them.

NO VOICE

The AFL-CIO’s hemming and hawing on single-payer came with a high price. It deprived the organization of a voice in the debate about health care reform that reached a crescendo during the first term of the Clinton presidency.

Not surprisingly, labor had little influence in the writing of the Clintons’ awful Health Security Act of 1993 (which advocated managed competition). Not surprisingly, single-payer legislation was shunted aside in Congress and nearly all state legislatures. Not surprisingly, the Health Security Act died in the Senate in 1994.

The death of that legislation, and a short-lived reprieve from rampant health care inflation in the mid-1990s, swept health care reform off the national agenda for the rest of the 1990s.

But by 2000, double-digit premium inflation had returned and unions were out on strike all over the country over employer attempts to cut insurance coverage and shift costs to employees. More and more union leaders are now calling for political action to solve the health care crisis.

But effective political action on the health care crisis is highly unlikely as long as the AFL-CIO refuses to endorse single-payer.

Even with the AFL-CIO in the ranks of the single-payer movement, the odds against single-payer being established in the near future are not good. But if the AFL-CIO were to endorse the single-payer solution and pour resources into organizing grassroots support for it, that would jolt the debate about single-payer up to a much more visible level, which would in turn make organizing for single-payer a lot easier.

Kip Sullivan is on the steering committee of the Minnesota Universal Health Care Coalition.

Posted by pnhp at 01:59 PM | Permalink

Real simple
By Thomas Geoghegan
To win the election and, once in power, to create new jobs, Democrats need a big plan everyone can understand: Have the government pay the first $1,000 in healthcare costs for every man, woman and child.
Please click here to read the interesting article

Posted by pnhp at 01:36 PM | Permalink

U.S. patients face long queues!

The Boston Globe
August 1, 2004
Colonoscopies tax health industry
By Liz Kowalczyk

… hundreds of thousands have queued up for colonoscopies.

The rush has strained the healthcare system…

… some (hospitals) are booked for six months.

http://www.boston.com/yourlife/health/diseases/articles/2004/08/01/colonoscopies_tax_health_industry?pg=full

Comment: The above comments are true. Significant queues have developed for
colonoscopies in the United States. But the point of using the selected excerpts from the article is that it demonstrates the type of deception that is being used to imply that universal health care systems always result in queues and marketplace systems never do. In fact, demand that exceeds capacity is what results in queues regardless of the method of funding health care. Many nations with universal public systems have proven that capacity can be adjusted to meet an appropriate level of demand.

The United States does have a significant but invisible queue due to two factors. Those without adequate insurance are not allowed a place in the line, and those who are in the system and theoretically have adequate coverage are receiving only half of the services that they should be. Neither of these groups are tallied, and so their “infinite” queue is neither defined nor discussed.

The deception of the opponents of reform in using queues as a reason to reject a universal system should be no more acceptable than my deception in editing out the comments that explain that the long queues are due to the recent recommendation that colonoscopy now be used for routine colon cancer screening. Capacity will be increased in response to this demand, just as capacity is being increased in Canada in response to increased demand for diagnostic imaging.

We know how to improve access and improve appropriate utilization of our health care system. Let’s start demanding more honesty in our national dialogue on reform.

Posted by pnhp at 08:58 AM | Permalink